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2016-585-E Finance - KidSCope: Chapel Hill Training Outreach Project, Inc. - Outside Agency Performance Agreement
DocuSign Envelope ID: 373C6CF5-BA35-4F9B-A420-087EBFE4784E OUTSIDE AGENCY PERFORMANCE AGREEMENT THIS AGREEMENT,made and entered into the first day of July 2016, ("Effective Date")by and between the County of Orange, a political subdivision of the State of North Carolina, 200 South Cameron Street, Hillsborough, North Carolina, 27278, ("County") and KidSCope: Chapel Hill Training Outreach Project, Inc., a not-for-profit corporation, located at 800 Eastowne Dr., Suite 105, Chapel Hill, NC 27514 ("Provider"). WITNESSETH: WHEREAS, it is in the interests of the County that said program be assisted by the County and thereby enhance its availability to residents of the County, and said program addresses an important community human services need, as identified by the Board of Commissioners; NOW, THEREFORE, in consideration of the above and the mutual covenants and conditions hereafter set forth, the County and KidSCope: Chapel Hill Training Outreach Project, Inc. agree as follows: 1. Term of the Agreement. The term of this Agreement shall be a program year beginning July 1, 2016 to June 30, 2017. 2. Scope of Services. a. Provider will provide services, as outlined in the attached Outside Agency Funding Application and any amendments or revision thereto which is attached as Exhibit"A" and incorporated by reference, to the residents of Orange County. The Scope of Services and the Program Budget may be different from the original application based on County appropriation; however, any revisions or amendments to this Agreement must be approved in writing by the County and attached to this Agreement as Exhibit B. b. The Provider shall be solely responsible for the means, methods, techniques, sequence, safety program and procedures necessary to properly and fully complete the work set forth in the Scope of Services. 3. Funding. a. The County agrees to appropriate for the provision of services described in Exhibit A, Scope of Services and more particularly described in the Revised Program Budget, the maximum sum of 75000. b. All funds appropriated shall be used for purposes described in Exhibit A. Any funds not used for the purposes stated shall be returned to the County. Any changes in the use of funds must be authorized in writing by the County prior to any expenditure of the funds by the Provider. If the funds are expended not in accordance with the Scope of Services, at the discretion of the County the Provider may be required to repay the funds to the County. c. The Provider shall be paid in four equal installments in the amount of$18,750. The first payment is contingent upon receipt of the agency's performance agreement; the remaining payments are contingent upon receipt of the request for reimbursement and related supporting documentation. (KidSCope: Chapel Hill Training Outreach Project,Inc.) Orange County Outside Agency Performance Agreement Revised 8/2016 DocuSign Envelope ID: 373C6CF5-BA35-4F9B-A420-087EBFE4784E d. The County's obligation to make the quarterly payments is contingent upon receipt of Progress Reports, which show satisfactory progress toward completion of performance measures and an accounting of expenditures as detailed in the attached Scope of Services. e. Once Provider has satisfied its obligations as provided in (d) payment will be made 21 days after receipt of the Progress Report and Request for Reimbursement or 21 days after due date of Progress Report whichever is later. f. The County is not obligated to provide any other support to Provider in this or in succeeding fiscal years. 4. Agency Reporting. a. Provider will provide Orange County a Progress Report that includes a fiscal report and updates on performance measures as outlined in the Scope of Services. Progress Report dates are: July 1 —December 31; January 1 —March 31 and April 1 - June 30. Reports are due on January 13,April 14, and July 14 of the program fiscal year. b. Provider agrees to allow the County to inspect its financial books and records, which document costs of those services,upon reasonable notice during normal working hours. 5. Termination. a. In the event of any of the circumstances set forth below (hereinafter referred to as "default"), the County may immediately terminate this Agreement, in whole or in part, and from time to time. Notice of termination must be in writing, state the reason or reasons for the termination, and specify the effective date of the termination: i. In the event that Provider shall cease to exist as an organization or shall enter bankruptcy proceedings, be declared insolvent, or liquidate all or substantially all of its assets, or significantly reduce its services or accessibility to Orange County residents during the term of this Agreement; or ii. In the event that Provider shall fail to render a satisfactory accounting as provided section 4 above, the County may terminate this Agreement and Provider shall return all payments already made to it by the County for services which have not been provided or for which no satisfactory accounting has been rendered; or iii. In the event of any fraudulent representation by the Provider in an invoice or other verification required to obtain payment under this Agreement or other dishonesty on a material matter relating to the performance of services under this Agreement. iv. Nonperformance,incomplete service or performance, or failure to satisfactorily perform any part of the work identified in the Scope of Services or to comply with any provision of this Agreement, as determined by the County in its sole discretion. v. Failure to adhere to the terms of applicable county, state or federal laws, regulations, or stated public policy. b. In the event of default by the Provider, the county may elect to terminate this Agreement, in whole or in part and/or require the Provider to repay the funds within ten(10)business days from written notice of default. The County may (but shall not be required to) grant the (KidSCope: Chapel Hill Training Outreach Project,Inc.) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID: 373C6CF5-BA35-4F9B-A420-087EBFE4784E Provider an opportunity to cure the default without termination of this Agreement. This clause shall not be interpreted to limit the County's remedies in law or in equity. c. Notwithstanding the foregoing, either party may terminate the agreement at any time without penalty; provided that written notice of such termination is furnished to the other party at least 30 days prior to termination. In the event of such termination, any payment due shall be prorated to the date of termination and any unused funds shall be returned to the County within 10 days of termination. d. Any termination of this Agreement for default under this section that is later deemed to be unjustified shall be deemed a termination for convenience. 6. Insurance. a. General Requirements. The Provider shall purchase and maintain, during the period of performance of this Agreement, insurance: i. Worker's Compensation. For protection from claims under workers' or workmen's compensation acts; ii. Comprehensive General Liability Insurance covering claims arising out of or relating to bodily injury, including bodily injury, sickness, disease or death of any of the Consultant's employees or any other person and to real and personal property including loss of use resulting thereof; iii. Comprehensive Automobile Liability Insurance, including hired and non-owned vehicles, if any, covering personal injury or death, and property damage; and iv. Professional Liability Insurance, covering personal injury,bodily injury and property damage and claims arising out of or related to the performance under this Agreement by the Consultant or his agents, consultants and employees. b. Limits of Coverage: Minimum limits of insurance coverage shall be as follows: INSURANCE DESCRIPTION MINIMUM REQUIRED COVERAGE • Worker's Compensation Limits for Coverage A- Statutory State NC& Coverage B -Employers Liability $500,000 each accident, disease policy limit and disease each employee • Commercial General $1,000,000 Each Occurrence Liability $2,000,000 Aggregate • Automobile Liability $500,000 Combined Single Limit • Professional Liability $1,000,000 Each Occurrence $2,000,000 Aggregate c. All insurance policies (with the exception of Worker's Compensation and Professional Liability)required under this Agreement shall name the County as an additional insured party and as a certificate holder. Evidence of such insurance and all correspondence shall be sent to: Orange County Risk Manager Post Office Box 8181 Hillsborough,NC 27278 (KidSCope: Chapel Hill Training Outreach Project,Inc.) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID: 373C6CF5-BA35-4F9B-A420-087EBFE4784E d. Nothing in this section is intended to affect or abrogate the County's sovereign immunity defenses. 7. Relationship of the Parties. Provider is an independent contractor of the County. Provider represents that they have or will secure, at his own expense, all personnel required in performing the services under this Agreement. Such personnel shall not be employees or have any contractual relationship with the County. All personnel engaged in work under this Agreement shall be fully qualified and shall be authorized and permitted under federal, state and local law to perform such services. 8. Compliance with all Laws. The Provider, at its sole expense, shall comply with all laws, ordinances, orders and regulations of the federal, state or local governments, as well as their respective departments, commissions, boards, and officers, which are in effect at the time of execution of this Agreement or are adopted at any time following execution of this agreement. 9. Subcontract. The County and Provider deem the services provided under this Agreement to be personal in nature and Provider may not subcontract any rights or duties under this Agreement to any other party without prior written consent from the County. 10. Assignment. The Provider shall not assign this Agreement, including the rights to payment, to any other party without the prior written consent of the County. 11. Indemnification. Provider agrees to defend, indemnify, and hold harmless the County, for all loss, liability, claims or expense (including reasonable attorney's fees) arising from bodily injury, including death or property damage, to any person or persons caused in whole or in part by the negligence or willful misconduct of the Provider, except to the extent same are caused by the negligence or willful misconduct of the County. It is the intent of this section to require Provider to indemnify the County to the extent permitted under North Carolina law. Nothing in this section is intended to affect or abrogate the County's sovereign immunity defenses. 12. Non-Appropriation. This Agreement is subject to the availability of funds to purchase the specified services and may be terminated at any time if such funds become unavailable. 13. Non-Discrimination. Provider agrees as part of consideration of the granting of funds by Orange County the parties hereto for themselves, their agents, officials, employees and servants agree not to discriminate in any manner of these basis of race, color, gender, national origin, age, handicap, religion, sexual orientation, familial status or veterans status with reference to any activities carried out by the grantee, no matter how remote. The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended and the Orange County Anti-discrimination Policy. This provision is enforced by action for specific performance, injunctive relief, or other remedy as by law provided; this provision shall be binding on the grantees, the successors and assigns of the parties hereto with reference to the above subject manner. 14. Living Wage. Orange County is committed to providing its employees with a living wage and encourages agencies if funds to pursue the same goal. The County's living wage is $ 13.15 per hour. To the extent possible, Orange County recommends that KidSCope: Chapel Hill Training Outreach Project, Inc.provide a living wage to its employees. 15. Notice. The Parties hereto agree and understand that written notice, mailed or delivered, to the last known address shall constitute sufficient notice to the County and the Provider. All notices (KidSCope: Chapel Hill Training Outreach Project,Inc.) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID: 373C6CF5-BA35-4F9B-A420-087EBFE4784E required and/or made pursuant to this Agreement to be given to the County and the Provides shall be in writing and mailed to the party addressed as follows: County: Finance&Administrative Services Provider: KidSCope: Chapel Hill Training Orange County Outreach Project, Inc. Post Office Box 8181 800 Eastowne Dr., Suite 105 Hillsborough,NC 27278 Chapel Hill,NC 27514 16. E ntire Agreement. This Agreement, including any referenced attachments, constitutes the entire Agreement between the parties and shall supersede, replace or nullify any and all prior Agreements of understandings; written or oral, relating to the matters set forth herein, and any such prior Agreements or understandings shall have no force or affect whatsoever on this Agreement. The County and Provider have read this Agreement and agree to be bound by all of its terms, and further agree that this Agreement constitutes the complete and exclusive statement of the Agreement between the County and Provider. 17. Severability. All clauses found herein shall act independently of each other. If a clause is found to be illegal or unenforceable, it shall have no effect on the other provisions of this Agreement. It is understood by the parties hereto that if any part, term or provision of this Agreement is by the Courts held to be illegal or in conflict with any laws of the State of North Carolina or the United States, the validity of the remaining portions or provisions shall not be affected, and the rights and obligations of the parties shall be construed and enforced as if the Agreement did not contain the particular part, term or provision held to be invalid. a. Governing Law. This Agreement and the duties, responsibilities, obligations and rights of respective parties hereunder shall be governed by the laws of the State of North Carolina. By executing this Agreement Provider affirms that Provider and any subcontractors of Provider are and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. By executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the services of any agent or subcontractor, on the list created by the State Treasurer pursuant to G.S. 147-86.58. 18. Signatures. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the intent of the Parties to comply with Article 11A and Article 40 of North Carolina General Statute Chapter 66. IN WITNESS WHEREOF,the Orange County and the Provider have signed this Agreement, effective on the last date this Agreement is signed by both parties as indicated by the dates set forth under signatures below. For and ', the,Provider LUV ro-xuko 10/25/2016 4F77ADF5R7R341M0 Date For and on ,.,,v.r.,1fsrfe{ ange County Government 156lAkuit, tka"mt-IrStt 10/26/2016 _O637994B755C477... Bonnie Hammersley, County Manager Date (KidSCope: Chapel Hill Training Outreach Project,Inc.) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID: 373C6CF5-BA35-4F9B-A420-087EBFE4784E ATTACHMENT "A" Orange County Certifications—FY 2016-17 Outside Agency Performance Agreement Chief Contact,Administrators, Chief Executive Officer and Chief Financial Officer I certify that I have provided a list of the chief contact, administrators, chief executive officer and chief financial officer for my agency with this Agreement and that I will keep it current to the County of Orange. The list should be in writing with the name, title,residential address;phone and email address and if possible, fax number. Officers and Board of Directors I certify that I have provided a current list of the Officers and Board of Directors with this Agreement and that we will continue to update the list as changes occur. The list should be in writing,with the name, physical address,mailing address and if possible,phone, fax and email address. Budget Submission I certify that I have provided a budget for the period to be covered by funding Orange County, and that any substantive changes made to this budget have been in advance authorized in writing by Orange County. Annual Financial Review I certify that I have provided a copy of the latest annual Financial Review for our agency and the budget adopted by the agency for the fiscal years encompassing this Agreement. If not,please explain on a separate sheet of paper. Alignment with Organization's Mission I certify that the programs and services for which this funding is requested align with the mission of the organization. Intended Purpose I certify that the funds provided to the agency under the terms of this Agreement will be used for a public purpose and shall only be used for the purposes intended and any money not used for those purposes will be promptly returned to Orange County. DocuSigned by: /'1 u�a roxwo- Di rector Ki dscope 10/25/2016 Certified by: 4E77ADF5B7834D0 Title: Date: (Provider's Signature) (KidSCope: Chapel Hill Training Outreach Project,Inc.) Orange County Outside Agency Performance Agreement Rev. 8/16 DocuSign Envelope ID: 373C6CF5-BA35-4F9B-A420-087EBFE4784E Exhibit A Provider's Outside Agency Application APPLICATION SUBMITTAL CHECKLIST FOR OFFICE USE ONLY Received By Agency Chapel Hill Training Outreach Project, Inc./KidSCope Date/Time / I Complete Y/N Program(s) _KidSCope Community Outreach Program Section Subsection For CDBG & HOME - HUD Regulations 1. Cover Page a. ® Applicant Contact Information b. ® Project/Program Contact Information c. ® Funding Requests Identified d. ® Signed Application Cover Page 2. Agency a. ® Agency's Years in operation 24 CFR 570.506, Information - b. ® Agency's Purpose/Mission 570.507, 570.610; 24 c. ® Agency's Types of Services Provided CFR Parts 84 or 85 d. ® Agency's Experience e. ® Other Pertinent Information 3. Program/ a. ® Type of Application and Program Identified 24 CFR 570.200(a), Project b. 570.201-570. 208, ® Summary of Program Information - c. ® Description of Identified Need 507.503 (for each d. ® Description of Population to be Served program/ project for e. ® Activity Manager and Location Description which funding f. ® Activity Implementation Timeline is requested) g. ® Agency Collaboration h. ® Describe Impact of Reduced/No Allocation i. ® Other Pertinent Information j. ® Complete Target Population/Beneficiary Chart k. ® Complete Schedule of Positions I. ® Signed Conflict of Interest Disclosure m. ® Complete Work Statement i o:° DocuSign Envelope ID: 373C6CF5-BA35-4F9B-A420-087EBFE4784E t A - continued Provider's Outside Agency Application MAIN APPLICATION 24 CFR 570.200(a), 4. Financial (for Program Budget Worksheet and Detail should reflect 570.201-570. 208, each expenses for the entire program and ALL sources of 507.503 program/ funding. 24 CFR 570.506, project for 570.507, 570.601, which funding a. ® Program Budget Worksheet 570.602, 570.607(b), is requested) b. ® Program Budget Detail 570.611 24 CFR c. ® Cost Per Unit 570.502-570.504, d. ® Agency Operating Budget Worksheet 570.506, 570.507, 570.610; 24 CFR Parts 84 or 85, and OMB Circulars A-87 or A- 122; Treasury Circular 1075 5. Supplemental A. ❑ Part A: CDBG & HOME Sections (as B. ❑ Part B: Construction/Rehab applicable) 6. Attachments a. ® Audit: Organizations receiving $300,000 or more OMB Circular A-133 in Federal financial assistance, and/or organizations with more than $500,000 of receipts and expenditures in a fiscal year, must secure an audit. b. ❑ IRS Federal Form 990 c. ® NC Solicitation License d. ® IRS Federal Tax-Exemption Letter e. ® Certificate of Insurance f. ® List of Board of Directors 24 CFR Parts 84 or 85 g. ® Articles of Incorporation/Bylaws 24 CFR 570.208, h. ® Authorization to Request Funds 570.500(c), 570.611 i. ® Authorized official designation j. ® 3-R Fee Verification Main Application 5/25/2016 9:13:32 AM 0 I:°3 3 2 of 23 DocuSign Envelope ID: 373C6CF5-BA35-4F9B-A420-087EBFE4784E t A - continued Provider's kNifkiciOcm9,yrik9Nlication 1. COVER PAGE (Each program requires a separate application.) a) Applicant Contact Information Applicant Organization's Legal Name: Chapel Hill Training Outreach Project Inc.,/KidSCope Applicant Organization's Physical Address: 800 Eastowne Dr., Suite 105, Chapel Hill, NC 27514 Applicant Organization's Mailing Address: 800 Eastowne Dr., Suite 105, Chapel Hill, NC 27514 Applicant Organization's Web Address: www.chtop.orq Executive Director: Mike Mathers Telephone Number: 919-490-5577, x223 E-Mail: mmathers( chtop.org DUNS Number: 122881048 (Dun & Bradstreet, Inc. provides this number at no charge, and it is required for Federal funding recipients.) b) Project/Program Contact Information Project/Program Name: KidSCope Project/Program Primary Contact and Title: Linda Foxworth, Director Telephone Number: 919-644-6590, x4810 E-Mail: Ifoxworth(akidscope.chtop.org c) Funding Request Identification Total Project/Program Cost: $156,116 Total Amount of Funds Requested: $81,700 Proposed Use of Funds Requested (2-3 Line Maximum): KidSCope will provide therapeutic mental health services and parent education to young Orange County children and their families. Please check all types, sources, and amounts of funding being requested. You must submit an application package for each funding source. *The Participating Jurisdiction reserves the right to fund projects from any funding source, subject to eligibility and funding constraints. _ CDBG Non-Construction (CH) $ Grant _ Loan 111 CDBG Construction (CH) $ Ej Grant F Loan HOME CHDO $ Grant T Loan _ E HOME Other $ Grant Loan J Human Services: 4 Carrboro $2,200 r Chapel Hill $4,500 14 Orange County $75,000 d) To the best of my knowledge and belief all information and data in this application is true and current. The document has been duly authorized by the governing board of the applicant. Signature: _U6e-(/_ r ,-C._ 7 (72 /// .' / Ex zi.c UJtivelDirector 4t Date 7Signature: ( n / ilit 71. a >4■-) B ard Chairperson Date Main Application 1/20/2016 2:52:21 PM Page 1 of 'I DocuSign Envelope ID: 373C6CF5-BA35-4F9B-A420-087EBFE4784E t A - continued Provider's Outside Agency Application MAIN APPLICATION 2. AGENCY INFORMATION Please provide the following information about your agency (Limit of 2 pages total): a) Years in Operation, Date of Incorporation (Month/Year) 1. Date of Incorporation: KidSCope was created in 1988 under OPC Mental Health Center, by a coalition of professionals and child advocates, to address a documented need for specialized services to young children who are experiencing social, emotional, and/or behavioral difficulties. KidSCope was divested under state mental health reform to a local non-profit, Chapel Hill Training Outreach Project, Inc. on October 1, 2005. 2. Years in Operation: KidSCope has been in operation since April 6, 1988. b) Agency's Purpose/Mission The mission of KidSCope is "To provide comprehensive early childhood mental health services to young children, their families, and care providers, who are experiencing emotional, social, behavioral, and/or developmental issues." c) Types of Services the Agency Provides KidSCope is the only program designed exclusively to provide mental health and family support to children birth to 5 and their families in Orange County, and one of only a few in North Carolina. KidSCope provides: • inclusive child care • social-emotional health services using evidence-based modalities, including Parent Child Interactive Therapy and Child Parent Psychotherapy, • child care mental health consultation and teacher education • parent education-Incredible Years Basic/Incredible Babies/Toddlers. • a myriad of childhood development and parenting resources d) Agency's Experience with Similar Programs as the Funding Request KidSCope coordinates services with the similar programs and agencies in order to ensure that children in need are identified and referred in a timely, efficient manner. Collaborations between KidSCope and other agencies increase and enhance our abilities to provide appropriate and comprehensive interventions and services. Through our partners we are able to offer a continuum of care, or"pipeline" for families of preschool children in Orange County to maximize community impact. These agencies include Children's Developmental Services Agency (CDSA), Orange County Department of Social Services, Child Care Services Association, Orange County Health Department's Family Success Alliance, Orange County Partnership for Young Children, Orange County Schools, Chapel Hill/Carrboro City Schools, and Head Start/Early Head Start, and Cardinal Innovations. Main Application 5/25/2016 9:13:32 AM .. g 41 of 23 DocuSign Envelope ID: 373C6CF5-BA35-4F9B-A420-087EBFE4784E t A - continued Provider's Outside Agency Application MAIN APPLICATION 3. PROJECT/PROGRAM INFORMATION Agency & Program Name: Chapel Hill Training Outreach Project, Inc./KidSCope As you complete your application, complete only those sections that pertain to the type of application you are submitting. The application is divided into several sections and not all sections apply to every project. Every applicant MUST complete the main application. a) Check the type of funding request for this application package submittal and complete the application and supplemental application sections as specified below: ® Human Services (Main Application Only) ❑ AH Non-Construction (Main Application Only) ❑ AH Construction — (Main Application AND Part B) ❑ AHDR Non-Construction (Main Application Only) ❑ AHDR Construction — (Main Application AND Part B) ❑ CDBG Non-Construction — (Main Application AND Part A) ❑ CDBG Construction — (Main Application AND Part A AND Part B) ❑ HOME CHDO Set-aside — (Main Application AND Part A) ❑ HOME Other — (Main Application AND Parts A AND Part B) Indicate the type of program for which you are requesting funding: Program Category Youth Adult Elderly Disabled Public Housing (not elderly) Neighborhoods/Residents Education x Health and Nutrition Job Training Sports and Arts Activities Pre-School Activities x After-School Activities Mentoring Transportation Housing Other: Proaram/Proiect Description (Label your responses as outlined below; not to exceed 3 pages.) Please provide the following information about the proposed program/project: b) Summarize the program services proposed and how the program will address the chosen Town/County priority? KidSCope proposes the following services: • customized assessment and evaluation for children birth to 5 to determine strengths and needs, • social-emotional health services using evidence-based modalities, including Parent Child Interactive Therapy and Child Parent Psychotherapy, Main Application 5/25/2016 9:13:32 AM .. g 6 of 23 DocuSign Envelope ID: 373C6CF5-BA35-4F9B-A420-087EBFE4784E t A - continued Provider's Outside Agency Application MAIN APPLICATION • parent education-Incredible Years Basic/Incredible Babies/Toddlers. • social-emotional health services using evidence-based modalities, including Parent Child Interactive Therapy and Child Parent Psychotherapy, By addressing these goals and providing services- • KidSCope addresses Orange County Goal 1, Priority Four, Protect Safety Net Programs • KidSCope addresses all three priority areas for the Town of Chapel Hill • KidSCope addresses the Town of Carrboro's Goal of Improving Services for Citizens c) Describe the local need or problem to be addressed in relation to the Consolidated Plan or other community priorities (i.e. Council/Board Goals). Cite local data to support the need for this program and the population being served. Of the 7,704 children, age 0-5, living in Orange County, approximately 1,310 to 2,080 may experience emotional and mental health in those early years —from 0 to 5— is key not only to future success but is essential to healthy development. Significant adversity in early childhood, including trauma, abuse, a parent with substance use disorder, and being raised in persistent poverty, can leave scars that impact children for the rest of their lives. The percentage of children in poverty has increased in Orange County since 2009, from 9.4% to 22% currently, almost a quarter of this fragile population. The Goals of KidSCope are: • To strengthen the social-emotional and mental health foundation for young children • To develop positive social-emotional and mental health in the early years to promote future success and healthy development. Success in child care is essential in promoting school success • To support family success strategies promoting positive relationships, physical and mental health well-being, and economic stability. By addressing these goals and providing services- • KidSCope addresses Orange County Goal 1, Priority Four, Protect Safety Net Programs • KidSCope address all three priority areas for the Town of Chapel Hill • KidSCope addresses the Town of Carrboro's Goal of Improving Services for Citizens d) Describe the population to be served or the area to benefit and indicate how you will identify beneficiaries. KidSCope is the only program designed exclusively to provide mental health and family support to children birth to 5 and their families in Orange County, and one of only a few in North Main Application 5/25/2016 9:13:32 AM .. of 2 DocuSign Envelope ID: 373C6CF5-BA35-4F9B-A420-087EBFE4784E t A - continued Provider's Outside Agency Application MAIN APPLICATION Carolina. KidSCope services prepare families for positive early experiences that "scaffold" healthy development, and build a foundation for later skills and learning capacities. Families may self-refer, or other agencies may contact KidSCope such as, Department of Social Services, Health Department, child care programs, Head Start and Early Head Start, School Systems, medical facilities, the court system, or a variety of other sources.. Ultimately, families/guardians make the decision to receive services. e) Who specifically will carry out the activities and in what location will they be carried out? Licensed mental health professionals will carry out the activities (evidence-based models) according to the best practices methods. Families will be served either in their homes, or at one of the KidSCope therapeutic settings in Chapel Hill/Carrboro, or Hillsborough, whichever is appropriate and convenient. f) Describe specifically the period over which the activities will be carried out, the frequency with which the activities will be carried out, and the frequency with which services will be delivered. Include an implementation timeline. The evidence-based models implemented by KidSCope staff for the population described will occur over the period determined by the model and the family needs. The models can be implemented weekly from 10-15 weeks to one year, with a "tune-up" available for families who need to review what they have learned. Services are customized to family needs and would not be easily adapted to one implementation timeline. g) Provide a bulleted list of other agencies, if any, with which your agency coordinates/collaborates to accomplish or enhance the Projected Results in the Program(s) to be funded. For each, give specific examples of the coordinated/collaborative efforts. • Children's Developmental Services Agency (CDSA) is mandated to evaluate and coordinate services for children 0-3 with developmental disabilities in the Infant- Toddler system. KidSCope works closely with Service Coordinators in Orange County to facilitate services for children in this age group. KidSCope refers children for evaluation and provides early intervention services to identified children through an annual contract. These early interventions occur with the child and parent and are focused on parent education and child development, including building positive relationships and social/emotional skills. • Orange County Department of Social Services (DSS): The KidSCope Child Care Consultant Program and the KidSCope Outreach Program receive referrals from Child Care Subsidy as well as Child Protective Services to screen and provide mental health services to children in their care who are in early childhood settings, in foster care, or living with parents. Specialized evidence based treatment modalities such as Parent Child Interactive Therapy and Child Parent Psychotherapy are used to build positive relationships in families who are struggling with children whose behavior is challenging. KidSCope works very closely with DSS workers to identify and serve children in the Child Protective Services system. Children who remain with parents, and children who are placed in foster care are served by KidSCope. Children of parents participating in job training through the Work First program are Main Application 5/25/2016 9:13:32 AM .. g of 23 DocuSign Envelope ID: 373C6CF5-BA35-4F9B-A420-087EBFE4784E t A - continued Provider's Outside Agency Application MAIN APPLICATION frequently placed in the KidSCope Children's learning Center for child care. KidSCope is able to support both the child and the family while they take the steps necessary to reach economic stability. • Child Care Services Association: (CCSA): This agency provides technical assistance services to early childhood educators in areas other than targeted mental health concerns. KidSCope has an interagency collaboration agreement with Promoting Healthy Social Behaviors in Child Care Centers, a state program implemented by CCSA which identifies the differences in the two programs. • Orange County Health Department: KidSCope refers children to OCHD for the CC4C program. OCHD refers children to KidSCope to work with children and families that need assistance with relationship building, parenting skills, and mental health interventions. The OCHD Child Care Health Consultant assists child care centers in providing healthy, safe environments for children. KidSCope also does joint planning and committee activities with OCHD through the Orange County Preschool Interagency Council and the Orange Chatham Early Childhood Mental Health Task Force. KidSCope partners with other Orange County agencies in the Family Success Alliance to serve families in Zone 4 and 6. • OCPYC: KidSCope has collaborated with the Orange County Partnership for Young Children (Smart Start) since 1994. The Partnership funds the KidSCope Child Care Consultation Program jointly with Cardinal Innovations, and our new Incredible Years Babies and Toddlers series. Our Developmental Day Center, the Children's Learning Center in Hillsborough, contracts with OCPYC to provide services for children eligible for NCPreK. OCPYC staff refers families to KidSCope for child care, and for mental health services. • Orange County Schools evaluate and coordinate early intervention services for children residing in the Orange County school district aged 3-5 with, or at risk for, developmental disabilities. KidSCope and the OCS staff meet regularly to coordinate for evaluation and services for children. OCS regularly refers children to KidSCope for mental health services. OCS provides space for KidSCope at one of their buildings at Hillsborough Elementary at no charge, while OCS places children with special needs in "developmental day" slots to address their identified needs. • Chapel Hill/Carrboro City Schools evaluate and coordinate early intervention services for children residing in Chapel Hill/Carrboro school district aged 3-5 with, or at risk for, developmental disabilities. KidSCope refers children for evaluation and accepts referrals for mental health services. • Cardinal Innovations/OPC Local Management Entity: This agency is the local authority for state funded mental health services, both Medicaid and state-funded. KidSCope provides services to young children and their families through an annual contract process. KidSCope has also applies for and receives funding through Cardinal for implementation of innovative early childhood mental health services and training opportunities. Services provided through our partnership with Cardinal Main Application 5/25/2016 9:13:32 AM .. g of 23 DocuSign Envelope ID: 373C6CF5-BA35-4F9B-A420-087EBFE4784E t A - continued Provider's Outside Agency Application MAIN APPLICATION Innovations are age appropriate, evidence- based, and occur mostly in the home with families and children. • Head Start/Early Head Start: These programs are available to low income families and families of children with special needs who qualify. KidSCope collaborates with both Chapel Hill/Carrboro Head Start and Orange County Head Start by giving and receiving referrals for families of young children. Since 2009 KidSCope has collaborated with Orange County and Chapel Hill/Carrboro Head Start programs to provide the national evidence-based parenting program for families of children who are age 3-8, The Incredible Years, funded through a grant from NC Department of Social Services. The program is designed to promote positive relationships and support parents/family members in improving parenting skills. The Incredible Years program has been very successful thanks to our Partnership with CHCCS PreK/Head Start. Classes are currently available in English and Spanish at Northside Elementary School through KidSCope. • KidSCope is a partner in the "Making Connections" Preschool Interagency Orange County Collaborative funded by the Triangle United Way. The collaborative takes a similar approach to the Family Success Alliance to address issues in FSA 6, providing supportive services for families of children birth to 5. h) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. Although we would continue to seek funding from other sources, if funding is not received through this application for the KidSCope Community Outreach program, the program will not be viable, or available to Orange County children and families. i) Include any other pertinent information. Program/Project Information j) Complete the Target Population and Program Beneficiary Demographics Chart k) Complete the Schedule of Positions Chart for Program Staff I) Disclosure of Potential Conflicts of Interested must be signed m) Complete the Work Statement Chart to describe the work to be performed, and be sure to attach copies of all data collection tools that will be used to verify achievement of program goals and objectives. Describe who will be responsible for monitoring progress. Information to Complete j.) Target Population Complete the following tables to the best of your ability. Show numbers of participants and percentages, as applicable, in each category. Main Application 5/25/2016 9:13:32 AM .. g 10 of 23 DocuSign Envelope ID: 373C6CF5-BA35-4F9B-A420-087EBFE4784E t A - continued Provider's Outside Agency Application MAIN APPLICATION Please indicate whether this project/program will serve: ® Persons ❑ Households ❑ Units Program: KidSCope Community Outreach Program Program Beneficiary Demographics Actual Estimated Projected 2014-15 2015-16 2016-17 Gender Male 58 53 57 Female 43 38 44 Total 101 91 101 Of the females, how many are single- female Head of Households (Omit for Human Services) Ethnicity African-American 22 28 28 American Indian or Alaska Native 0 0 0 Asian 3 2 3 Caucasian 32 45 31 Native Hawaiian or other Pacific Islander 0 0 0 Other 44 16 39 Total 101 91 101 Of the above, how many Hispanic/Latino 30 28 30 Of the above, how many non- Hispanic/Latino 71 63 71 Total 101 91 101 Age 0-5 years 101 91 101 6-18 years 19-50 years 51-61 years 62+ years Total 101 91 101 Geographic Location Durham City 1 0 1 Durham County 0 0 0 Carrboro 16 14 16 Chapel Hill 38 32 36 Chapel Hill Public Housing Residents Don't track Don't track Don't track Orange County 46 45 48 Raleigh 0 0 0 Wake County 0 0 0 Main Application 5/25/2016 9:13:32 AM P g 1 of 23 DocuSign Envelope ID: 373C6CF5-BA35-4F9B-A420-087EBFE4784E t A - continued Provider's Outside Agency Application MAIN APPLICATION Total 101 91 101 Income Level —See following chart (Omit for HS) < 30%Area Median Income 31-50% Area Median Income 51-80% Area Median Income > 80%Area Median Income Total 0 0 0 Special Needs (Omit for HS) Elderly(Over 62) Disabled (not elderly) Homeless People with HIV/Aids Total 0 0 0 Main Application 5/25/2016 9:13:32 AM Pa g I 2 of 23 DocuSign Envelope ID: 373C6CF5-BA35-4F9B-A420-087EBFE4784E t A - continued Provider's Outside Agency Application MAIN APPLICATION CDBG & HOME ONLY- Area Benefit Activities (Infrastructure and Public Facilities) Street Census Tract Block Group Total Persons #LMI Persons 2015 Area Median Family income Limits U.S. Department of Housing & Urban Development (HUD) 2015 Area Median Family Income Limits Effective March 15, 2015 Income 1 2 3 4 5 6 7 8 Level person people people people people people people people 30% AMI $14,150 $16,200 $20,090 $24,250 $28,410 $32,570 $36,730 $40,890 50% AMI $23,600 $27,000 $30,350 $33,700 $36,400 $39,100 $41,800 $44,500 80% AMI $37,750 $43,150 $48,550 $53,900 $58,250 $62,550 $66,850 $71,150 100% AMI $47,188 $53,938 $60,688 $67,375 $72,813 $78,188 $83,563 $88,937 115% AMI $54,266 $62,028 $69,791 $77,481 $83,734 $89,916 $96,097 $102,278 http://www.huduser.ord/portal/datasets/il/ill 5/FY2015 IL nc.pdf Main Application 5/25/2016 9:13:32 AM 0 I:° 13 of 23 DocuSign Envelope ID: 373C6CF5-BA35-4F9B-A420-087EBFE4784E t A - continued Provider's Outside Agency Application MAIN APPLICATION k.) Schedule of Positions Please include program staff positions followed by volunteer positions; these financial figures should match the personnel figures in your Agency Comparative Budget Excel Form. Similar positions can be combined. (i.e., 8 Occupational Therapists can be inserted as one line item). If provided, indicate: Position Titles % (R) *= Position FTE* Program Actual Estimated Projected %Total Retirement Vacant Staff+ 2014-15 2015-16 2016-17 Budget Plan (H) Health Plan KidSCope Director 1.0 0.35 28,230 16,492 17,055 3% R Office Assistant .94 0.77 26,912 23.231 23,231 5% R,H Program Assistant .20 0.50 2,556 2,471 2,471 0% Bilingual Child Therapist 0.75 0.49 14,528 0 0 0% R,H Child Therapist 0.87 0.91 39,536 44,226 45,995 9% R,H Child Consultation/Parent Educator 1.00 1.00 44,484 26,574 27,450 5% R,H Child Consultation/Parent Educator 0.80 1.00 41,233 42,886 42,886 8% R,H Programs Coordinator 1.00 1.00 52,768 71,202 69.917 14% R,H Programs Coordinator 1.00 1.00 49,640 19,803 0 0% R,H Program Coordinator 1.00 1.00 18,489 29,697 29,697 6% R,H Bilingual Parent Educator 0.36 2.00 17,124 16,260 16,260 3% Volunteer hours'he only volunteers we have are Advisory Council members who meet 5 times a year and these are not counted as agency program volunteer hours. Notes: • Similar positions can be combined: i.e. 8 Occupational Therapists can be inserted as one line item. • ** Full Time Equivalent staff will be noted as 1.00; half time as .50; quarter time as .25, etc. • + Denotes the percentage of staff time involved with this program. • Calculate a Full Time Equivalent for all recorded volunteer hours using the following: Total Volunteer Hours = Volunteer FTE 1,960 Main Application 5/25/2016 9:13:32 AM .. g 141 of 23 DocuSign Envelope ID: 373C6CF5-BA35-4F9B-A420-087EBFE4784E t A - continued Provider's Outside Agency Application MAIN APPLICATION I.) DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST Are any of the Board Members or employees of the agency which will be carrying out this project, or members of their immediate families, or their business associates: YES NO E '-a) Employees of or closely related to employees of the Town of Chapel Hill, Orange County, Carrboro, or Hillsborough? 1,2 b) Members of or closely related to members of the governing bodies of Chapel Hill, Carrboro, Hillsborough, or Orange County? E EiJ c) Current beneficiaries of the project/program for which funds are requested? E 0 Paid providers of goods or services to the program or having other financial interest in the program? If you have answered YES to any question, please provide a full explanation below. To the best of my knowledge and belief all of the above information is true and current. I acknowledge and understand that the existence of a potential conflict of interest does not necessarily make the project ineligible for funding, but the existence of an undisclosed conflict may result in the termination of any grant awarded. Signature: .z... .e/(--21/1-fe?„ //2--e" // ) Exeeiitive Director Date Signature: aitha, 7,,LtivitoAeAA_) oard Chairperson D Je Main Application 1/21/2016 9:51:54 AM Page 10 of 16 DocuSign Envelope ID: 373C6CF5-BA35-4F9B-A420-087EBFE4784E t A - continued Provider's Outside Agency Application MAIN APPLICATION m.) Work Statement This form is used to document program activities, program goals, performance measures, and actual results. (Add more rows as needed) If this is a new program, you will only document the projected information. • Program Activities should outline major activities the agency implements to accomplish its program goals. • Program Goal should explain what the program is trying to achieve/accomplish. Goals are statements about what the program should accomplish. SMART Goals • Performance Measures describe how you will evaluate the degree in which you achieved the stated goals. • Actual Program Results use program results to indicate the actual measureable achievement of goals. If goals were not met, please explain. Main Application 5/25/2016 9:13:32 AM .. g 16 of 23 DocuSign Envelope ID: 373C6CF5-BA35-4F9B-A420-087EBFE4784E t A - continued Provider's Outside Agency Application MAIN APPLICATION Actual Estimated Projected 2014-2015 2015-2016 2016-2017 Assess preschoolers to Assess preschoolers to Assess preschoolers to Program Activity 1 determine needs determine needs determine needs Assess 122 in Orange Assess 122 in Orange Assess 122 in Orange Program Goal county count count 100 preschoolers will be 91 preschoolers will be 100 preschoolers will be Performance Measures assessed assessed assessed 113 preschoolers were Program Results assessed Provide Evidence Based Provide Evidence Based Provide Evidence Based therapeutic therapeutic therapeutic Program Activity 2 Interventions Interventions Interventions Program Goal Provide to 100 children Provide to 91 children Provide to 100 children 90% parents will report 90% parents will report 90% parents will report Performance Measures improvement improvement improvement 100%of those surveyed Program Results reported improvement Individual counseling Individual counseling Individual counseling and education to and education to and education to families to increase families to increase families to increase knowledge of successful knowledge of successful knowledge of successful Program Activity 3 parenting. parenting. parenting. Provide counseling and Provide counseling and Provide counseling and education to 100 education to 91 families education to 100 families to help children to help children develop families to help children develop positive positive behavior and develop positive Program Goal behavior and social skills social skills behavior and social skills 90% of parents surveyed 90% of parents surveyed 90%of parents surveyed will report increased will report increased will report increased knowledge and knowledge and knowledge and Performance Measures understanding understanding understanding 100%of families surveyed reported increased knowledge Program Results and understanding Program Activity 4 Program Goal Performance Measures Program Results Pro� gram Activity 5 Main Ap iM tam Goal 5/25/2016 9:1332 AM ' age I of 2 Performance Measures Program Results DocuSign Envelope ID: 373C6CF5-BA35-4F9B-A420-087EBFE4784E t A - continued Provider's Outside Agency Application MAIN APPLICATION 4. FINANCIAL INFORMATION FOR SERVICE PROGRAMS a.) Program Budget Please complete a Program Budget Excel Form for each requested program. The Program Budget should reflect only figures and amounts associated with the Program(s) for which you are seeking funding and not the total agency budget. If the program's finances experienced significant changes that you would like to explain, please use the space below. It is required that your Excel budget worksheet be embedded on the next page. You must also submit an electronic copy of the MS Excel file with your application, as a separate file. Main Application 5/25/2016 9:13:32 AM 0 I:°' 3 , 1 of 23 DocuSign Envelope ID: 373C6CF5-BA35-4F9B-A420-087EBFE4784E t A - continued Provider's Outside Agency Application MAIN APPLICATION Section III. Program Information Program Budget Worksheet AGENCY NAME: Chapel Hill Training-Outreach Project, Inc. (KidSCope) Actual Estimated Projected Percent PROGRAM REVENUE 2014-15 2015-16 2016-17 Change Private Donations $ 13,202 $ 14,100 $ 14,100 0% Program Generated Revenue (fees) $ 32,343 $ 28,000 $ 28,000 0% Local Government Grants: Orange County $ 75,000 $ 75,000 $ 75,000 0% Town of Chapel Hill $ 4,500 $ 4,500 $ 4,500 0% Town of Carrboro $ 2,000 $ 2,200 $ 2,200 0% Other Local: Strowd Roses $ 5,000 -100% Other Local: 0 Other Local: 0 provide a separate list. Non-Local Government Grants Triangle United Way $ 12,306 $ 4,102 $ - -100% State Government 0 Federal Government 0 Other Grants: 0 Other Grants: 0 Miscellaneous/Other Revenue 0 Please list 3 largest Miscellaneous sources: $ - $ - $ - Total Program Revenue $ 139,351 $ 132,902 $ 123,800 -7% PROGRAM EXPENSES Compensation $ 149,366 $ 97,845 $ 97,845 0% Rent& Utilities $ 13,783 $ 17,395 $ 17,395 0% Supplies& Equipment $ 1,906 $ 2,600 $ 2,600 0% Travel &Training $ 9,550 $ 11,200 $ 11,200 0% Other Expenses: $ 31,428 $ 27,076 $ 27,076 0% Please list 3 largest"Other Expenses": Indirect cost to CHTOP, Inc. $ 8,806.00 Occupancy costs $ 5,030.00 Computer Maintenance $ 5,000.00 Total Program Expenses $ 206,034 $ 156,116 $ 156,116 0% SURPLUS/(DEFICIT) FOR PERIOD: ($66,684)I ($23,214)I ($32,316)I -39°I Main Application 5/25/2016 9:13:32 AM P g 20 of 23 DocuSign Envelope ID: 373C6CF5-BA35-4F9B-A420-087EBFE4784E t A - continued Provider's Outside Agency Application MAIN APPLICATION b.) Program Budget Detail What is the cost to deliver your project/program? List each project/program element in the table below, including the cost of each element, the quantity and unit of measure, and the subtotal for each element. Where necessary, allocate costs to the use of shared space, vehicles or equipment. Example Program: Credit Counseling Class Cost Elements Cost($) Quantity/Unit of Measure Subtotal ($) Credit Counseling Teacher–in class $25 96 hours (8 hrs/mth x 12 months) $2,400 Credit Counseling Teacher—class prep $25 48 hours (4hrs/mth x 12 mths) $1,200 Credit Counselor—one-on-one $20 120 hours (10 hrs/mth x12 mths $2,400 Materials $25 120 course packets/credit reports $3,000 Total $9,000 Complete the table below for the project/program for which you are requesting funds. Attach additional rows/pages, as needed. Program: Cost Elements Cost( ) Qua rtity/Unit of measure Subtotal(S) Compensation $8,153.7 mo $8,153.75 staff/admin. support $97,845 Materials $216 $216 mo. X 12 2,600 Rent and Utilities $1449 $1449.58 x12 months 17,395 Travel and Training $933 $933 x 12 mo local travel and tng 11,200 Other $2256.33 mo. X 12 (see below) 27,076 Top Three-indirect Indirect=8,806, computer=$5,000 Occupancy Occupancy$5,030 Computer Maintenance Total $156,116 C.) Cost per Unit Actual 2014-15 Estimated 2015-16 Projected 2016-17 Total Cost of Program $206,034 $156,116 $156,116 Total # of Units 254 250 212 Cost Per Unit $824.14 $690.80 $736.40 This Cost Per Unit must reflect the total program budget and the total number of program beneficiaries (households or persons) in this application and must be consistent with report submittals from previous years (if applicable). Main Application 5/25/2016 9:13:32 AM OI:° ag 21 of 23 DocuSign Envelope ID: 373C6CF5-BA35-4F9B-A420-087EBFE4784E t A - continued Provider's Outside Agency Application MAIN APPLICATION d.) Agency Operating Budget Please show all sources and amounts of funding for your entire current fiscal year. What is your agency's fiscal year? Example: July 1, 2016 through June 30, 2017. Submit operating budget in your own format. Do not include funds that have been applied for but not yet awarded: If the total revenue is not the same amount as the budget for any fiscal year, please attach a statement explaining the deficit or surplus. It is required that your Excel budget worksheet be embedded on the next page. You must also submit an electronic copy of the MS Excel file with your application, as a separate file. Main Application 5/25/2016 9:13:32 AM .. g 22 of 23 DocuSign Envelope ID: 373C6CF5-BA35-4F9B-A420-087EBFE4784E t A - continued Provider's Outside Agency Application MAIN APPLICATION Section VI. Financial Data Operating Budget for Entire Agency AGENCY NAME: Chapel Hill Training-Outreach Project, Inc. (KidSCope) Actual Estimated Projected Percent AGENCY REVENUE 2014-15 2015-16 2016-17 Change Private Donations $ 13,202 $ 14,100 $ 14,100 0% Agency Generated Revenue (fees) $ 32,343 $ 28,000 $ 28,000 0% Local Government Grants: Orange County $ 75,000 $ 75,000 $ 75,000 0% Town of Chapel Hill $ 4,500 $ 4,500 $ 4,500 0% Town of Carrboro $ 2,000 $ 2,200 $ 2,200 0% Other Local: Strowd Roses $ 5,000 -100% Other Local: 0 Other Local: 0 provide a separate list. Non-Local Government Grants Triangle United Way $ 12,306 $ 56,244 $ 66,672 19% State Government 0 Federal Government 0 Other Grants: 0 Other Grants: 0 Miscellaneous/Other Revenue $ 332,795 $ 319,405 $ 290,491 -9% Rease list 3 largest Miscellaneous sources 13-14: OCPFYC- Incredible years $120,500.00 Smart Start Orange County $45,000.00 Cardinal Innovation $40,000.00 Total Agency Revenue $ 472,145 $ 504,449 $ 480,963 -5% AGENCY EXPENSES Compensation $ 422,461 $ 386,528 $ 364,197 -6% Rent& Utilities $ 25,404 $ 30,516 $ 30,817 1% Supplies& Equipment $ 20,816 $ 28,959 $ 30,589 6% Travel &Training $ 18,896 $ 29,363 $ 29,572 1% Other Expenses: $ 51,252 $ 52,297 $ 54,002 3% Rease list 3 largest"Other Expenses" 13-14: Indirect Cost to CHTOP, Inc $ 25,979.00 Computer Maintenance $ 7,400.00 Occupancy costs $ 5,385.00 Total Agency Expenses $ 538,829 $ 527,663 $ 509,177 -4% SURPLUS/(DEFICIT) FOR PERIOD: ($66,684) ($23,214) ($28,214) -22%l Main Application 5/25/2016 9:13:32 AM P g ; 23 of 23 DocuSign Envelope ID: 373C6CF5-BA35-4F9B-A420-087EBFE4784E EXHIBIT `B" Scope of Services—FY 2016-17 Outside Agency Performance Agreement Agency Name: KidSCope: Chapel Hill Training Outreach Project, Inc. Program Name: Funding Award: $75,000 Outline how the agency will spend Orange County's funding award. Expense Description Amount Salary and Benefits for staff to implement the program 75,000 Program Services For assistance with this or the following section, please reference the Exhibit A instructions and example, located within the contract and reporting memorandum. Outline the major activities the agency will employ to attain the Anticipated Outcomes below,by June 30,2016. • Assess preschoolers to determine needs • Provide Evidence Based therapeutic Interventions • Individual counseling and education to families to increase knowledge of successful parenting. Anticipated Outcomes The Anticipated Results column must include quantifiable results in the form of number of persons/units served within Orange County, only (all Towns and municipalities). If you use percentages, you must also provide the total number of participants within that measure's description or for an earlier performance measure. Performance Measures Anticipated Results Assess preschoolers 122 children Provide counseling and education to families 100 families Parents report improvement for therapeutic interventions 90% DocuSigned by: Certified by: roxwo-n T�tle: Di rector KidSCope Date: 10/25/2016 4177A Bf5-B9-334 DO... (Provider's Signature) DocuSign Envelope ID: 373C6CF5-BA35-4F9B-A420-087EBFE4784E 2OCHAPEHIL3 ACORD,. 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