The Three (3) Areas of Services Rendered in the Agreement Are Outlined Below

LETTER OF AGREEMENT

This agreement, datedAugust 9, 2010, is entered into between Daybreak Family Services and Broken Arrow Public Schools (BAPS). This letter of agreement is for the period of August 12, 2010 through June 30, 2011 and may be renewable annually with consent of both parties. It is agreed by both parties that Daybreak Family Services will provide School Based Counseling, Mental Health Services, and have access to provide therapy/counseling services to students at Rhoades Elementary School.

The purpose of this agreement is to provide for greater parent/student/teacher access to quality counseling, therapy, and mental health services in the Broken Arrow Public School community.

The three (3) areas of services rendered in the agreement are outlined below.

SCHOOL BASED COUNSELING FOR SECONDARY

In order to implement the agreement, the school agrees to designate a secondary site with the following criteria to be met.

Daybreak Family Services Will Provide:

Services:
One weekly, two-hour evening Drug/Alcohol Prevention/ Suspension Reduction classes for secondary students and parents.
One weekly, four-hour block of services to support students at the Broken Arrow Academy.
One weekly, two-hour evening Anger Management Program (6-12th grade students/parents).
Monthly Time/Effort Logs
Provide a safe environment and appropriate supervision of school students while under the direct care of Daybreak Family Services personnel.
Free assessments for students and families for services.

MENTAL HEALTH SERVICES FOR ELEMENTARY

In order to implement the agreement, the school agrees to provide use of facilities at the elementary sites to house the program.

BAPS will provide the following for the implementation of the program:
Access to one (1) room at each elementary site with access as needed for family interviews, group counseling, and individual counseling sessions.
Reasonable janitorial services for the above room(s).
Reasonable physical maintenance needs of the above room(s).
Furniture (tables, chairs, desks) for the above room(s).
Maintenance of all appropriate special education/Section 504 files, if applicable.
Access to student records, including academic, attendance, behavior, and student identification records, upon the written permission of the student’s parent(s)/guardian(s).
Daybreak Family Services will provide the following for the implementation of the program:
Staff members will be available at the elementary sites to serve program students during regular school hours and scheduled sessions. Daybreak Family Services staff members providing counseling sessions with BAPS students will be appropriately licensed counselors. Daybreak Family Services staff members working directly with BAPS students must satisfy the requirements identified in the BAPS background/security check.
Four hundred (400) hours of individual and/or group counseling services for elementary students. The program is an “open-ended” model so that students can begin and end counseling sessions at various dates. Students are accepted into the program through a BAPS school and parent referral process. Students will receive from 1 to 8 counseling sessions as appropriate. If warranted, some students may be approved for additional time. In those situations, the school counselor or principal will be consulted and, upon approval, contact the parent for the extension.
Program supplies and equipment.
Maintenance of rooms in appropriate and attractive order.
Professional staff to serve on education and IEP teams as requested or required.
Provide a safe environment and appropriate supervision of students while under the direct care of Daybreak Family Services personnel.
Free assessments for students and families for all other services provided by Daybreak Family Services.
Copies of Daybreak Family Services staff licensing information.
Daybreak Family Services staff will complete all required BAPS paperwork related to students participating in the program, including, but not limited to, monthly Time/Effort Logs.
Program Outline:
The counseling program for students includes, but is not limited to, the following topics:

 Following Directions

 Setting Daily Goals: Anger Management

 Awareness & Attitudes in Self and Others & Anti-Bullying

 Taking Responsibility for Our Own Behavior

 Doing the Right Thing

 Playing by the Rules and Helping Others to Play by the Rules

 Giving and Receiving Feedback

 Pulling it All Together

RHOADES ELEMENTARY SCHOOL SERVICES

Daybreak Family Services will provide the following services and resources to the students at Rhodes Elementary School:

A minimum of one full-time licensed or license eligible therapist to provide individual and group therapy.
A minimum of a half time up to a full time psychosocial rehabilitation specialist in each school to work with the therapist.
Daybreak Family Services staff will be available during each school day to assist teachers with any crises or stressful events that need intervention.
Daybreak Family Services will bill eligible Medicaid students for all services provided.
Daybreak Family Services will provide a parenting class once a month where requested.
Daybreak Family Services will provide pro bono services to students who do not have Medicaid or a financial resource to pay for services. Students who are in this situation will be allowed to participate in groups and each therapist will be able to see 2-3 students per week in individual therapy on a pro bono basis.
Daybreak Family Services has extensive support staff who will assist the therapist on site in providing services. Daybreak Family Services has an Electronic Medical Records system (ThinkHealth) and all staff have access to supervision through direct access to our Clinical Director, Suzy Ewing, LCSW, LMFT.
Daybreak Family Services encourages family involvement in the therapy process and will make every effort to include families in counseling.
Daybreak Family Services staff will go to the student’s homes in the evening to meet with family members when necessary.

Broken Arrow School District agrees to provide the following:

Referral of students needing school-based services to Daybreak Family Services staff.
Access to a space to provide individual therapy, group and rehabilitation services in the school.
Internet access for staff to connect to Daybreak Family Services’ remote desktop electronic records.
Access to on site computers where possible.
Assistance in monitoring the phase out of other providers who are seeing students in the school and ensuring that new students are not being seen by another program.

Service Fees for Rhoades Elementary Services

Daybreak Family Services shall not bill or collect fees for services rendered to BAPS school students during the school-based program from the parents/guardians or third-party payment insurance provider.
In the event that any student requires a level of care beyond the services available in the above identified program and provided, with the consent and approval of the student’s parent(s)/guardians(s), outside of the above identified program, including but not limited to, inpatient, residential, or other outpatient care, Daybreak Family Services may bill the student’s parents/guardians or relevant third party payer. Furthermore, Daybreak Family Services shall advise the parent/guardians in advance that any care agreed to by them outside of the program identified above shall be at their own expense and/or billed to their insurance carrier and/or Medicaid, if applicable. Additionally, Daybreak Family Services shall not advise parent/guardians to seek reimbursement from BAPS for services authorized by the parent and provided by Daybreak Family Services.

Service Fees

Daybreak Family Services will not advise parents/guardians to seek reimbursement from BAPS for services authorized by the parent and provided by Daybreak Family Services.
Daybreak Family Services will bill BAPS eighteen thousand dollars ($18,000.00) for services provided from August 12, 2010 to May 31, 2011. Invoices will be issued to BAPS at the end of each service month for one thousand eight hundred dollars ($1,800.00) for a total of 10 monthly installments. Daybreak Family Services will not bill BAPS for services that are not provided or needed (i.e. educational classes, training, drug treatment scholarships, etc.).
BAPS will allocate eighteen thousand dollars ($18,000.00) for services provided to students by Daybreak Family Services. BAPS will provide payments of one thousand eight hundred dollars ($1,800.00) at the end of each service month for only services provided. BAPS will not pay for services that are not provided nor needed (i.e. educational classes, training, drug treatment scholarships, etc.).

Representation for all Services

BAPS and Daybreak Family Services agree to assign to specific staff members the primary responsibility for administrative activities related to this agreement, identified herein as:

Rob ArmstrongBAPS - Secondary Services
Gayla NidaBAPS - Elementary Services
David PetersDaybreak Family Services

BAPS and Daybreak Family Services agree to assign a specific staff member as a site liaison with the primary responsibility of assisting the site Principal, Broken Arrow staff and Daybreak Family Services staff with the smooth logistical implementation of the services rendered at Rhoades Elementary, identified herein as Tiffany Green (BAPS) and David Peters (Daybreak Family Services).

Insurance

Prior to the commencement of services under this agreement, Daybreak Family Services agrees to maintain liability insurance coverage in minimum amounts of Twenty-Five Thousand Dollars ($25,000.00) for property damage, and One Hundred Thousand dollars ($100,000.00) for bodily injury arising out of any single occurrence. Daybreak Family Services shall give at least ten (10) days notice to BAPS before cancellation of any coverage for any reason. Daybreak Family Services agrees to maintain said liability coverage in force during the entire term of this agreement.

Hold Harmless

Daybreak Family Services will not hold the BAPS responsible for actions of Daybreak Family Services employees or clients, which result in loss or damages whether action is unintended, negligent or intended. Similarly, BAPS will not hold Daybreak Family Services responsible for actions of BAPS staff or any student, whether or not approved for the Daybreak Family Services program or parents of any student or any other person over which Daybreak Family Services has no supervision or control which results in loss or damages whether such action resulting in loss or damages, is unintended, negligent or intended.

In the event of any disagreement as to the administration of the project, the matter will be resolved by the designated Administrators as referenced in this document

BROKEN ARROW PUBLIC SCHOOL DISTRICT NO. 3

BOARD OF EDUCATION

BY:

President

Subscribed and sworn before me this the day of , 2010.

My Commission expires:

Notary Public

DAYBREAK FAMILY SERVICES

BY:

Daybreak Family Services

Subscribed and sworn before me this the day of , 2010.

My Commission expires:

Notary Public

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