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Saint Francis Ministries, Inc AGREEMENT BETWEEN THE CITY OF SALINA,KANSAS and Saint Francis Ministries,Inc. for Substance Abuse Diagnosis,Counseling,Treatment,and/or Prevention Services This Agreement is entered into March 22,2021 by and between the City of Salina,Kansas,(the"City")and Saint Francis Ministries Inc.,a Kansas not-for-profit corporation(the"Contractor"). Recitals A. The City desires to contract for Substance Abuse services for the purpose of Diagnosis,Counseling,Treatment and/or Prevention Program in compliance with federal,state,and local regulations. B. The Contractor has the requisite qualifications and experience to perform the services needed by the City and desires to perform those services pursuant to the terms of this Agreement. The parties,in consideration of the mutual promises set forth in this Agreement,agree and covenant: 1. Definitions. Capitalized words used in this Agreement shall have the following meanings: "Agreement" means this Agreement for Substance Abuse Counseling, Treatment, and Prevention services, as amended and supplemented from time to time. "City"means the City of Salina,Kansas. "Contractor"means Saint Francis Ministries,Inc.,a Kansas not-for-profit corporation and its successors. 2. Exhibits. The following Exhibits are attached to and made a part of this Agreement(Mark with"X"if applicable): Exhibit A: Responsibilities of the Parties Exhibit B: Term; Schedule Exhibit C:Basis of Payment Exhibit D: Insurance Requirements 3. Responsibilities of the Parties. The parties agree to perform the responsibilities outlined in the attached and incorporated Exhibit A. 4. Term;Schedule. The Contractor agrees to perform its responsibilities during the term and according to the timeframe and schedule described in Exhibit B,subject to the potential for prior termination pursuant to the terms of this Agreement. 5. Payment. The City shall pay the Contractor for the performance of its responsibilities pursuant to this Agreement as set forth in Exhibit C. 6. Insurance Requirements. 6.1. Types and Amount of Coverage.The Contractor agrees to obtain insurance coverage as specified in Exhibit D,attached hereto,and shall not make any material modification or change from these specifications without the prior approval of the City. If the Contractor subcontracts any of its obligations under this Agreement,the Contractor shall require each such subcontractor to obtain insurance coverage as specified in Exhibit D. Failure of the Contractor or its subcontractors to comply with these requirements shall not be construed as a waiver of these requirements or provisions and shall not relieve the Contractor of liability. 6.2. Rating.All insurance policies shall be issued by insurance companies rated no less than A-VII in the most Contractor Services(2014-06-18) recent "Bests" insurance guide, and admitted in the State of Kansas. Except as otherwise specified in Exhibit D, all such policies shall be in such form and contain such provisions as are generally considered standard for the type of insurance involved. 6.3. Certificate of Insurance. The parties acknowledge that the Contractor has provided the City with a certificate of insurance listing the City as the Certificate Holder and evidencing compliance with the insurance requirements in this Agreement. The City reserves the right to require complete certified copies of all insurance policies procured by the Contractor pursuant to this Agreement,including any and all endorsements affecting the coverage required hereunder. 7. Injury to Persons or Damage to Property. The Contractor acknowledges responsibility for any injury to person(s) or damage to property caused by its employees or agents in the performance of its duties under this Agreement and shall immediately notify the City's Risk Management Department at (785) 309-5705 in the event of such injury to person(s) or damage to property. 8. Indemnification. To the fullest extent permitted by law, the Contractor shall defend, indemnify and hold harmless the City,its agents,representatives,officers,officials and employees from and against all claims,damages,losses and expenses (including but not limited to attorney fees and court costs)attributable to bodily injury, sickness, disease,death, or injury to, impairment,or destruction of property,including loss of use resulting therefrom,to the extent that such claims,damages,losses, and expenses relate to,arise out of,or are alleged to have resulted from the wrongful acts,negligent acts,errors,omissions,or defective work or services of the Contractor, its employees, agents, or any tier of subcontractors in the performance of this Agreement. 9. Voluntary Termination. Either party may terminate this Agreement,with or without cause, upon thirty(30)days advance written notice to the other party. In the event of such termination, the Contractor shall be compensated for such services as have been satisfactorily performed through the date of termination, but no compensation shall be earned after the effective date of the termination.Within five(5)days of any such termination,all finished or unfinished documents,data,studies, surveys, drawings, maps,models,photographs,reports or other material prepared by the Contractor pursuant to this Agreement shall be delivered to the City.Notwithstanding the above,the Contractor shall not be relieved of any liability to the City for damages sustained by the City by virtue of any breach of this Agreement by the Contractor,and the City may withhold any payments to the Contractor for the purposes of set-off until such time as the exact amount of damages due the City from the Contractor may be determined. 10. Default. If either party fails to comply with any term of this Agreement within ten(10)days after written notice to comply has been mailed by the non-defaulting party to the defaulting party,such failure shall be deemed an immediate breach of this Agreement("Event of Default"). 11. Remedies. Upon the occurrence of an Event of Default,the non-defaulting party shall have the following rights and remedies,in addition to any other rights and remedies provided under this Agreement or by law: 11.1 Termination. The non-defaulting party shall have the right to terminate this Agreement or terminate the defaulting party's rights under this Agreement. 11.2 Other Remedies. The non-defaulting party may pursue any available remedy at law or in equity(including specific performance)by suit,action,mandamus or other proceeding to enforce and compel the performance of the duties and obligations set forth in this Agreement, to enforce or preserve any other rights or interests of the non-defaulting party under this Agreement or otherwise existing at law or in equity and to recover any damages incurred by the non-defaulting party resulting from such Event of Default. 12. Non-Assignable. Due to the unique qualifications and capabilities of the Contractor,neither the rights nor responsibilities provided for under this Agreement shall be assignable by either party,either in whole or in part. 13. Notices. All notices required or permitted to be given pursuant to this Agreement shall be in writing and delivered personally or sent by registered or certified mail, return receipt requested, or by generally recognized, prepaid, commercial courier or overnight air courier service. Notice shall be considered given when received on the date appearing on the return receipt, but if the receipt is not returned within five(5)days,then three (3)days after mailed, if sent by registered or certified mail or commercial courier service; or the next business day, if sent by overnight air courier service. Notices shall be addressed as 2 appears below for each party,provided that if any party gives notice of a change of name or address,notices to the giver of that notice shall thereafter be given as demanded in that notice. CITY: City Clerk Attn:Debbie Pack P.O.Box 736 Salina,KS 67402-0736 CONTRACTOR: Saint Francis Ministries,Inc. Darrin Sewell 110 W.Otis Avenue Salina,KS 67401 14. Retention and Inspection of Records. The Contractor shall maintain complete, accurate, and clearly identifiable records with respect to all costs and expenses incurred under this Agreement. The records shall be maintained during the term of this Agreement, and for a period of three (3)years from the date of final payment under this Agreement (the"Retention Period");provided,however,that if any litigation,claim or audit is commenced prior to the expiration of the Retention Period, then the Retention Period shall be extended until all litigation, claims or audit findings have been completely terminated or resolved,without right of further appeal. During the Retention Period,the Contractor shall allow a representative of the City during normal business hours to examine,audit,and make transcripts or copies of such records and any other documents created pursuant to,or arising under,this Agreement. The City agrees to responsibly utilize all information obtained pursuant to this paragraph for the purposes of reviewing, confirming, and verifying the nature and amount of all costs and expenses incurred under this Agreement. The City agrees to take reasonable precautions not to disclose such information outside the scope of those stated purposes,subject to the Kansas open records act or other applicable law. 15. Non-appropriation. The City is subject to Kansas budget and cash basis laws,and operates on a calendar fiscal year. In the event that this Agreement involves financial obligations spanning multiple fiscal years for the City,it is subject to annual appropriation by the City's governing body for future fiscal years. If the City's governing body does not appropriate the funds necessary to fulfill the City's financial obligations pursuant to this Agreement,the City shall so notify the other parties to this Agreement and this Agreement shall be null and void for purposes of the fiscal year(s)affected by the decision of the governing body not to appropriate. 16. Relationship. It is expressly understood that Contractor in performing services under this Agreement,does so as an independent contractor. The City shall neither have nor exercise any control or direction over the methods by which Contractor performs its responsibilities as outlined in Exhibit A. The sole interest and responsibility of the City is to see that the services covered by this Agreement are performed and rendered in a competent,efficient,and satisfactory manner. Contractor shall be exclusively responsible for all taxes, withholding payments, employment-based benefits, deferred compensation plans, including but not limited to its workers compensation and social security obligations,and the filing of all necessary documents, forms,or returns pertinent to the foregoing. 17. Subcontracting. Contractor shall not subcontract any work or services under this Agreement without the City's prior written consent. 18. Compliance with Applicable Law. Contractor shall comply with all applicable federal,state,and local law in the performance of this Agreement. 19. Equal Opportunity. (a) In conformity with the Kansas act against discrimination and Chapter 13 of the Salina Code, the Contractor and its subcontractors, if any,agree that: (1) The Contractor shall observe the provisions of the Kansas act against discrimination and Chapter 13 of the Salina Code and in doing so shall not discriminate against any person in the performance of work under this Agreement because of race,sex,religion,age,color,national origin,ancestry or disability; 3 (2) The Contractor shall include in all solicitations, or advertisements for employees, the phrase "equal opportunity employer,"or a similar phrase to be approved by the City's human relations director; (3) If the Contractor fails to comply with the manner in which the Contractor reports to the Kansas human rights commission in accordance with the provisions of K.S.A.44-1031 and amendments thereto,the Contractor shall be deemed to have breached this Agreement and it may be canceled,terminated or suspended, in whole or in part,by the City; (4) If the Contractor is found guilty of a violation of Chapter 13 of the Salina Code or the Kansas act against discrimination under a decision or order of the Salina human relations commission or the Kansas human rights commission which has become fmal,the Contractor shall be deemed to have breached this Agreement and it may be canceled,terminated or suspended,in whole or in part,by the City; (5) The Contractor shall not discriminate against any employee or applicant for employment in the performance of this Agreement because of race,sex,religion,age,color,national origin,ancestry or disability;and (6) The Contractor shall include similar provisions in any subcontract under this Agreement. (b) The provisions of this section shall not apply to this Agreement if the Contractor: (1) Employs fewer than four employees during the term of this Agreement;or (2) Contracts with the City for cumulatively$5,000 or less during the City's calendar fiscal year. 20. Administration of Agreement. All references in this Agreement requiring the City's participation or approval shall mean the participation or approval of the City Manager or his designee,unless otherwise provided herein. 21. Attorney Fees. If any suit or action is instituted by either party hereunder,including all appeals,the prevailing party in such suit or action shall be entitled to recover reasonable attorney fees and expenses from the non-prevailing party, in addition to any other amounts to which it may be entitled. 22. Right to Independent Legal Advice. The Contractor understands and acknowledges the right to have this Agreement reviewed by legal counsel of the Contractor's choice. 23. Applicable Law;Venue. This Agreement and its validity,construction and performance shall be governed by the laws of Kansas. In the event of any legal action to enforce or interpret this Agreement,the sole and exclusive venue shall be in the Saline County,Kansas District Court. 24. Interpretation. This Agreement shall be interpreted according to its fair meaning, and not in favor of or against any WV- 25. Time. Time is of the essence of this Agreement. No extension will be granted unless in writing and signed by the parties. Should the end of a time period fall on a legal holiday that termination time shall extend to 5:00 p.m.of the next full business day. 26. Severability. The unenforceability,invalidity,or illegality of any provision of this Agreement shall not render the other provisions unenforceable,invalid,or illegal. 27. Authority and Consent to Transaction. Each party represents to the other that the person executing this Agreement has full and legal authority to bind such party to the terms of this Agreement, and that the execution and delivery of this Agreement have been duly and validly authorized by the governing body of each party. 28. Persons Bound. This Agreement shall extend to and bind the heirs,executors, administrators,trustees, successors and authorized assigns of the parties hereto. 29. Counterparts. This Agreement may be executed in any number of counterparts, each of which shall be deemed an original,or in multiple originals,and all such counterparts or originals shall for all purposes constitute one agreement. 4 30. Amendments.Neither this Agreement nor any of its terms may be changed or modified,waived,or terminated except by an instrument in writing signed by an authorized representative of the party against whom the enforcement of the change,waiver, or termination is sought. 31. Waiver. No failure or delay by a party hereto to insist on the strict performance of any term of this Agreement, or to exercise any right or remedy consequent to a breach thereof,shall constitute a waiver of any breach or any subsequent breach of such term. No waiver of any breach hereunder shall affect or alter the remaining terms of this Agreement,but each and every term of this Agreement shall continue in full force and effect with respect to any other then existing or subsequent breach thereof. 32. Conflict Resolution. No interpretation of this Agreement shall be allowed to fmd the City has agreed to binding arbitration. 33. No Third Party Beneficiaries. Solely the parties to this Agreement shall have rights and may make claims under this Agreement. There are no intended third party beneficiaries under this Agreement,and no third parties shall have any rights or make any claims hereunder. 34. Typewritten or Handwritten Provisions.Typewritten or handwritten provisions inserted or attached,and initialed by all parties,shall supersede all conflicting printed provisions. 35. Feminine-Masculine,Singular-Plural. Wherever used,singular shall include the plural,plural the singular,and use of any gender shall include all genders. 36. Headings. The headings of the sections of this Agreement are included for the purposes of convenience only and shall not affect the interpretation of any provision hereof. 37. Merger Clause. These terms are intended by the parties as a complete, conclusive and final expression of all the conditions of their Agreement. No other promises, statements, warranties, agreements or understandings, oral or written, made before or at the signing thereof,shall be binding unless in writing and signed by all parties and attached hereto. IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed by their authorized representatives. CITY OFS; ! • : • , By: 41/AT l' -C-11,1r, Manager Attest: 40 Che 1 of is,De ifty City Clerk Form: 1 11. e_.I Counsel Saint Francis Ministries,Inc.,a Kansas not-for-profit corporation By: C /44., J. C/a/ name) /53GS,ol 74.41 D(title) 5 EXHIBIT A RESPONSIBILITIES OF THE PARTIES [INSERT Proposal as submitted by the Agency] A-1 EXHIBIT B TERM; SCHEDULE Two year term, expiring December 31,2022 B-1 EXHIBIT C BASIS OF PAYMENT 1. Compensation: Specific amount to be determined by the City Commission; dependant on continued funding for the City from the Special Alcohol 19.7% of Collections up to $134,203 2. Invoices: None Required 3. Payment: To be made on a quarterly basis, as proceeds of the Alcohol Tax are received from the State of Kansas C-1 EXHIBIT D INSURANCE REQUIREMENTS Pursuant to Section 6 of the Agreement, the Contractor shall obtain, pay for,and maintain— and shall require each of its authorized subcontractors to obtain and maintain—for the duration of the Agreement,policies of insurance meeting the following requirements: Commercial General Liability Professional Liability,Errors and Omissions $500,000 Single Limit Coverage Workers Compensation--Statutory Certificate of Insurance is required, City of Salina named as additional insured D-1 �Y c Deanna Parker Knapp Sant Francis. Interim Director of the Saint Francis liral MINISTRIES Foundation Providing healing and hope to children and families City Clerk's Office Attn: Shandi Wicks, City Clerk P.O. Box 736 300 West Ash Street, Room 206 Salina, KS 67401 February 12, 2021 Dear Ms. Wicks, It is our pleasure to provide you with Saint Francis Ministries' transmittal letter for the City of Salina 2021-2022 Section 888 Special Alcohol Funding application. We are committed to preventing and treating alcohol and drug abuse and dependency in our community and have worked in collaboration with the City of Salina to do so for many years. We are honored to have the opportunity to continue to provide vital interventions that make a positive and life-changing impact on the citizens of our community. Our primary contact for this application is Darrin Sewell, Executive Director of Outpatient Behavioral Health. He may be reached at the following phone number, email address, and address: Phone: 785-577-5728 Email: Darrin.Sewell@st-francis.org Address: Darrin Sewell, 110 W. Otis Ave., Salina, KS 67401 If you have any questions about the program, please feel free to contact Mr. Sewell, while questions about the grant, grant award, or requested changes to the document should be directed to me. Thank you for extending the opportunity to be of service to Salina and its citizens again. Sincerely, Deanna Parker Knapp Interim Director Foundation and Grant Development 800-423-1342 Ext. 2970 110 W Otis Avenue Salina, Ks 67401 800.423.1342 SaintFrancisMinistries.org City of Salina 2021 — 2022 Section 888 Special Alcohol Funding Application Guidelines and Proposal Format Proposal Content 3 Amount of Funding Requested: $ 134,203 total for the two year period. 3 Narrative Questions: 4 Required Attachments: 13 Program Budgetary Information 14 Services Summary 15 Other Attachments 18 Program Objectives and Information: The City of Salina receives funding derived from the Special Tax on Alcohol sales. A portion (one-third) of this tax is intended to be used to prevent and treat alcohol and drug abuse and dependency. Biennially, the City provides the opportunity for community organizations providing such services to submit proposals for the use of these funds. Organizations requesting funding must submit a proposal with substantially the following format and content. Please note that some information relates to your overall program, while others may address the specific application of section 888 resources available from the City of Salina. This is a two year funding cycle. The amount of funds available is dependent on the production of the Special Alcohol tax. Total funding received during 2019 and 2020 totaled $399,286. Requests for program funding are anticipated to exceed the amounts available. Program funding is awarded on a calendar year basis, with the first distribution anticipated to be available on or near April 15, 2021, with quarterly distributions to follow. In the event that there is a reduction in the flow of funds, any agencies awarded funding will share in that reduction proportionately to the size of the original awards. According to the statute, "moneys in the Special Alcohol Fund shall be expended only for the purchase, establishment, maintenance, or expansion of services or programs whose principal purpose is alcoholism and drug abuse prevention and education, alcohol and drug detoxification, intervention in alcohol and drug abuse, or treatment of persons who are alcoholics or drug abusers or in danger of becoming alcoholics or drug abusers". Our policy has been that any applicant must have been in operation within the City of Salina for at least two years in order to qualify for funding. Please provide a transmittal letter including name, address, and phone of the primary contact person from your agency. The City of Salina requires a formal agreement to address funds distributed to community agencies. We have attached the form of such an agreement. In general, it addresses the purposes for which funds are to be used, accounting and reporting requirements, indemnification, equal employment opportunity and affirmative action requirements, as well as the timing of funds distribution. Finally, applicants should be cognizant of the provisions of KSA 45-240 relating to public disclosure requirements as a result of funds provided to"not-for- profit" organizations. Please submit completed applications and attached materials to: 1I I City Clerk's Office Attn: Shandi Wicks, City Clerk P.O. Box 736 300 West Ash Street, Room 206 Salina, KS 67401 Or to debbie.pack@salina.org The application deadline is 5:00 PM, Friday, February 26, 2021. We currently anticipate that the City Commission will award funding at their regular meeting on March 22, 2021. Depending on the number of applications received, the Commissioners may request to hear from program applicants at a study session at a date prior to the date of funding approval. 21 Proposal Content Amount of Funding Requested: $ 134,203 total for the two year period. Typically funding is distributed as received. The quarterly distributions may vary depending on consumption of alcohol and taxpayer compliance. In the most recent 8 quarters, total funds received by the City have fluctuated between $23,594 and $71,130 quarterly. Funds received are then distributed to the successful agencies proportionately to their awards. 31 Narrative Questions: 1. Saint Francis Ministries' (Saint Francis) mission is to provide healing and hope to children and families, and to transform lives in ways that others believe to be impossible. Since 1945, Saint Francis has been action-oriented organization working in the Salina area to do exactly that. Children, young adults and parents often need support to make changes leading to transformation in the family system when substance use is a part of their lives. Research has shown that "each family and each family member is uniquely affected by the individual using substances."' Through our Outpatient Behavioral Health Substance Use Treatment program (referred to throughout the application as SUTx), Saint Francis Community and Residential Services, Inc., a subsidiary of Saint Francis Ministries, is able to fulfill a distinctive purpose in the lives of our clients struggling with substance use needs and to meet the objectives of the Special Alcohol statute.This program helps youth and adults learn to live a healthy lifestyle free from the use of alcohol and/or drugs in order to improve and strengthen family functioning and to become more productive citizens within the Salina community. Our dual education and treatment program teaches the effects of alcohol and drugs on the client's physical and mental health, with a special focus on relationships within the family and community. It can be difficult for parents or family members to understand that substance use has an impact on brain functioning,2 and that addiction is a disease that requires support through counseling addressing the physical, social, psychological, and spiritual aspects of one's life. Saint Francis's Substance Use Treatment program provides varying levels of treatment to meet the needs of individuals within the Salina area community. Our staff coordinates services with families, schools, and other professionals to maximize the impact of an individualized substance use treatment plan that will enable the client to reach the highest level of growth and development possible. Family and support systems are a key factor in recovery and treatment of substance abuse, and they are encouraged to be part of the treatment process.3 As a result of seeing many referrals for teenagers needing SUD treatment who had parents who had a need for their own engagement in treatment, Saint Francis expanded treatment services in 2012 to include adults with children, adults who have a family focus, and adults who elected to use an agency with a spiritual basis. This expansion has helped families to find a unified healing process that focuses on the family as a system rather than only treating the individual. Research has shown that substance use can severely impact parenting abilities and can lead to children being removed from their care.4 Saint Francis is committed to educating and treating parents whose alcohol and/or drug use impacts their parenting abilities. One way that Saint Francis accomplishes this is through a gender-specific program targeted to help pregnant women who use substances. This program focuses on engaging the mothers-to-be in treatment to provide them the best chance of a healthy pregnancy and ' Lander,L., Howsare,J.,&Byrne, M.(2013). The impact of substance use disorders on families and children:From theory to practice. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3725219/pdf/nihms- 496858.pdf 2 National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services. (2020).Drugs, Brains, and Behavior: The Science of Addiction. https://www.drugabuse.gov/sites/defau lt/fi les/soa.pdf 3 Center for Substance Abuse Treatment: Substance Abuse Treatment and Family Therapy, https://www.ncbi.nlm.nih.gov/books/NBK64269/ 4 Child Welfare Information Gateway. Parental Substance Use and the Child Welfare System, https://www.childwelfare.gov/pubpdfs/parentalsubabuse.pdf 4I delivery, with the hope that the baby will grow into a healthy adult. This program continues Saint Francis's legacy of more than seventy-five years of specialized treatments for youth and families. Research demonstrates that many adolescents engage in negative activities in the hours after school, which can create significant problems for themselves, their families, and the community in which they live. Saint Francis offers group sessions scheduled after normal school hours, typically between 3:00 PM and 7:30 PM. Providing services during a high- risk time when many youths are unsupervised at home helps to quell dangerous behaviors exhibited by adolescents engaging in substance use. Additionally, participation in afternoon and evening treatment hours can help to promote families' involvement in treatment. Since the COVID-19 pandemic began, we have offered individual and group telehealth sessions to ensure clients continue to receive timey treatment at outlined in their treatment plan. Parents whose children are struggling with alcohol and/or drugs can feel isolated and overwhelmed. Saint Francis assists parents by providing practical supports such as help setting boundaries, deciding appropriate consequences for negative behaviors, or helping the parent resolve conflict with their child. With the Matrix Model addressing the needs for family and involving the parents in the recovery of their child, Saint Francis is helping to ensure that clients are better supported and strengthened through relapse prevention. Adults who seek help through Saint Francis's programs often need help with balancing treatment, recovery, and parenting, and our family-focused programming helps to address these challenges. All Saint Francis staff providing alcohol and drug treatment are licensed by the State of Kansas's Behavioral Science Regulatory Board as addiction counselors and can provide services in the areas of prevention, intervention, and treatment. When Peer Mentors have been used to assist with treatment, they are Certified Peer Mentors by the Kansas Department for Aging and Disabilities Services (KDADS). Along with licensed addiction counselors, Saint Francis has staff that are licensed as mental health providers to assist in recognizing client' needs related to mental health related factors. Research has shown that there is a co-dependent "connection between mental illness and the use of addictive substances".5 Our counselors are trained in trauma-related treatment, as trauma has a significant interconnected relationship with substance use disorders. According to the International Society for Traumatic Stress Studies, problematic alcohol use and dependency affect 25- 75% "of individuals who have survived abuse or traumatic experiences... Men and women reporting sexual abuse have higher rates of alcohol and drug use disorders than other men and women..." and "adolescent sexual assault victims are 4.5 times more likely to experience alcohol abuse or dependence, 4 times more likely to experience marijuana abuse or dependence, and 9 times more likely to experience hard drug abuse or dependence".6 Given that over 13% of teens will have experienced a traumatic event by the time they reach 17 years of age, and that one in five teens will engage in an abusive or dependent relationship with substances,' having staff who are trained in 5 The National Bureau of Economic Research. (2002). Mental Illness and Substance Abuse, https://www.nber.orgicligest/apr02/w8699.html 6 ISTSS. Traumatic Stress and Substance Abuse Problems. https://www.istss.org/ISTSS_Main/media/Documents/ISTSS_TraumaStressandSubstanceAbuseProb_Engli sh_FNL.pdf 7 The National Child Traumatic Stress Network: Making the Connection: Trauma and Substance Abuse, https://www.nctsn.org/sites/default/files/resources//making_the_connection_trau ma_substance_abuse.pdf 51 trauma-related treatment is a tremendous asset. Many of the children, youth, adults, and families who come through our doors have experienced significant trauma, and thus our clients greatly benefit from our services and programs benefit from being trauma- informed. We have implemented Seeking Safety, an evidence-based model developed by Dr. Lisa Najavits, to provide trauma-informed treatment to SUTx clients. In 2019, Saint Francis Ministries hosted a trauma training by Dr. Najavits for providers within the organization and within the community. Saint Francis will continue to provide prevention program and services to youth and family members through referrals from public schools, courts and court services, community corrections, child welfare contractors, and other community groups in Salina. We have worked more closely with the Salina truancy court to assist with youth who have substance use issues, in addition to treating parents who have begun to address their own SUD because of how it is affecting their child's truancy. 2. Saint Francis Ministries will use Section 888 funds to provide substance use treatment to youth ages 12-18 and to adults referred from: Salina-area schools, mental health agencies, attorneys, juvenile judges, county attorneys, community corrections, child welfare contractors, self-referral, other treatment facilities, and parents. Section 888 funding enables Saint Francis to provide quality SUTx services for all youth and their families regardless of their ability to pay. For clients requesting assistance with the cost of treatment, paperwork is completed to verify and ascertain an income-based fee for services. For those with severely limited financial resources, few other options would remain to assist them to receive much-needed treatment services if Section 888 funding was not available, as funding for this program through KDADS's Behavioral Health Services is limited. Due to the demand for SUTx services and the limited funding available, Saint Francis has absorbed much of the cost of providing these services. Parents who are receiving Reintegration Foster Care services, who are working to complete court-ordered case plans to have children placed returned to their home, often have deductibles that are so high that it makes it impossible for them to tap into their insurance for assistance with treatment. Many of these parents do not qualify for KDADS block grant or other funding sources because of their income, but still do not have the financial means to afford treatment. Section 888 funding helps to offset the unreimbursed expenses for either the child or parent in need of treatment Additionally, Section 888 funding will allow for the purchase of treatment videos and learning materials, workbooks, training materials, and supplies. Funding will also be used to provide counseling and parent education so that a client's family can become involved in developing recovery and relapse prevention plans, as well as to fund the provision of wraparound services by counselors. Wraparound services include activities such as helping clients get into inpatient or residential treatment, working with the teen and their parents to get them back into school, providing support during court hearings, working with the family's case manager to help facilitate the progress needed to return a teen to their home, and communicating their needs to these institutions. These activities are not covered by other means but are important to helping clients stay in treatment while rebuilding and strengthening their families in their own homes. For teens who are in detention centers, Saint Francis addiction counselors have found that they can increase the timeliness of needed services by providing assessments that are coordinated through the court system, and conducted on-site at the courthouse. Our provision of on-site assessments allows the judge to make faster determinations with the quick receipt of information from our counselors, such as whether a youth can receive outpatient treatment and be returned home or whether they need inpatient treatment and 61 will be returned to detention until an inpatient bed is available, as well as what additional services a youth may need. While Saint Francis helps to reduce the City's cost to transport the client to/from detention to receive assessment and reduce a teen's time in detention, Section 888 helps to fund the lost session time, as Saint Francis is not paid by the court system when subpoenaed to attend on a youth's behalf. Saint Francis has been involved with Salina's truancy court for the last three years in our Substance Use Treatment and Community Outreach programs. Young clients who test positive for substance use, which is often a key factor in the choice to skip school, have received Saint Francis's SUTx at the request of the court. A gender-specific treatment program has been designed for girls and women, as their needs differ from those of boys and men. Female-specific SUTx also includes the aforementioned program treating pregnant women who use substances. Additional evidence-based programs specific to the client's age, gender, and needs are used as applicable on their recovery journey, including Seeking Safety,8 Voices,9 Helping Women Recover,10 and Helping Men Recover." Saint Francis' client satisfaction surveys comparing data from FY19-20 (07/01/18- 06/30/20) records data pertaining to the client's self-identified place in the Stages of Change model. This data shows that while 74% of clients with less than three months of treatment stated being in the first three stages ("no problem acknowledged," "not sure they want to change," and "getting ready to change"), by three months of treatment, only 6% of clients were not "in the process of change" or"maintaining change." 3. The Saint Francis Substance Use Treatment program (SUTx) has worked actively in Salina since 1995. Our collaboration with Saline County Community Corrections since the program began at this time. All juveniles referred by Community Corrections will complete an assessment to determine if they need educational/prevention services and/or a treatment program that is offered by Saint Francis or another organizational partner. We also accept referrals from the Salina County Attorney's Office and the Juvenile Intake and Assessment Program. USD 305 may refer youth for assessment if the school suspects an alcohol- and/or drug- related problem. If further services are warranted, Saint Francis will work with school counselors to coordinate services that will not disrupt their school schedule. This includes tobacco cessation if a client wishes to quit smoking. The Director of Saint Francis's Substance Use Treatment program is part of the advisory board for the Salina Initiative for Restorative Justice (SIRJ) to provide alternatives to juvenile court and detention for low-risk offenders. Saint Francis has also partnered with Salina Schools, Central Kansas Mental Health, providers of inpatient and residential treatment, the Saline County District Court, Salina client attorneys, the Kansas Highway patrol, and Central Kansas Foundation. Relationships with each of these organizations is based upon services Saint Francis provides for youth and families.These services include some or all of the following: alcohol 8 Seeking Safety, https://www.treatment-innovations.org/ 9 Voices, https://www.stephaniecovington.com/assets/files/Trainings %20and%20Workshops%2C%20Voices%202nd%20Edition.pdf 10 Helping Women Recover, https://www.stephaniecovington.com/assets/files/Trainings %20and%20Workshops%2C%20H W R.pdf 11 Helping Men Recover, https://www.stephaniecovington.com/helping-men-recover-a-program-for-treating- addiction1.php 71 and drug assessments, individual counseling sessions, education, progress reports, and attendance in court by counselors for case management purposes. The variety of available services offered has allowed for the above-named agencies to refer their clients for services to address each individual's treatment needs. Additionally, Saint Francis Ministries is a member of the Salina Area Chamber of Commerce. Their mission "to advance the general welfare and prosperity of the Salina area.... working together to make the Salina community a better place to live and work" is whole-heartedly shared by Saint Francis.12 By partnering with Salina-area community organizations, we can bring hope and healing to the individuals in our community who are seeking treatment services. 4. A. Saint Francis provides the following services to youth ages 9-18 and adults: • Alcohol and Drug Diagnostic Evaluation: This service assesses the client's degree of alcohol/drug use to determine what level of service is needed. • Referrals: If a client needs services that are not available through our organization, the counselors will then seek appropriate services from agencies that can provide those services. • Crisis Intervention: If a client or family member needs immediate services, a counselor is available to assist in the needs of the person calling. Interventions may involve helping a child, youth (who we receive the most calls from), or adult to avoid using substances, to talk through the emotions that are triggering a potential relapse, or to advise them to go to the emergency room if they need immediate help after using. • Family Involvement: Counselors encourage parents in learning new parenting skills through education regarding substance abuse within families, especially as it relates to their adolescent. Parents learn how to set rules and limits for their children and are helped to seek services which they may have been afraid to seek for themselves or for their child. • Individual Sessions: Clients of all levels receive individual sessions to address their SUTx needs. If the needs of the client are determined to be less than those of intensive services (which include 9 or more hours of recovery-oriented programming each week), they will be assigned to individual counseling sessions to meet their needs. Telehealth sessions will continue to be available during the pandemic. • Relapse Prevention: Clients develop a relapse prevention or recovery plan to help both the client and their parent (if applicable) to realize the warning signs that generally occur prior to relapse. Completion of this plan helps the client and family to monitor the client's behavior in an attempt to remain substance-free, or if a relapse occurs, what should be done to assist their return to a substance-free lifestyle. This may include creating a plan for parents who use substances whose children would be placed at risk of removal from the home due to abuse or neglect if they were to relapse. • Group Sessions: Group counseling sessions are divided into one-hour units that typically consist of 2-3 hours per session and focus on early recovery skills, decision-making skills, anger management, relapse prevention, and family education. Each client's treatment plan will determine the number of group sessions 12 Salina Area Chamber of Commerce, https://www.salinakansas.orq/mission.html 81 to attend per week. Telehealth sessions will continue to be available during the pandemic. • Intensive Outpatient Treatment: Clients whose assessment determines a need for intensive outpatient services will receive the Matrix Model for Teens and Young Adults, a sixteen-week individual program with more than twenty-five years of research and development by the Matrix Institute on Addiction. This model is a comprehensive, organized set of evidence-based therapeutic interventions including individual, family, and group counseling sessions; twelve-step programs; and separate parent and adolescent substance education groups. This program is designed to meet the unique treatment and service needs of youth and families requiring intensive treatment to achieve recovery. Few clients are in need of this service. B. Individuals are referred to our services through Salina-area schools, mental health agencies, attorneys, juvenile judges, county attorneys, community corrections, child welfare contractors (including Saint Francis' Reintegration Foster Care and FFPSA programs), self-referral, other treatment facilities, and parents. C. Youth between ages 9-18 and adults with children or who have a family focus (e.g., a relative of a child in foster care who is a viable permanency option) are the targeted individuals for Saint Francis's Substance Use Treatment program. Saint Francis has specialized in the provision of child and family services since 1945, specifically in regard to the juvenile justice system, residential treatment, and foster care. D. Our Substance Use Treatment program is currently able to serve all referrals as deemed appropriate. We have 3 SUTx counselors in Salina, as well as one counselor and one peer mentor provided under the Seeking Safety Family First Preservation Services (FFPSA) grant with the State of Kansas. During the COVID-19 pandemic, SUTx counselors began to provide telehealth services to clients to ensure that their treatment would not be disrupted. As a result of this, we were able to serve 133 new clients in FY2020, along with those who began the program in FY19. There is currently no waiting list for our program. E. Yes; Section 888 funds are specifically used to provide services to clients in the Salina area who are receiving Substance Use Treatment services through our Outpatient Behavioral Health program, whether in-person at the program office (509 E. Elm Street, Salina, KS) or online via telehealth. These funds are used to pay for treatment for any client who is unable to pay for the portion of services not covered by insurance, as well as to purchase treatment videos and learning materials, workbooks, training materials, and supplies. The balance of Saint Francis Ministries' agency resources are largely restricted to programs and services for which we have State contracts, such as Reintegration, Foster Care, and Adoption services, Seeking Safety and Family Centered Treatment FFPSA grants, and Fatherhood FIRE, a federal grant, and to the activities outlined and allowable by those contracts. F. Saint Francis will continue to provide Substance Use Treatment services to clients as specified above. In the last year, we have continued to focus on increasing staff skills and training in trauma-informed practices to better serve our clients. Trauma-informed services are particularly beneficial to this population as counselors can assist clients to discover and heal from the trauma that has led to substance use as a means to cope. Our addiction counselors have continued to attend virtual trainings during the COVID- 19 pandemic to increase their professional abilities to provide trauma-informed treatment services to clients struggling with SUD. Virtual services, such as individual and group telehealth sessions, were made available almost immediately at the 91 beginning of the pandemic. Additionally, Saint Francis has begun to provide SUTx to Salina youth who are in residence in secure care facilities to facilitate their healing and help them to return home to their families in Salina. Saint Francis is committed to providing healing and hope to those we serve. We will continue to deliver this program, as previously stated, by serving referrals from the sources stated in the response to 4.A. above. G. Saint Francis is part of a robust community network that serves youth and adults struggling with SUD in Salina. As mentioned previously, we accept referrals from a wide variety of local agencies and organizations, and our collaboration with them is tailored to meet the needs of the individual referred. We are always willing to work with our partners and new agencies to develop services and review current practices to ensure better client care. Additionally, Saint Francis Substance Use Treatment staff help to transition clients to outside services when necessary with comfort and ease. When a referral from within Saint Francis or an outside agency is received, progress reports are completed in a timely manner. Mental health evaluations and/or treatments are often recommended in addition to recommendations for a full physical examination for clients with medical issues. Youth who are sexually active are advised to contact the Saline County Health Department or their local doctor for health-related services. Clients experiencing grief issues are referred to mental health providers. Youth that have dropped out of school are referred to obtain their GED certificates or to online educational programs. Additionally, parents may require supplementary family and individual services that we do not provide within our program and are recommended to those organizations and services as needed. Within the treatment setting, Saint Francis coordinates services based upon the client's age, gender, and individual needs, which includes providing evidence-based models such as Seeking Safety, Voices, Helping Women Recover, and Helping Men Recover. 5. Saint Francis recognizes that safe, healthy families, and the support that this constellation provides to both the individuals comprising it, are the best solution to help children and youth achieve better outcomes within environments of stability and individualized care. The importance of involving the family in a client's recovery has become increasingly well supported a 2017 study shows that"evidence-based interventions targeting affected family members have been shown to improve health outcomes for all family members, result in better addiction treatment outcomes, and prevent adolescent substance abuse".13 With a focus on the principles of Family Centered Practice,Saint Francis is able to help individuals and families heal by practicing three core concepts, which include: engaging family members to understand their lives, goals, strengths, and challenges and developing a relationship between family and practitioner; working with the family to set goals, strengthen capacity, and make decisions; and providing individualized, culturally response, and evidence-based interventions for each family.14 This is not only applicable to the work that we do in our Outpatient Behavioral Health Substance Use Treatment 13 Ventura,Alicia S.and Sarah M. Bagley. To Improve Substance Use Disorder Prevention, Treatment and Recovery:Engage the Family. https://jou rnals.lww.com/jou rna ladd icti on med ici ne/Abstractl2017/10000/To_I mprove_Su bsta nce_U se_D isor der_P reve ntion,.2.as px 14 National Resource Center for Family Centered Practice, https://clas.uiowa.edu/nrcfcp/what-family- centered-practice 10 I program, but to the work that many of our referred youth and parents are doing in other Saint Francis programs that seek to involve and heal the family as a whole. While family wellbeing is increasingly recognized as integral to individual recovery, this is not an area that most insurance/block grant/MCO funding covers. Without Section 888 funding, assisting clients in the Salina area to access treatment and recovery resources would be difficult. The Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that 1 in 8 U.S. children ages 17 and younger, or up to 13%, live in households with at least one parent suffering from a SUD.15 Further, approximately 3 in 1,000 U.S. hospital births each year are affected by neonatal abstinence syndrome due too parental use of substances. Children who are exposed to substance use through a parent are more likely to develop an SUD, as well as increased chances of experiencing negative outcomes such as poor cognitive, social, and emotional development; depression, anxiety, and other trauma and mental health symptoms; and physical and health issues.1617 Additional research shows that a child/adolescent with good relationship with their parent is more likely to emulate the parent's substance use behaviors.18 The behaviors that a parent exhibits can even have an effect on dissuading a teen's peers from engaging in substance use.19 The importance of Section 888 funding to achieve improvements in education, treatment, resilience to and recovery from substance use disorders cannot be underestimated. Without Section 888 funding, our ability to provide parents and adolescents with substance use treatment, and to provide them with the necessary knowledge, skills, and tools to break the cycle of family substance use will be substantially decreased. The National Institute on Drug Abuse published a research-based guide that indicates that individuals with coexisting mental health disorders and drug abuse need treatment that can be integrated into every aspect of their life and not focused solely on either the mental health disorder or substance use treatment. Epidemiological studies have found that mental health and substance use disorders are highly comorbid among adults and that integrated treatment is consistently superior when compared to individual diagnoses with separate treatment plans.20 Saint Francis Ministries has the network and relationships in place to make referrals, as necessary, to mental health providers for individuals with co- occurring disorders, which increases the effectiveness of treatment. However, some co- occurring disorders are managed in Saint Francis's SUTx program. • Individuals with significant long-term substance use behaviors will experience negative effects in cognitive functioning, which has a direct impact upon the length of treatment required for abstinence and recovery. Long-term substance use can have lasting effects on cognitive functioning well after the client has ceased to use substances, which impacts not only the client but their family and support system. Treatment can be a long-term process involving relapse and multiple interventions before successful abstinence and 15 Lipari, Rachel N.and Struther L.Van Horn. Children Living with Parents who Have a Substance Use Disorder.The CBHSQ Report:August 24,2017.Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. 16 Solis,J.M.,Shadur,J.M., Burns,A.R., & Hussong,A.M. (2013). Understanding the Diverse Needs of Children Whose Parents Abuse Substances. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3676900/ 17 American Academy of Pediatrics: Families Affected by Parental Substance Use. https://pediatrics.as ppublications.org/content/pediatrics/138/2/e 20161575.full.pdf 18 Andrews,J.A., Hops, H., &Duncan, S.C. (1997).Adolescent Modeling of Parent Substance Use: The Moderating Effect of the Relationship with the Parent. https://psycnet.apa.org/record/1997-05658-001 19 Shakya, Holly B., Christakis, Nicholas A.,&Fowler,James H. (2012). Parental Influence on Substance Use in Adolescent Social Networks. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3562377/ 20 Kelly,T.M.&Daley, D.C.(2013).Integrated Treatment of Substance Use and Psychiatric Disorders. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3753025/ 11IP _ recovery are achieved. Section 888 funding helps too easily facilitate transition back into the program for either brief interventions or long-term treatment, depending on the client's needs. Without this resource, which has helped us to bring greater healing and hope to youth and families in Salina for many years, many of the individuals who have overcome SUDs in our community would not have been able to enter treatment. Saint Francis Ministries recognizes that now, more than ever, youth and parents need substance use treatment services. The effect of the COVID-19 pandemic has impacted members our community in ways that directly affect their mental health, and consequently, substance use behaviors.The National Institute on Alcohol Abuse and Alcoholism(NIAAA) released a COVID-19 surveillance report showing that spirit and beer sales between March and August 2020 increased by an average of 23% compared to prior three-year averages and beer sales increased by an average of 5%.21 A recent study on alcohol consumption during the pandemic found that the frequency of alcohol consumption had increased by 1 day more per month for 3 of 4 adults, with women also experiencing increases in heavy drinking and problems related to drinking.22 Increasing alcohol consumption among Salina citizens may be exacerbated by the circumstances resulting from the pandemic,which has a direct effect on a client's individual health as well as the health and wellbeing of their family in an inordinately stressful time. Saint Francis strives to provide our clients with the supports, tools, training, and wraparound services they need to develop resiliency and abstinence skills to succeed in treatment during the pandemic and long after. With our mission to bring healing and hope to families in ways that others believe to be impossible, we will continue to serve children, youth, adults, and families, and strive to be an instrument of healing in mind, body, and spirit. Saint Francis will continue to deliver evidence-based, trauma-informed substance use treatment services that develop abstinence behaviors, engender and support recovery, and facilitate long-term healing and growth for individuals and their families. 21 National Institute on Alcohol Abuse and Alcoholism. (2020).Alcohol Sales During the COVID-19 Pandemic. https://pubs.niaaa.nih.gov/publications/surveillance-covid-19/COVSALES.htm 22 Pollard, Michael S.,Tucker,Joan S., &Green, Harold. (2020). Changes in Adult Alcohol Use and Consequences During the COVID-19 Pandemic in the US. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770975 12I Required Attachments: 1. Annual budget for the program in the required format. New programs need only submit a budget for the 2021-2022 grant period. Existing programs must also provide an updated report for the prior year(2020). Please see completed form below on pq. 14. 2. Services Summary. Please see completed form below on pq. 15. 3. Copy of Bylaws, Articles of Incorporation, or other similar document establishing the purpose for your organization. Saint Francis' documentation is already on file. 4. A copy of Saint Francis' current licensure for services from KDADS is below on pq. 16. 5. A copy of Saint Francis' fee schedule is below on pq. 17. 6. Other attachments you might wish to include. Please list: A Telehealth information flyer is below on pq. 18. A Sliding Fee Request form is below on pq. 20. 131 Program Budgetary Information Agency: Saint Francis Community and Residential Services, Inc. 2/18/21 3:23 PM DS Saint Francis Community and Residential Services,Inc. Chemical Dependency-Salina Center Special Alcohol(Section 888)Funding Grant Expenses Based of 2020 calendar year Financial Statement. 3.0 FTE therapists 7/1/21 rev start for new Peer Mentor 3 FTE therapists& 3 FTE therapists Actual(Unaudited) .5 FTE Peer &1 FTE Peer 01/01/20-12/31/20 Request for 2021 Request for 2022 Revenue: Private Insurance 26,289.69 29,902 33,067 Private Fee for Service: Client 5,257.94 5,980 6,613 SATR Funding - - - Medicaid Funding 143,716.96 163,463 180,766 Donations and contributions Section 888(Special Alcohol)Funds 40,490.32 61,438 72,765 Other sources(specify) Interest income - - - Miscellaneous Income 2,030.18 - - Total revenues 217,785.09 260,783 293,211 Expenses: Salaries 149,281.96 160,659 179,887 Benefits and Employer Taxes 45,840.97 48,436 54,188 Supplies 2,679.40 3,126 3,662 Consultants (776.50) 1,535 1,791 Rent - - - Utilities 5,375.85 6,272 7,168 Travel and transportation-staff 566.90 661 756 Support to other agencies - - - Other: (please specify) - - Licenses,dues,bank fees - 1,250 1,917 Public&staff relations 119.31 139 163 Equipment depreciation 762.40 889 1,042 Equipment lease 1,719.48 2,006 2,293 Computer Software 627.70 732 942 Program Expenses 237.59 277 388 Contract Services-non-client (129.68) 254 356 Insurances 2,976.45 8,929 9,822 Training - 2,100 2,400 Indirect administrative fee 21,322.16 23,517 26,437 Total Expenses 230,603.99 260,783 293,210 Net Income/(Loss) (12,818.90) (0) 0 14IPage Services Summary For Twelve months ending: 12/31/2020 Program/Service Total Agency Section 888 (Program) Beneficiaries # # # People # Sessions People Sessions Inquiries Evaluations 82 90 36 40 Individual Counseling 126 1378 55 607 Group Counseling 56 388 25 171 Family Counseling Aftercare Inpatient Care (Detox) Alcohol and Drug Prevention and Education (Excluding ADIS) ADIS Dollars Contributed to third parties Referrals to other Agencies Other Services (Specify): Peer Support 2 2 Case Management 7 96 Total Unduplicated Persons Served 152 67 Please complete the table to the best of your ability, matching the categories listed to services provided by your agency. A note on how to count: If one individual attends three individual counseling sessions, it counts as 1 person and 3 sessions. If one individual receives an Individual Counseling session, participates twice in a group, and then receives a referral to another agency, you would count one individual in each service category. There would be two group sessions. However, total persons served would be 1. Likewise, if an individual were to go through your program once, and then be re-admitted, they would still count as 1 individual served in total, although they may have been counted many times. 151 §i II( a g c.i 17:4 g ., -., : 11 IP Iftg EY 1111/11 I :(1") li 4 vs; -* `"Z t74 M 011; ; A41 g w �- Z in A ilk$ C EiiiiY. 1 - I 0 cr (fj111411 A a 1114;" 44o 14.. , .... .i cA gi IH,E 1 pl N. . :2 .1., di: 16IPage L-Name,F-Name: SUBSTANCE USE Record Number: PROGRAM Date of Birth: Saint Francis SSN: Behavioral Health APPS Unique ID: ENCOUNTER FORM Date: ❑Tele Med ❑Face to Face Location: ❑Sunflower(Cenpatico) 0 Aetna MCO ❑UnitedHealthcare(Optum) 0 Co-Pay 0 Family Pres 0 SB 123- OPre ❑Post 0 School 0 AAPS/Beacon Health Options 0 Insurance Carrier ❑Seeking Safety ❑ Self-Pay 0 Reintegration Foster Care 0 Other OUTPATIENT THERAPY CPT Description Unit Value Time Units Charge ❑ H0001 Alcohol and Drug Assessment Per Session $175.00 O H0004 Individual Counseling and Therapy Per 15 Min $37.50 ❑ H0005 U5 Group Counseling Per 15 Min $10.00 ❑ H0006 U5 Case Management Per 15 Min $13.25 ❑ H0007 Crisis Intervention Per 15 Min $33.00 O H0015 U5 Intensive Outpatient Program(Under 18) Per Day $150.00 O Q3014 Telemedicine Originating site fee Per Session $20.00 ❑ A0160 Support Services Per 15 Min $10.50 ❑ Q38 Peer Support Group Per 15 Min $8.00 O H0038 HF Peer Support Individual Per 15 Min $16.00 ❑ 99202 GPRA Assessment Per Assessment $10.00 ❑ Amazing Altematives/PEP n/a n/a n/a $85.00 ❑ Consultation Per 15 Min $25.00 O Travel Time for Consultation Per 15 Min $12.50 ICD-10 CODES TOTAL: ❑F10.I0 Alcohol Use Disorder,Mild 0 Z72.0 Tobacco Use Disorder,Mild ❑F10.20 Alcohol Use Disorder, ❑ F17.20 Tobacco Use Disorder, ❑ Moderate ❑ Severe ❑ Moderate ❑ Severe ❑F11.10 Opioid Use Disorder,Mild 0 F14.10 Cocaine Use Disorder,Mild ❑F11.20 Opioid Use Disorder, ❑ F14.20 Cocaine Use Disorder, ❑ Moderate ❑ Severe ❑ Moderate ❑ Severe ❑F13.10 Sedative,Hypnotic,Or Anxiolytic Use Disorder,Mild ❑ F15.10 Amphetamine Type Substance/Other or Unspecified Stimulant Use Disorder,Mild ❑F13.20 Sedative,Hypnotic,Or Anxiolytic Use Disorder, F15.20 Amphetamine-Type Substance/Other or Unspecified ❑ Stimulant Use Disorder, ❑ Moderate ❑ Severe 0 Moderate ❑ Severe ❑F12.10 Cannabis Use Disorder,Mild 0 F16.10 Phencyclidine Use Disorder,Mild ❑F12.20 Cannabis Use Disorder, ❑ F16.20 Phencyclidine Use Disorder, ❑ Moderate ❑ Severe ❑ Moderate 0 Severe 0 F16.10 Other Hallucinogen Use Disorder,Mild 0 F19.10 Other(Or Unknown)Substance Use Disorder,Mild ❑F16.20 Other Hallucinogen Use Disorder, ❑ F19.20 Other(Or Unknown)Substance Use Disorder, ❑ Moderate ❑ Severe 0 Moderate 0 Severe ❑F18.10 Inhalant Use Disorder,Mild 0 F18.20 Inhalant Use Disorder, ❑ Other: 0 Moderate 0 Severe NOTES: PROVIDER SIGNATURE PROVIDER NUMBER FORMS/KS Behavioral Health/SUD/Encounter Form/December 15,2020/Page 1 of 1 17IPage Other Attachments: Saint Rands Providing healing and hope cl Behavioral Health to children and families TeleHealth Behavioral Health Services Access Mental Healthcare Remotely Services We Offer _ • Individual Therapy • Substance Use Counseling • Medication Management Al' 4 r 1, ilie as _;•14, o- fitskd I. i •y! ' ' ' II 44 outpatientbehavioralhealth@st-francis.org SaintFrancisMinistries.org Salina Wichita Great Bend 645 E. Iron Ave. 3730 E. Lincoln St. 2208 E. 11th St. Salina, KS 67401 Wichita, KS 67218 Great Bend, KS 67530 18IPage Treatment requirements •Eligible for Level 1 services .Ab o u t •No signif cant withdrawal requiring medical monitoring Saint Francis •Able to stably remain in the home •Mental health concerns do not Ministries interfere with treatment •Open to change Avoice of hope foi children and youth since •Wbehaviors and ly examineoimpro current 1945. eh sling aid Swint 4aricldree nod s fa to behaviorsand set goals for improvemeni provide healing and hope to children and families. •Able to maintain abstinence with `Me of er abroad range of oro0rams and services rrF minimal support to over 31000 children and families in Kansas. Oklahoma.Nebrasya Texas.AFta>-Iliirois_ •Supportive recovery environment Mississppi.and Central Arne, ,t irk 1r-Ab •Willing to develop safety plan for - children in the event of relapse ��\ •Willing to report relapses to counselor Saint Francis t s i vira MINISTRIES - .--:=•---,-; r 1 www saintfrancisrninistries_org _ 888.732.4673 .e°� .,• = 1‘ 1.��, ..;;.:.... NW.0, e_.t • Do you have a client safety concern? �` r '- t tY Please contact Saint Francis first,but you may r also contact the Joint Commission. 630-792-5800 I patien tsafetyreportQoin tea mm ission.org Saint Francis UMINISTRIES Strong families make The road to recovery is unique for each family.That's why Saint Francis doesn't use children's lives better, a one size fits all approach to treatment. so Saint Francis helps Rather,we help you take ownership of your recovery by providing flexible,individualized families heal. treatment practices. Key principles: •Safety-helps families find safety in their relationships,behaviors,and emotions Seeking Safety is treatment designed for •Integration-combines substance useit . families dealing with substance use disorder and trauma treatment and who are at risk of having their children removed from the home. •Content-examines cognitive,behavioral, and interpersonal concerns Our program offers evidence-based,in- •Processes-provides structured treatment home or in-office services designed to help that addresses countertransference,self- parents,pregnant women,and new parents care,and other areas of need related to with infants heal from substance abuse and substance use and trauma i trauma so they can strengthen their families •Flexibility-designed to treat women, and reorient their lives. men,and mixed groups-in a variety of settings Process: •The Kansas Department for Children and Families refers clients. ' •Counselor offers the program to a family. ".! _ •In-home family with additional option of is _ ii, �*` I` in-office sessions for group or -�• individual.Sessions include: - h v `" 1. Check-in j, 2.Quotation ,e - 3.Discussion topic presented for group/family activity y' : ' 4.Check-out • 5.Set commitments for ' - - At I ')1i next session This curriculum was developed by Lisa M.Najavits.PhD 6.Sessions for individuals with In 1992 at the Harvard Medical School Mclean Hospital F substance use disorder 19 1 Client Name: SUBSTANCE USE PROGRAMRecord Num: Saint Fronds SLIDING FEE SCHEDULE V Behavioral Health Birth Date: REQUEST Admission Date: Program: Parent/Guardian Name: Number of persons living in home: Annual Income: Wages S Verified by: Other11Tax Return(attached) (i.e.Social Security,Alimony,etc.) $ ❑Pay Stub(attached) Total annual net income: S Extenuating Circumstances: Determination: Explanation: ❑No scholarship ❑Sliding Fee Schedule OFull Scholarship OPartial Scholarship This information is true and correct to the best of my/our knowledge. Parent/Guardian Signature: Date: Prepared By: Date: Approved By: Date: Original—File Copy—Financial Services FORMS/SUD/Slidlag Fee Schedule Request/October 0,2018/Page 1 of 1 20IPage '1 ACC)I?I) CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) �i 03/30/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Lindsey Sturn NAME: Assurance Partners,LLC PHONE (800)563-1871 FAX (785)825-5098 (A/C,No,Ext): (A/C,No): 201 E Iron Avenue E-MAIL Isturn@yourassurance.com ADDRESS: P.O.Box 1213 INSURER(S)AFFORDING COVERAGE NAIC# Salina KS 67402-1213INSURERA: Scottsdale Insurance Company 41297b INSUREDINSURER B: Philadelphia Indemnity Insurance Company 18058 Saint Francis Ministries,Inc. INSURER C: United Wisconsin Insurance Company 29157 509 East Elm StreetINSURER D: Travelers Casualty&Surety Company of America 31194 INSURER E: Salina KS 67401 INSURER F: COVERAGES CERTIFICATE NUMBER: 20.21 All Lines REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DDIYYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITYEACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 300,000 X CLAIMS-MADE OCCUR PREMISES(Ea occurrence) $ X Professional Liability MED EXP(Any one person) $ 5,000 A OPS1585923 07/01/2020 07/01/2021 PERSONAL BADV INJURY $ 1,000,000 - GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ 3,000,000 X POLICY PRO LOC PRODUCTS-COMP/OPAGG $ 3,000.000 JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) _ X ANY AUTO _BODILY INJURY(Per person) $ B OWNED SCHEDULED PHPK2153809 07/01/2020 07/01/2021 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED X NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY (Per accident) UMBRELLA LIABEACH OCCURRENCE $ 4,000,000 - OCCUR A X EXCESS LIAB CLAIMS-MADE XLS0112660 07/01/2020 07/01/2021 AGGREGATE $ 4,000,000 DED X RETENTION S 500,000 $ WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY Y/N 500000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ C OFFICER/MEMBER EXCLUDED? N/A 0400181793 07/01/2020 07/01/2021 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Limit $1,000,000 Crime D 107003061 07/01/2020 07/01/2021 Deductible $10,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Agreement between City of Salina and Saint Francis Community Services,Inc.for the provision of substance abuse prevention and treatment programming for the period of 03/22/2021-12/31/2022. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN City of Salina Dept.of Finance&Admin. ACCORDANCE WITH THE POLICY PROVISIONS. 300 West Ash AUTHORIZED REPRESENTATIVE PO Box 736 . /J Q Salina KS 67402-0736 /tib '., i--` ^ I ©1988-2015 ACORD CORPORATION. All rights reserved. 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