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HomeMy WebLinkAbout2017-480-E Finance - Freedom House Recovery Center, Inc. - Outside Agency Performance Agreement DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB OUTSIDE AGENCY PERFORMANCE AGREEMENT THIS AGREEMENT, made and entered into the first day of July 2017, ("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 Freedom House Recovery Center, Inc., a not-for- profit corporation, located at 104 New Stateside Drive, Chapel Hill,NC 27516 ("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 Freedom House Recovery Center, Inc. agree as follows: 1. Term of the Agreement. The term of this Agreement shall be a program year beginning July 1, 2017 to June 30, 2018. 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 B, Scope of Services and more particularly described in the Revised Program Budget, the maximum sum of 36000 b. All funds appropriated shall be used for purposes described in Exhibit B. 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 9000. 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. 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. (Freedom House Recovery Center,Inc.) Orange County Outside Agency Performance Agreement Revised 7/2017 Page 1 of 7 DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB 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 12, April 13, and July 13 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 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. (Freedom House Recovery Center,Inc.) Orange County Outside Agency Performance Agreement Page 2 of 10 Rev. 7/17 DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB 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 d. Nothing in this section is intended to affect or abrogate the County's sovereign immunity defenses. (Freedom House Recovery Center,Inc.) Orange County Outside Agency Performance Agreement Page 3 of 10 Rev. 7/17 DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB 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 Non-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 $ 13.75 per hour. To the extent possible, Orange County recommends that Freedom House Recovery Center, 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 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: (Freedom House Recovery Center,Inc.) Orange County Outside Agency Performance Agreement Page 4 of 10 Rev. 7/17 DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB County: Finance &Administrative Services Provider: Freedom House Recovery Center, Orange County Inc. Post Office Box 8181 104 New Stateside Drive Hillsborough,NC 27278 Chapel Hill,NC 27516 16. Entire 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. 18. 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. Provider shall at all times remain in compliance with all applicable local, state, and federal laws, rules, and regulations including but not limited to all state and federal anti-discrimination laws, policies, rules, and regulations and the Orange County Non-Discrimination Policy and Orange County Living Wage Policy (each policy is incorporated herein by reference and may be viewed at http://www.orangecountync.gov/departments/purchasing_division/contracts.php). Any violation of this requirement is a breach of the Agreement and County may immediately terminate this Agreement without further obligation on part of the County. This paragraph is not intended to limit and does not limit the definition of breach to discrimination. 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. 19. 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 al? °FEalf of the Provider AlnAl 8/31/2017 \.--BA5B219C D785471... Date (Freedom House Recovery Center,Inc.) Orange County Outside Agency Performance Agreement Page 5 of 10 Rev. 7/17 DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB r 7 For �ni of Orange County Government Ov,Ut,tf, holokU"SLui 9/5/2017 () 79Q4az55E47_z Bonnie Hammersley, County Manager Date (Freedom House Recovery Center,Inc.) Orange County Outside Agency Performance Agreement Page 6 of 10 Rev. 7/17 DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION FOR OFFICE USE ONLY Agency Freedom House Recovery Center Received By Program(s) Mental Health and Substance Use Date/Time Disorder Services Section Subsection 1. Cover Page a. ® Applicant Contact Information b. ® Funding Requests c. /t Signed Application Cover Page d. Signed Disclosure of Conflicts of Interest and Clause 2. Agency Information a. ® Agency's Years in operation b. ® Agency's Purpose/Mission c. ® Agency's Types of Services Provided d. •1 Agency's Experience with Programs e. ® Other Pertinent Agency Information f. ® Schedule of Positions g. ® Living Wage h. 2 Agency Budget 3. Program Information a. ® Human Services Needs Priority b. I1 Type of Program A separate Section 3 is c. ® Agency Collaboration required for each program. d. ® Summary of Program e. ® Description of Identified Need f. ® Description of Population to be Served g. -1 Program Staffing, Capacity, & Expertise h. ® Program Implementation Timeline i. ® Value of Investment j. ® Impact of Reduced/No Allocation k. ® Other Pertinent Information I. /1 Target Population/Beneficiary Chart m. ® Work Statement n. ® Program Budget, Detail, &Cost per Individual Application Submittal Checklist 1/31/2017 11:17:39 AM Page 1 of 37 DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 4. Attachments a. ® Audit: Organizations receiving $300,000 or more 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 g. ® Solid Waste Program Fee(SWPF)Verification Application Submittal Checklist 1/31/2017 11:17:39 AM Page of DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 1. COVER PAGE a) Applicant Contact Information Applicant Organization's Legal Name: Freedom House Recovery Center, Inc. Applicant Organization's Physical Address: 104 New Stateside Drive Chapel Hill, NC 27516 Applicant Organization's Mailing Address: same as above Applicant Organization's Web Address: www.freedomhouserecovery.orq Executive Director: Trish E. Hussey Telephone Number: 919-942-2803 E-Mail: trish.h(a�fhrecovery.orq Tax ID Number: b) Funding Request List all FY17-18 Human Services (HS) Funding Being Requested — For All Programs) and the Proposed Use of Funds (2-3 lines or less) Program Carrboro Chapel Orange Total -HS Hill -HS County-HS Ex.Youth Afterschool Program $10,000 $15,000 $5,000 $30,000 Afterschool Program Coordinator salary and materials for youth activities and projects 24/7/365 Urgent Behavioral Health Care (Facility- $5,000 $14,000 $16,000 $35,000 Based Crisis and Detox Services) To support the day- to-day services(i.e. staffing,facility costs, supplies and equipment) Maggie Alvis Women's and Men's Halfway Houses $5,000 $5,000 $15,000 $25,000 (Residential Rehabilitation) To support the day-to-day services (i.e.staffing,facility costs, supplies and equipment) Community Mental Health Programs (Compeer, $6,000 $6,000 $6,000 $18,000 ProBono Counseling Network, Family Advocacy Network) To support the day-to-day services and education (i.e. staffing, supplies and travel) Totals $16,000 $25,000 $37,000 $78,000 c) To the best of my knowledge and belief all information and data in this application is true and current. The document ha been duly authorized by the governing board of the applicant. - ' 1 Signatu - -- " " _' 7/ 3c1,1 c "1-- Executive Director Date Signature: (. /7; Board Chairperson Date AGENCY INFORMATION 1/27/2017 10:16:45 AM Page 6 of 24 DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION d) DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST AND NON DISCRIMINATION CLAUSE Are any of the Board Members or employees of the agency which will be carrying out this program or members of their immediate families, or their business associates... YES NO ❑ ® a) Employees of or closely related to employees of the Town of Carrboro, the Town of Chapel Hill, or Orange County? C ►I b) Members of or closely related to members of the governing bodies of the Town of Carrboro, the Town of Chapel Hill, or Orange County? ❑ ►1 c) Current beneficiaries of the program for which funds are being requested? ❑ ❑ d) 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. NON-DISCRIMINATION Provider agrees as part of consideration of the granting of funds by funding agencies to 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, gender identity/expression, 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. 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 program ineligible for funding, but the existence of an undisclosed conflict may result in the termination of any grant awarded. E , Signatur ` ,,, „ `rr;,, _. / ❑'Z . Executive Director Date I Signature: _ 7 L i - / -- Board Chair erson Date AGENCY INFORMATION 1/27/2017 10:16:29 AM Page 8 of DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 2. AGENCY INFORMATION (Be Very Brief and Concise) Please provide the following information about your agency (2 pages OR LESS): a) Years in Operation, Date of Incorporation (Month/Year): 02/74 b) Agency's Purpose/Mission (no more than a few sentences): Our mission is to promote, enhance and support recovery for men, women and children affected by substance use disorder and mental illness by using a holistic, evidence-based and person-centered approach. Our expertise and broad array of treatment services stabilize, nurture and enhance the personal growth and development of those we serve so that they can recover to live rich, full lives. c) Types of Services the Agency Provides (bullet format): • 24/7/365 Urgent Behavioral HealthCare (Facility-based Crisis and Detoxification) • Mobile Crisis Management • Short and long-term residential rehabilitation/halfway houses • Intensive outpatient services for children and adults • Aftercare • Psychiatric evaluation • Medication management, • Integrated primary health care clinic • Pro bono counseling for those in need • Compeer services for those with Severe and Persistent Mental Illness • Parenting education • Community resource referrals • Community intervention support for children and adults • We serve clients of all ages, regardless of their ability to pay. d) Agency's History with Providing These Services: Freedom House Recovery Center began over 40 years ago as a non-hospital medical detox and halfway house for recovering alcoholics in Chapel Hill. Since then Freedom House has consistently grown to address the critical and changing needs of the 75,000+ North Carolinians in our service area affected by substance use disorder and mental illness by expanding both our services and geographic reach through innovative programs and partnerships. We enjoy the reputation as a leader in our field and have become the largest provider of mental health and substance abuse treatment in our service area and Cardinal Innovations has selected us as a Comprehensive Community Clinic. We serve individuals, young children through the senior years, who suffer from mental illness and/or substance use disorders. Our comprehensive, best-practice based programs serve the low-income, uninsured, indigent and homeless populations. Last year, Freedom House served 12,000+ individuals, including over 3,000 children or adolescents and nearly 1,000 who were over the age of 55. Thirty percent of our clients are dually-diagnosed, suffering from both a mental illness and Agency Information 1/31/2017 11:11:58 AM Page 5 of 37 DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION substance use disorder. They were also generally disenfranchised when knowing how best to seek medical or behavioral health care, often using hospital Emergency Departments for this care. Additionally, our Chapel Hill Integrated Care Clinic provides limited primary care to our behavioral health care clients -- particularly important because chronic conditions such as diabetes, hypertension and other cardiovascular conditions have high comorbidity with mental illness and substance use disorders. Given the nature of mental health issues and lack of, or heavily burdened, community resources, medical conditions often go untreated without this critical continuity of care. Nationally, statistics show that individuals with mental illness die 25 years earlier than others, largely due to treatable medical conditions. (National Association of Mental Health Program Directors, 2006). 77% of clients receiving integrated care at Freedom House experienced a stabilization of their chronic disease. e) Other Pertinent Agency Information (Ex. Has the agency experienced any major changes in the past year?Is there a new Executive Director?Are there new initiatives?) • On July 1, 2016, Freedom House Recovery Center and Mental Health America of the Triangle (MHAT) combined programs and services to ensure that more individuals without adequate health care coverage receive access to mental health resources. All of MHAT's programs and their staff — Family Advocacy Network, Compeer, Pro Bono Counseling Network, Orange Partnership for Alcohol and Drug- Free Youth, and Family Success Alliance—joined Freedom House. We are including requests for funding for some of these programs within this application. • We have been awarded the Community Comprehensive Clinic (CCC) status in Orange County by Cardinal Innovations, which will help make outpatient services to the many indigent clients we serve more sustainable. f) Schedule of Positions (For Entire Agency) • Full Time Equivalent(FTE)staff will be noted as 1.00; half time as .50; quarter time as .25, etc. • Calculate a Full Time Equivalent for all recorded volunteer hours using the following: Total Volunteer Hours =Volunteer FTE 2,080 # of FTE - Full-Time Paid Positions: 132 #of FTE - Paid Part-Time Positions: 73 # of Volunteers: 150 # of FTE - Volunteers:4,844 volunteer hours g) Living Wage Does this agency pay permanent employees a minimum living wage? (Yes/No) Yes If yes, is this agency an Orange County Living Wage Certified Employer? NO We have not completed the application as yet but will complete this asap. If no, please explain. Agency Information 1/31/2017 11:11:58 AM Page 6 of 3 ° 0 c Sheetl Cn m Salary Schedule 2017-2018 —_ - --- _ Freedom House Recovery Center - - - - - -- Pc►sitiotf�T1t1�P3 �iCihC �, � 1tti ' u w � ty�; t., ��'�iF� 0 k. . W Executive Director 1 FTE 150,000.00 150,000.00 150,000.00 X ° QI Director 1 FTE 63,000.00 63,000.00 63,000.00 X n Clinical Director 1 FTE 76,000.00 76,000.00 76,000.00 X W Chief Operating Office .5 FTE 45,000.00 X CO Associate Clinical Director 1 FTE 64,000.00 32,000.00 X m HR Director 1 FTE 75,999.00 68,000.00 68,000.00 X W HR Administrative Support 1 FTE 33,575.00 45,000.00 45,000.00 X o CO Director of Facility Mgt .75 FTE 46,500.00 46,750.00 46,750.00 X o Development Director 1 FTE 45,000.00 50,000.00 50,000.00 X D Administrative Asst" 1 FTE 34,000.00 34,000.00 X `6 W Acount Manager/CFO 1 FTE 75,000.00 75,000.00 75,000.00 X o Accountant Su ort .75 FTE 25,000.00 79,000.00 26,000.00 ?( --1 m Billing Specialist 3 FTE 140,125.00 116,200.00 118,500.00 X ° _ Food Coord 1 FTE 32,000.00 40,000.00 40,000.00 X D W m � Kitchen Support 1.5 FTE 30,000.00 30,000.00 30,000.00 z y Maintenance 2 FTE 62,000.00 42,000.00 46,000.00 X TOTAL 997,199.00 946,950.00 834,250.00 y 76,323.00 72,442.00 59,995.00 Payroll Txs 50,065.00 80,250.00 60,000.00 Benefits 1,123,587 00 1,099,642 00 954,245 00 Total Gh J Hal P tams — . , Facillity Based Crisis/Non/Hospital Medical Detox Staff Psychiatrists/NPs 1.5 FTE 294,800.00 304,800.00 305,800.00 X Program Director 1 FTE 73,000.00 82,000.00 82,000.00 X Nursing Staff 4.5 FTEs 275,500.00 365,500.00 365,500.00 X Qualified Prof 6.5 FTEs 464,900.00 489,800.00 489,800.00 X UM Staff/Intake 1.75 FTE 59,000.00 65,000.00 65,000.00 X Care Coordinators 2 FTEs 124,000.00 134,000.00 134,000.00 X Health Care Coun 6 FTEs 276,900.00 292,400.00 292,400.00 X TOTAL 1,568,100.00 1,733,500.00 1,734,500.00 119,960.00 132,612.00 132,612.00 Payroll Txs 85,250.00 95,250.00 95,250.00 Benefits 1,773,310.00 1,961,362.00 1,962,362.00 Total Mobile Crisis and WIC 0 0 c Sheetl Cn M CD QPs 6FTEs 286,540.00 485,140.00 498,800.00 0 add 2 FTE in 21,920.00 37,113.00 38,158.00 0 CD late 2016 20,400.00 36,950.00 38,600.00 0 328,860.00 559,203.00 575,558.00 w C) CH Residential Halfin+a Houses AM sand Men's Program Directors 2FTE 75,000.00 75,500.00 77,500.00 X W HCC 5.0 FTE 165,500.00 165,500.00 165,500.00 X o PRN Staff 66,380.00 56,500.00 56,500.00 n TOTAL 306,880.00 297,500.00 299,500.00 m 23,099.00 27,380.00 27,380.00 Payroll Txs CO 20,544.00 21,184.00 25,184.00 Benefits T 350,523.00 346,064.00 352,064.00 Total M CO o0 0 0 Chapel Hill Outpatient Clinic/Chatham Clinic o D Director of Outpatient Clinic 1 FTE 64,000.00 67,000.00 67,000.00 X C6 W Receptionist/Screening 1 FTE 37,000.00 75,000.00 75,000.00 X o C Psychiatrist/NP 1.3 FTE 289,000.00 195,420.00 195,420.00 X � Nurse 4 FTE 38,000.00 38,000.00 38,000.00 X o x Comm. Intervention 6 FTE 482,000.00 604,600.00 604,600.00 X > _ QPs/Licensed 7 FTE 469,580.00 639,340.00 639,340.00 X m D z 1,379,580.00 1,619,360.00 1,619,360.00 n 104,973.00 114,436.00 114,436.00 P2 oll Txs < 80,523.00 80,540.00 80,540.00 Benefits 1,565,076.00 1,814,336.00 1,814,336.00 Total r Person Counseling Center/Caswell Clinic 0 Receptionist/Screening 1 FTE 34,000.00 36,500.00 36,500.00 X z Office Manager 1 FTE 37,500.00 42,000.00 42,000.00 X UM Staff/Intake 2 FTE 67,500.00 77,000.00 77,000.00 X Psychiatrist 1.50 FTE 224,000.00 189,500.00 189,500.00 Pro ram Director 1 FTE 67,000.00 69,000.00 69,000.00 X Nurse Practitioner 1 FTE 91,500.00 98,400.00 98,400.00 X Comm. Intervention 8 FTE 472,500.00 523,450.00 523,450.00 X QPs/Licensed 7FTE 482,160.00 605,340.00 605,340.00 X 1,476,160.00 1,641,190.00 1,641,190.00 113,079.00 125,551.00 125,551.00 Payroll Txs 80,454.00 120,546.00 120,546.00 Benefits 1,669,693.00 1,887,287.00 1,887,287.00 Total FiveCounty Programs 694,500.00 785,800.00 785,800.00 Salaries 0 0 c Sheetl Cn M m 51,799.00 60,113.00 60,113.00 Payroll Txs m 65,500.00 55,896.00 55,896.00 Benefits o 811,799.00 901,809.00 901,809.00 Total 0 Durham Center Access/Mobile Crisis/Walk-in Crisis 2,080,620.00 578,450.00 585,400.00 Salaries ^' Becomes FH OPT in 2016 159,167.00 44,250.00 44,783.00 Payroll Txs o 70,749.00 35,500.00 36,500.00 Benefits 2,310,536.00 658,200.00 666,683.00 Total T Durham lfway Houses U3 co 456,690.00 388,850.00 368,500.00 Salaries M will become 2 houses with 36,467.00 26,987.00 28,190.00 Payroll Txs co same number of beds in Feb 2016 55,516.00 45,500.0 o, . f 0 548,673.00 461,337.00 443,390.00 Total o SAB/t)S becomes OPT i �' > 2016 n 0 160,000.00 C 12,240.00 Pa oll Txs S2 m 25,624.00 Benefits o = 197,864.00 Total G mD z MHAT Pro rams 528,574.00 528,574.00 < D r_ n D o TOTAL $ 10,679,921.0 $ 10,217,814.00 $ 10,086,308.00 z 'Includes Professional Medical and clinical) Volunteer Hours= 3924 ECalculate q orde d volunteer hours using the following: Total Volunteer Hours=Volunteer FTE a Fuil Time Equivalent uivalent for all recorded 1942 r - DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION h) Agency Budget i. Is your agency currently receiving and/or requesting other(non-Human Services) local (Town of Carrboro, Town of Chapel Hill, Orange County) government funding? (Yes/No) No If yes, please list below: Include all programs that have funding requests/awards/totals from Carrboro, Chapel Hill, and Orange County governments (other than Human Services). DO NOT include federal funding sources, such as CDBG and HOME. Program FY16-17 FY17-18 Source Award Request Ex: Affordable Rental 0 $20,000', Carrboro-Affordable Housing Rehabilitation Ex: Agency Administration $15,000 $15,000 Carrboro—Other Ex. Total $15 000 $35,000 Carrboro Total Funding *Add rows or attach additional page, if needed. ii. Submit your agency's budget. You may complete the provided template (separate xls file) or you may submit your own budget file (as long as it contains the same information, and in a similar format, as requested in the provided template). Agency Budgets are required to define budget amounts for the previous program year, current program year, and next program year for the following categories: • Revenues o Private Donations o Program Generated Revenue o Local Government Grants • Carrboro Human Services • Carrboro Other • Chapel Hill Human Services • Chapel Hill Other(DO NOT include CDBG funding here) • Orange County Human Services Agency Information 1/31/2017 11:11:58 AM Paue 7 of 37 DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION • Orange County Other(DO NOT Include HOME funding here) o Other Government Grants • Triangle United Way • State Government • Federal Government(CDBG/HOME/etc.) • Private Foundation Grants o Other Revenue • Expenditures o Compensation o Rent & Utilities o Supplies & Equipment o Travel &Training o Other Expenses iii. Does your agency budget show a Surplus or Deficit? Deficit Is there a significant change?Yes/No Yes Please provide a brief explanation for Surplus or Deficit, and significant changes. Through changes in the behavioral health field, and the loss of a program in Durham County, Freedom House lost administration funding that has impacted our budget. iv. What is your agency's fiscal year? July 1, 2016- June 30, 2017 (Example: July 1, 2016 through June 30, 2017) Agency Information 1/31/2017 1 1:11:58 AM Paae 8 of DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Agency Budget Operating Budget for Entire Agency AGENCY NAME Freedom House Recovery Center(Behavioral Healthcare) Estimated 2016- Projected 2017 1 etrcent AGENCY REVENUE tual 20155-16...a ,u 1 ,1..,.. , 18..._ Change. Private Donations $ 79,048 $ 146,000 $ 162,500 11% Agency Generated Revenue(fees) $ 835,813 $ 747,400 $ 700,500 -6% Local Government Grants: IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Human Services-Town of Carrboro $ 9,157 $ 13,700 $ 16,000 17% Other-Town of Carrboro $ - $ - 0 Human Services-Town of Chapel Hill $ 22,500 $ 23,000 $ 25,000 9% Other-Town of Chapel Hill $ - $ - $ - 0 Human Services-Orange County $ 29,000 $ 29,000 $ 37,000 28% Other-Orange County $ 59,719 $ - $ - 0 Other-Town of Hillsborough $ - $ - $ - 0 Other Government Grants Triangle United Way $ 44,187.00 $ 44,187.00 $ 44,187.00 $ - State Government $ 9,934,124.00 $ 9,954,500.00 $ 9,955,000.00 $ 0.00 Federal Government(CDBG/HOME/etc.) $ 125,000.00 $ 125,000.00 $ 125,000.00 $ - Private Foundation Grants $ 165,444.00 $ 227,230.00 $ 210,000.00 $ 0.08 Other Revenue $ 216,465 $ 350,000 $ 350,150 $ 0.00 Total Agency Revenue $ 11,520,457 $ 11,660,017 $ 11,625,337 0% AGENCY EXPENSES Compensation $ 10,233,331 $ 10,127,814 $ 10,086,308 0% Rent&Utilities $ 375,526 $ 378,903 $ 380,301 0% Supplies& Equipment $ 433,383 $ 436,258 $ 438,658 1% Travel&Training $ 77,569 $ 83,569 $ 85,570 2% Other Expenses: $ 576,111 $ 583,473 $ 584,500 0% IIIIIIIIIIIIIIIIIIMIIIIOIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII Total Agency Expenses $ 11,695,920 $ 11,610,017 $ 11,576,337 : 0% SURPLUS/(DEFICIT)FOR PERIOD: $ (175,463)1 $ 50,000 1 $ 50,000 1 0% FY 2015-16 Comparative Agency Budget Revised 9/29/2014 DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 3. PROGRAM INFORMATION (Submit a separate Section 3 for each program) Program Name: 24/365/7 Urgent Behavioral Health Care (Facility-Based Crisis and Detox) Program Primary Contact and Title: Trish Hussey Telephone Number: 919-942-2803 E-Mail: trish.h(a.fhrecovery.org a) Indicate the type of Human Service Needs Priority, if program applicable: ® Priority Area #1: safety-net services for disadvantaged residents C Priority Area #2: education, mentorship, and afterschool programming for youth facing a variety of challenges ® Priority Area #3: programs aimed at improving health and nutrition of needy residents b) Indicate the type of program for which you are requesting funding (Check all that apply to this program) Public Housing Program Category Youth Adult Elderly Disabled Neighborhoods/Residents Affordable Housing Affordable Healthcare X X X X Education X X X X Family Resources X X X X Jobs/Jobs Training Food Transportation X X X X Other: Please specify c) 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, briefly describe the coordinated/collaborative efforts. • Local EMS: to recognize individuals who are in a mental health or substance use crisis but not in need of emergency medical services and bring them to our Urgent Behavioral Healthcare Unit • Orange County Health Department and Carolina Health Net: to refer indigent clients to a medical home, as well as to provide primary health care to indigent clients within our Freedom House Integrated Care Clinic. • Local police and Sheriff's departments CIT (Community Intervention Training) project: to train law officers to understand more fully how to work with individuals in our community who are chronically mentally ill or addicted. • Orange Rape Crisis: to provide the needed support for women who come to us with recent and historical sexual abuse. • Interfaith Council: to provide behavioral health care to their homeless clients. • Interfaith Food Shuttle: to provide fresh and healthy food for our residential clients. DO NOT SUBMIT THIS PAGE 1/31/2017 11:11:58 AM Page 9 of 37 DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION • UNC Hospitals: to provide (1) integrated care for patients with mental illness and/or substance use disorders who are in need of continued recovery treatment and care, and (2) step down program for individuals who are may be intravenous drug users (Opioid addicted), and who require IV Port antibiotics, as well as treatment. DO NOT SUBMIT THIS PAGE 1/31/2017 11:11:58 AM Page 10 of 3 DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Program Description (3 pages OR LESS) Please provide the following information about the proposed program: Summarize the program services proposed and how the program will address a Town/County priority/goal? Freedom House provides a comprehensive array of individualized, wrap-around behavioral health care services to youth and adults through four main programs in Orange County: Facility-Based Crisis and Detox/Behavioral Health Urgent Crisis Care, Residential Rehabilitation, Outpatient, and Child and Family Services. We are one of the few providers in NC that offers a full continuum of care regardless of ability to pay. Our programs directly address the second-highest Town/County priority as outlined in the 2012 assessment, Human Services Needs in Chapel Hill: Affordable Health Care, with a focus on mental health options and substance use disordedr programs. Facility-Based Crisis and Detox/Behavioral Health Urgent Crisis Program This 24/7/365 program is generally the first step toward wellness and recovery for people, and it meets the community's need for immediate response to crises. Instead of going to the local ED or being incarcerated, crisis services provide the urgent treatment needed. During a stay in the crisis/detox unit, we are able to assess the person's needs, and make thoughtful and informed decisions, together with the individual, as to the next step in their treatment. Freedom House is partnering with UNC Hospitals to provide integrated care for patients with mental illness and/or substance use disorders who are in need of continued recovery treatment and care. The goals of the partnership are: (1) to provide continuity of care and improved outcomes for patients, including low-income and indigent patients and reduce ED usage and readmission rates at UNC Hospitals. Diverting referrals to our local crisis unit instead of high cost State and local hospitals, not only saves money, but it also provides a stronger continuum of care for individuals as they discharge from the crisis unit and into longer term care. Our diversion rate was 90% last year. We have also just embarked on an additional partnership with UNC to support step down patients with resistant diseases who require IV port antibiotics. d) Describe the community need or problem to be addressed in relation to the Chapel Hill Human Services Needs Assessment, Orange County BOCC Goals and Priorities, Town of Chapel Hill Council Goals, Carrboro goals, or other community priorities (i.e. Council/Board Goals). Reference local data (using the provided links, i.e. Chapel Hill Human Services Needs Assessment)to support the need for this program. Thousands of people in Orange County are touched by the diseases of alcoholism, drug addiction, and mental illness. There are more than 59,000 adolescent and adult residents are affected by alcohol drug abuse/addiction (Alcohol/Drug Council of NC). Substance abuse costs Orange County residents over $195 million every year. Additionally, mental illness afflicts 24% of North Carolina's population and costs the state $4.8 billion (28,000 of these are Orange County residents). DO NOT SUBMIT THIS PAGE 1/31/2017 11:11:58 AM Pugs 11 of 37 DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION According to County Health Rankings and Roadmaps, Orange County citizens report 3.1 poor mental health days per month and 16% report they drink excessively, higher than the state average (University of Wisconsin Population Health Institute). North Carolina has a goal to reduce the number of poor mental health days to 2.8 per month by 2020 (Healthy NC 2020). Although the state has a goal to reduce the rate of mental-health visits to emergency departments by 2020, reduced funding levels have led to fewer services for this vulnerable population and in turn to crowded emergency rooms. It is also estimated that there are 150,000 ER visits in NC yearly for acute psychiatric or substance abuse crises, 13% of which return within 30 days. These emergency department visits have gone up in NC, and from 2008-2010, mental illness ER visits increased by 17.7% on a national level. Across the country each year, severe mental illness results in a loss of $193.2 billion in earnings and 217 million days of productivity. In addition, the Centers for Disease Control reported that nearly 10% of all Emergency Department visits in North Carolina list mental illness as a diagnosis. The national average is 5%. The Affordable Care Act has improved access to mental health services for many; however, since Medicaid was not expanded in NC, a large proportion of people remain uninsured and without access to these services. Or, if they have some health insurance, the co-pay or deductible amount, coupled with their income, prevents them from seeking mental health care. Understanding of the challenges Orange County residents who suffer from mental illness and/or substance use disorder, the Orange County Board of Commissioners established this goal as their top priority in 2016: Ensure a community network of basic human services and infrastructure that maintains, protects and promotes the well-being of all county residents. This goal specifically notes mental health as an area of focus. e) Who is your target population of individuals to benefit from this program and how will they be identified and connected with the program? The population to be served is men and women, 18 years and older, who suffer from mental illness and/or substance use disorders, and who often have chronic medical conditions related to their mental illness, addiction or medication used to treat illness. Our programs will serve the low-income, uninsured, indigent and homeless populations in Orange County. Clients come to Freedom House most often by referral from hospitals, clinics, physicians, local social service agencies, law enforcement or the court system. Clients also come to Freedom House on their own accord, without referral. We gather necessary demographic data during the intake process. f Describe the credentials of the program manager and other key staff. (Ex. Identify Program Manager and credentials, describe training provided to volunteers, etc.) Our caring treatment team includes physicians, psychiatrists, psychologists, psychiatric nurse practitioners, nurses, licensed clinical social workers, licensed clinical addiction specialists, Licensed professional clinicians, certified substance abuse counselors and other qualified professionals. Freedom House Crisis Care DO NOT SUBMIT THIS PAGE 1/31/2017 11:11:58 AM Page 12 of DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Coordinators work with UNC ER staff, individuals, and our doctors and clinicians to admit difficult cases into the crisis unit, diverting them from the local or State hospitals. Staff develops a Person Centered Plan (PCP) for each individual with appropriate steps to the next level of care, with a goal of self-sufficiency and sobriety. Needed services from the Integrated Care Clinic are incorporated into the PCP. Programs will be carried out on our Chapel Hill campus. Key personnel: • Program Director: David Williams, RN, MSN, LCAS, CSI • Clinical Director: Heather Griffin-Dolciney, LCSW, LCAS • Medical Director: Duncan McEwen, MD • Executive Director: Trish Hussey, MA g) Describe the specific period over which the activities will be carried out and include an implementation timeline. These programs are well-established, ongoing programs on which the community depends. Activities are carried out daily. Our Crisis and Detox/Behavioral Health Urgent Crisis Care services are 24/7/365. This funding request covers activities occurring in FY 2017-2018. h) Why is funding this program a good investment for the community? How does funding this program add value to the community? (250 words OR LESS) Freedom House is the largest provider of substance use disorder and mental health services in the county, and no other provider provides integrated primary health care. In fact, our Chapel Hill Outpatient Clinic is the designated "safety net" clinic for the county of Orange. We are one of the few agencies that continue to provide services to homeless, uninsured and indigent clients. Community investment in behavioral health care, especially for those who are underserved, not only positively impacts the individuals and families themselves, but also impacts the community. For example, For instance, for every $1 spent on addiction treatment, the community saves $7 in criminal justice costs and $12 in related health-care costs (Alcohol and Drug Council). i) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. The number of individuals served would be negatively impacted by a reduction in or absence of funding. Facility Based Crisis and Detox/Behavioral Health Urgent Crisis Care services are historically underfunded by State IPRS dollars, as well as Medicaid. The requirements of the Service Definitions that oversee these types of licensed programs exceed the billing rate for the service. Funding is tight for crisis services, and every dollar we receive is critical in maintaining crisis services. j) Include any other pertinent information. Freedom House tracks success through a variety of measures which relate to the quality of outcomes of our clients. Measures can include sobriety post discharge, emergency department or crisis recidivism, improvements in physical health and medication adherence, quality of life improvements such as decent housing, employment, family reunification, etc. By tracking our performance, Freedom House can monitor the effectiveness of our programs and practices and make adjustments. DO NOT SUBMIT THIS PAGE 1/31/2017 11:11:58 AM Paoe 13 of DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Additional Program Information k) Target Population Complete the following tables, with numbers (not percentages) of individuals served and to be served, to the best of your ability, I Program Target Population Demographics Actual Estimated Projected 2015-16 2016-17 2017-18 Gender Male 1,135 1,410 1,817 Female 929 1,229 1,612 Total 2,064 2,639 3,429 Ethnicity African-American 956 1,224 1,561 American Indian or Alaska Native 11 22 26 Asian 16 36 43 Caucasian 973 1,212 1,612 Native Hawaiian or other Pacific Islander 0 0 0 Other: specify Hispanic/Latino 108 145 187 Total 2,064 2,639 3,429 Of the above, how many Hispanic/Latino 108 145 187 Of the above, how many non-Hispanic/Latino 1,956 2,494 3,242 Total 2,064 2,639 _ 3,429 Age 0-5 years 6-18 years 29 58 69 19-50 years 1523 1,580 2,057 51+ years 512 1,001 1,303 Total 2,064 2,639 3,429 Geographic Location Alamance County 32 47 60 Chatham County 21 41 53 Durham County 26 32 42 Wake County 4 13 17 Orange County Breakdown Chapel Hill Public Housing 28 41 53 Town of Chapel Hill (Non-Public Housing) 621 789 1,039 Town of Carrboro 629 778 994 Town of Hillsborough 72 101 137 City of Mebane(Orange County) 24 49 64 Orange County(Outside Municipalities) 596 729 946 Other 11 19 24 Total I 2,064 _ 2,639 3,429 DO NOT SUBMIT THIS PAGE 1/31/2017 11:11:58 AM Page 14 of 3 DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Work Statement I) Complete the Work Statement Chart to describe the work to be performed. This chart 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. Every program is required to have AT LEAST 1 Program Activity, which should be SMART (Specific, Measurable, Achievable, Relevant, and Time- bound. Click on SMART Goals to learn more. • Program Activities should outline major activities the agency implements to accomplish its program goals. (i.e. Deliver meals to elderly/disabled residents.) • Program Goal should explain what the program is trying to achieve/accomplish. Goals are statements about what the program should accomplish. (i.e. Deliver 100 meals per day, Monday-Friday.) • Performance Measures describe how you will evaluate the degree in which you achieved the stated goals. (i.e. Will track the number of meals delivered each day.) • Actual Program Results use program results to indicate the actual measureable achievement of goals. If goals were not met, please explain. (i.e. Delivered an average of 105 meals per day.) Work Statement Chart for Program: 24/365/7 Urgent Behavioral HealthCare (Facility-Based Crisis and Detox) 1. Program Activity Name Provide services to all referrals from the community that meet admission criteria. Program Goal Provide services to 3,429 individuals in need of addiction or mental health treatment. Performance Measures We will use our EMR system to track these numbers. Previous Year Program Results We served 2,064 clients served in the Crisis Unit. Current Year Estimated Results We anticipate serving 2,639 clients in the Crisis Unit. Next Year Projected Results We anticipate seeing an increase from the previous FY in clients served in the Crisis Unit which also includes walk-in crisis clients. 2. Program Activity Name Crisis staff begin discharge planning with each client in the crisis unit, using motivational interviewing techniques to incentivize clients to move into the next appropriate level of care. Program Goal Provide treatment planning to refer 100% of those served to the next appropriate level of care. Performance Measures Our EMR system tracks this information and flow of client services. DO NOT SUBMIT THIS PAGE 1/31/2017 11:11:58 AM Page 15 of DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Previous Year Program Results Crisis staff provided treatment and discharge planning for 100% of all clients. Current Year Estimated Results Crisis staff will provide treatment and discharge planning for 100% of all clients. Next Year Projected Results Crisis staff will provide treatment and discharge planning for 100% of all clients. 3, Program Activity Name Freedom House Crisis Care Coordinators work with UNC ER staff, individuals and our doctors and clinicians to admit difficult cases into the crisis unit, diverting them from the local or State hospitals. Program Goal Divert 96% of those referred to the crisis unit from our local hospital ER and expensive State hospitals. Performance Measures Care Coordinators track all referrals and their outcomes using a referral tracking log. Previous Year Program Results Diverting referrals to our crisis unit instead of high cost State and local hospitals not only saves money, but it also provides a stronger continuum of care for individuals as they discharge from the crisis unit and into longer term care. Our diversion rate was 90%. Current Year Estimated Results Diverting referrals to our crisis unit instead of high cost State and local hospitals not only saves money, but it also provides a stronger continuum of care for individuals as they discharge from the crisis unit and into longer term care. We anticipate a diversion rate of 96%. Next Year Projected Results Diverting referrals to our crisis unit instead of high cost State and local hospitals not only saves money, but it also provides a stronger continuum of care for individuals as they discharge from the crisis unit and into longer term care. We anticipate a diversion rate of 96%. DO NOT SUBMIT THIS PAGE 1/31/2017 11:11:58 AM Page 16 of DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION m) Program Budget 1. Submit your program budget. You may complete the provided template (separate xls file)or you may submit your own budget file (as long as it contains the same information, in the same format, as requested in the provided template). Program Budgets are required to define budget amounts for the previous program year, current program year, and next program year for the following categories: • Revenues O Private Donations O Program Generated Revenue O Local Government Grants • Carrboro Human Services • Carrboro Other • Chapel Hill Human Services • Chapel Hill Other(DO NOT include CDBG funding here) • Orange County Human Services • Orange County Other(DO NOT Include HOME funding here) O Other Government Grants • Triangle United Way • State Government • Federal Government(CDBG/HOME/etc.) • Private Foundation Grants O Other Revenue • Expenditures O Compensation O Rent & Utilities O Supplies & Equipment O Travel &Training O Other Expenses 2. Program Budget Detail— Provide description of"other" budget items, not defined. Our projected numbers served show a much larger increase because we are including clients who utilize our walk-in crisis services which we were not capturing in our reporting totals before (FY15-16). Projected numbers for FY17-18 are also capturing UNC IV port clients which skews the Cost per Individual. This partnership will generate additional funding for the crisis services. 3. This program budget represents what percent of the agency budget? 21.94% 4. COST PER INDIVIDUAL This Cost per Individual must reflect the total program budget divided by the total number of program individuals in this application. ;Actual,;2015-16 Estimated 2016-17 Projected 2017-18 ,3 Total Cost of Program $2,133,028 $2,549,910 $2,539,428 Total # of Individuals 2,064 2,639 3,349 Cost Per Individual $1,033.44 $966.24 $758.26 DO NOT SUBMIT THIS PAGE 1/31/2017 1:07:36 PM Page 1 7 of 37 DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Program Budget Operating Budget for Program PROGRAM NAME Freedom Houses Recovery Center Facility Based Crisis/Detox(Urgent Care) qua Estimated;01 P oe, ce 201 Percent g '7 44-44'4:4;i4,0 .PROGRAM REVENUE 205- 6 4:44,-'44-''' - Private Donations $ 22,889 $ 23,500 $ 25,000 6% Program Generated Revenue $ 151,196 $ 150,000 $ 160,000 7% Local Government Grants: Human Services-Town of Carrboro $ 4,000 $ 5,000 $ 5,000 0% Other-Town of Carrboro $ - $ - $ - 0 Human Services-Town of Chapel Hill $ 12,000 $ 12,000 $ 14,000 17% Other-Town of Chapel Hill $ - $ - $ - 0 Human Services-Orange County $ 21,750 $ 16,000 $ 16,000 0% Other-Orange County $ - $ - $ - 0 Other-Town of Hillsborough $ - $ - $ - 0 Other Government Grants Triangle United Way $ 15,241.00 $ 14,241.00 $ 43,250.00 $ 2.04 State Government $ 1,726,291.00 $ 1,629,169.00 $ 1,676,178.00 $ 0.03 Federal Government(CDBG/HOME/etc.) $ - $ - $ - 0 Private Foundation Grants $ - $ - 0 Other Revenue $ 179,000 $ 700,000 $ 600,000 $ 0.14 Total Program Revenue $ 2,132,367 $ 2,549,910 $ 2,539,428 0% PROGRAM EXPENSES Compensation $ 1,878,913 $ 2,255,440 $ 2,300,600 2% Rent&Utilities $ 84,460 $ 89,997 $ 30,028 -67% Supplies&Equipment $ 125,223 $ 131,827 $ 135,200 3% Travel&Training $ 10,395 $ 14,668 $ 15,200 4% Other Expenses: $ 34,037 $ 57,978 $ 58,400 1% Total Program Expenses $ 2,133,028 $ 2,549,910; $ 2,539,428 : 0% SURPLUS/(DEFICIT) FOR PERIOD: 1 $ (661)1 $ $ - I 01 DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Program Name: Men's and Maggie Alvis Women's Halfway Houses (Residential Rehabilitation) Program Primary Contact and Title: Trish Hussey Telephone Number: 919-942-2803 E-Mail: trish.hfhrecovery.orq n) Indicate the type of Human Service Needs Priority, if program applicable: ® Priority Area#1: safety-net services for disadvantaged residents C Priority Area #2: education, mentorship, and afterschool programming for youth facing a variety of challenges ® Priority Area #3: programs aimed at improving health and nutrition of needy residents o) Indicate the type of program for which you are requesting funding (Check all that apply to this program) Program Category Youth Adult Elderly Disabled Public Housing Neighborhoods/Residents Affordable Housing X X X X Affordable Healthcare X X X X Education X X X X Family Resources X X X X Jobs/Jobs Training X X X X Food X X X X Transportation X X X X Other: Please specify p) 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, briefly describe the coordinated/collaborative efforts. • Orange County Health Department and Carolina Health Net: to refer indigent clients to a medical home, as well as to provide primary health care to indigent clients within our Freedom House Integrated Care Clinic. • Orange Rape Crisis: to provide the needed support for women who come to us with recent and historical sexual abuse. • Interfaith Council: to provide behavioral health care to their homeless clients. • Interfaith Food Shuttle: to provide fresh and healthy food for our residential clients. • Job Links and the Orange site of Durham Community College: to help individuals with their GED. • Orange Vocational Rehabilitation: to provide job trainings skills. • Community Care of North Carolina: work closely with CCNC to become a designated Access to Care Clinic for low-income and indigent individuals and families. DO NOT SUBMIT THIS PAGE 1/31/2017 11:11:58 AM Page 18 of 37 DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Program Description (3 pages OR LESS) Please provide the following information about the proposed program: Summarize the program services proposed and how the program will address a Town/County priority/goal? Freedom House provides a comprehensive array of individualized, wrap-around behavioral health care services to youth and adults through four main programs in Orange County: Facility-Based Crisis and Detox/Behavioral Health Urgent Crisis Care, Residential Rehabilitation, Outpatient, and Child and Family Services. We are one of the few providers in NC that offers a full continuum of care regardless of ability to pay. Our programs directly address the second-highest Town/County priority as outlined in the 2012 assessment, Human Services Needs in Chapel Hill: Affordable Health Care, with a focus on mental health options and substance abuse programs. Chapel Hill Residential Rehab Programs Freedom House works to provide effective, economical community services that break the cycle of poverty, substance use disorders and mental illness by providing residential rehab treatment to men and women whose illnesses have left them homeless, disenfranchised, and without work. This long-term treatment program gives the support needed for these men and women to find strong recovery and re-enter their lives with jobs and housing, and more importantly, with a sustaining recovery from their illnesses. We provide structured case management support to meet the needs of the men and women in the residential rehab programs, often focusing on housing, job readiness, interpersonal and financial skills, education and family reunification. For example, 42% of clients are parents whose children are in custody of DSS or in temporary custody of a family member. Staff assists residents in developing an appropriate dialogue with DSS with the goal of reunification after treatment. We also involve family members in the treatment of the residents, working not only toward healing the client, but also helping to heal the relationship of the entire family. q) Describe the community need or problem to be addressed in relation to the Chapel Hill Human Services Needs Assessment, Orange County BOCC Goals and Priorities, Town of Chapel Hill Council Goals, Carrboro goals, or other community priorities (i.e. Council/Board Goals). Reference local data (using the provided links, i.e. Chapel Hill Human Services Needs Assessment) to support the need for this program. Thousands of people in Orange County are touched by the diseases of alcoholism, drug addiction, and mental illness. There are more than 59,000 adolescent and adult residents are affected by alcohol drug abuse/addiction (Alcohol/Drug Council of NC). Substance abuse costs Orange County residents over$195 million every year. Additionally, mental illness afflicts 24% of North Carolina's population and costs the state $4.8 billion (28,000 of these are Orange County residents). According to County Health Rankings and Roadmaps, Orange County citizens report 3.1 poor mental health days per month and 16% report they drink excessively, higher DO NOT SUBMIT THIS PAGE 1/31/2017 11:11:58 AM Page 19 of DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION than the state average (University of Wisconsin Population Health Institute). North Carolina has a goal to reduce the number of poor mental health days to 2.8 per month by 2020 (Healthy NC 2020). The Affordable Care Act has improved access to mental health services for many; however, since Medicaid was not expanded in NC, a large proportion of people remain uninsured and without access to these services. Or, if they have some health insurance, the co-pay or deductible amount, coupled with their income, prevents them from seeking mental health care. Current mental health service delivery in NC is inadequate. In the wake of NC's mental health reform and the country's economic downturn, many individuals who need mental health services are unable to access care because they either do not meet certain diagnostic criteria, or they are unable to get past established financial barriers. The Kaiser Foundation estimates this population to be 357,000. Studies show that mental illness is significantly higher among the uninsured, and that currently 182,000 uninsured adults in our state have a mental illness. Untreated mental illness has many consequences, both for individuals suffering and for the larger community. Substance use disorders and untreated mental illness are directly connected with indigence, unemployment, adolescent pregnancy, school dropout, crime, chronic illness and death. Freedom House has developed community partnerships and programs that build the necessary skills and connections to employment, education and housing clients will need when they reenter the community. Their recovery can diminish the societal and economic costs to their families and communities. Understanding of the challenges Orange County residents who suffer from mental illness and/or substance use disorder, the Orange County Board of Commissioners established this goal as their top priority in 2016: Ensure a community network of basic human services and infrastructure that maintains, protects and promotes the well-being of all county residents. This goal specifically notes mental health as an area of focus. r) Who is your target population of individuals to benefit from this program and how will they be identified and connected with the program? The population to be served is men and women who suffer from mental illness and/or substance use disorders, and who often have chronic medical conditions related to their mental illness, addiction or medication used to treat illness. Our programs will serve the low-income, uninsured, indigent and homeless populations in Orange County. Clients come to Freedom House most often by referral from hospitals, clinics, physicians, local social service agencies, law enforcement or the court system. Clients also come to Freedom House on their own accord, without referral. We gather necessary demographic data during the intake process. s) Describe the credentials of the program manager and other key staff. (Ex. Identify Program Manager and credentials, describe training provided to volunteers, etc.) DO NOT SUBMIT THIS PAGE 1/31/2017 11:11:58 AM Page 20 of DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Our caring treatment team includes physicians, psychiatrists, psychologists, psychiatric nurse practitioners, nurses, licensed clinical social workers, licensed clinical addiction specialists, certified substance abuse counselors and other qualified professionals. Key personnel: • Program Director: Mary Oliver, HCC • Clinical Director: Heather Griffin-Dolciney, LCSW, LCAS • Medical Director: Duncan McEwen, MD • Executive Director: Trish Hussey, MA t) Describe the specific period over which the activities will be carried out and include an implementation timeline. These programs are well-established, ongoing programs on which the community depends. Activities are carried out daily. Our halfway houses are staffed 24/7/365. This funding request covers activities occurring in FY 2017-2018. u) Why is funding this program a good investment for the community? How does funding this program add value to the community? (250 words OR LESS) Freedom House is the largest provider of substance use disorder and mental health services in the county, and no other provider provides integrated primary health care. In fact, our Chapel Hill Outpatient Clinic is the designated "safety net" clinic for the county of Orange. We are one of the few agencies that continue to provide services to homeless, uninsured and indigent clients. Community investment in behavioral health care, especially for those who are underserved, not only positively impacts the individuals and families themselves, but also impacts the community. For example, For instance, for every $1 spent on addiction treatment, the community saves $7 in criminal justice costs and $12 in related health-care costs (Alcohol and Drug Council). v) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. The number of individuals served would be negatively impacted by a reduction in or absence of funding. Our licensed halfway houses are not a Medicaid billable service and are funded at a very low State rate that does not cover the cost of running the programs, making it difficult to sustain these critical treatment/housing programs which have a higher rate of success than other programs in the state and nation. w) Include any other pertinent information. Freedom House tracks success through a variety of measures which relate to the quality of outcomes of our clients. Measures can include sobriety post discharge, emergency department or crisis recidivism, improvements in physical health and medication adherence, quality of life improvements such as decent housing, employment, family reunification, etc. By tracking our performance, Freedom House can monitor the effectiveness of our programs and practices and make adjustments. DO NOT SUBMIT THIS PAGE 1/31/2017 11:11:58 AM Page 21 of 7 DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Additional Program Information x) Target Population Complete the following tables, with numbers (not percentages) of individuals served and to be served, to the best of your ability, Program Target Population Demographics Actual Estimated Projected 2015-16 2016-17 2017-18 Gender Male 30 51 50 Female 66 58 60 Total 106 109 110 Ethnicity African-American 45 54 53 American Indian or Alaska Native Asian Caucasian 58 49 54 Native Hawaiian or other Pacific Islander Other: specify Hispanic/Latino 3 6 3 Total 106 109 110 Of the above, how many Hispanic/Latino 3 6 3 Of the above, how many non-Hispanic/Latino 103 103 106 Total 106 109 110 Age 0-5 years 6-18 years 4 5 5 19-50 years 84 88 89 51+ years 18 16 16 Total 106 109 110 Geographic Location Alamance County 4 5 5 Chatham County 2 5 5 Durham County Wake County Orange County Breakdown Chapel Hill Public Housing Town of Chapel Hill (Non-Public Housing) 39 37 38 Town of Carrboro 26 24 24 Town of Hillsborough 6 8 8 City of Mebane(Orange County) 3 2 2 Orange County(Outside Municipalities) 26 28 28 Other Total 106 109 110 DO NOT SUBMIT THIS PAGE 1/31/2017 11:11:58 AM Page 22 of DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Work Statement y) Complete the Work Statement Chart to describe the work to be performed. This chart 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. Every program is required to have AT LEAST 1 Program Activity, which should be SMART (Specific, Measurable, Achievable, Relevant, and Time- bound. Click on SMART Goals to learn more. • Program Activities should outline major activities the agency implements to accomplish its program goals. (i.e. Deliver meals to elderly/disabled residents.) • Program Goal should explain what the program is trying to achieve/accomplish. Goals are statements about what the program should accomplish. (i.e. Deliver 100 meals per day, Monday-Friday.) • Performance Measures describe how you will evaluate the degree in which you achieved the stated goals. (i.e. Will track the number of meals delivered each day.) • Actual Program Results use program results to indicate the actual measureable achievement of goals. If goals were not met, please explain. (i.e. Delivered an average of 105 meals per day.) Work Statement Chart for Program: Men's and Maggie Alvis Women's Halfway Houses (Residential Rehabilitation) 4. Program Activity Name ; Staff will work with stakeholders and community partners (UNC Hospitals, the Court system, IFC shelter, etc.) to identify referrals for individuals in our community who need long-term halfway house services. Program Goal 110 men and women receive long-term (3-6 months) recovery and community support services. Performance Measures Outcomes are evaluated using NCTOPPS tool and our EMR. Previous Year Program Results Provide services to 106 individuals and maintain a 98% utilization rate. Current Year Estimated Results Provide services to 109 individuals and maintain a 98% utilization rate. Next Year Projected Results Provide services to 110 individuals and maintain a 98% utilization rate. 5. Program Activity Name Staff develops a Person-Centered Plan for each individual, with a goal of self-sufficiency and sobriety upon graduation. Program Goal 78 % of all clients will graduate from the program and re-enter the community and/or family. Performance Measures Clinical staff will regularly monitor the case planning activities for each client during their stay in the program. Previous Year Program Results 77 % of all clients will graduate from the program and re-enter the community and/or family. Current Year Estimated Results 77 % of all clients will graduate from the program and DO NOT SUBMIT THIS PAGE 1/31/201711:11:58AMPage 23 of DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION re-enter the community and/or family. Next Year Projected Results Of the 77% of clients who graduate from the program, another 10% will successfully discharge to ADATC or other appropriate level of care. 6. Program Activity Name Staff develops a Person-Centered Plan for each individual, with a goal of self-sufficiency and sobriety upon graduation. Program Goal 65% of clients who graduate will secure housing upon discharge. Performance Measures Follow up surveys and a 3 month follow-up plan are used to gain this information regarding housing. Previous Year Program Results 64% of clients who graduate will secure housing upon discharge. Current Year Estimated Results 64% of clients who graduate will secure housing upon discharge. Next Year Projected Results 65% of clients who graduate will secure housing upon dischar e. z) Program Budget 5. Submit your program budget. You may complete the provided template (separate xls file) or you may submit your own budget file (as long as it contains the same information, in the same format, as requested in the provided template). Program Budgets are required to define budget amounts for the previous program year, current program year, and next program year for the following categories: • Revenues o Private Donations o Program Generated Revenue o Local Government Grants • Carrboro Human Services • Carrboro Other • Chapel Hill Human Services • Chapel Hill Other(DO NOT include CDBG funding here) • Orange County Human Services • Orange County Other(DO NOT Include HOME funding here) o Other Government Grants • Triangle United Way • State Government • Federal Government (CDBG/HOME/etc.) • Private Foundation Grants o Other Revenue • Expenditures o Compensation o Rent & Utilities o Supplies & Equipment o Travel & Training o Other Expenses DO NOT SUBMIT THIS PAGE 1/31/2017 11:11:58 AM Page 24 of DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 6. Program Budget Detail — Provide description of"other" budget items, not defined. 7. This program budget represents what percent of the agency budget? 3.74% 8. COST PER INDIVIDUAL This Cost per Individual must reflect the total program budget divided by the total number of program individuals in this application. Actual 201546 Estimated 2016-17 Pr ojected 2011.18 Total Cost of Program $417,679 $426,337 $433,300 Total #of Individuals 106 109 110 Cost Per Individual $3,940.37 $3,911.35 $3,939.09 DO NOT SUBMIT THIS PAGE 1/31/2017 1:07:05 PM Page 2 37 DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Program Budget Operating Budget for Program PROGRAM NAME: Freedom Houses Recovery Center Residential Men and Women Actual Estimated. Project q Percent PROGRAM REVENUE ,'v 201 ' S ,v _ 2016-1 v 2017- ho e. Private Donations $ 289 $ 1,000 $ 1,000 0% Program Generated Revenue $ 26,562 $ 28,250 $ 29,150 3% Local Government Grants: Human Services -Town of Carrboro $ 4,000 $ 4,000 $ 5,000 25% Other-Town of Carrboro $ - $ - $ - 0 Human Services-Town of Chapel Hill $ 5,000 $ 5,000 $ 5,000 0% Other-Town of Chapel Hill $ - $ - $ - 0 Human Services-Orange County $ 7,250 $ 7,250 $ 15,000 107% Other-Orange County $ - $ - $ - 0 Other-Town of Hillsborough $ - $ - $ - 0 Other Government Grants Triangle United Way $ 5,242.00 $ 5,250.00 $ 5,250.00 $ - State Government $ 300,736.00 $303,987.00 $304,400.00 $ 0.00 Federal Government(CDBG/HOME/etc $ - $ - $ - 0 Private Foundation Grants $ - $ - 0 Other Revenue $ 68,600 $ 71,600 $ 68,500 $ 0.04 Total Program Revenue $ 417,679 $ 426,337 $ 433,300 2% PROGRAM EXPENSES Compensation $ 330,280 $ 336,337 $ 339,500 1% Rent& Utilities $ 37,757 $ 38,500 $ 40,000 4% Supplies&Equipment $ 34,430 $ 36,000 $ 38,000 6% Travel &Training $ 7,425 $ 8,000 $ 8,200 3% Other Expenses: $ 7,787 $ 7,500 $ 7,600 1% Total Program Expenses $ 417,679 $ 426,337 $433,300 2% SURPLUS/(DEFICIT) FOR PERIOD: I $ - 1 $ 1 $ - 1 01 DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Program Name: Community Mental Health Programs: Pro Bono Counseling Network, Compeer and Family Advocacy Network Program Primary Contact and Title: Trish Hussey Telephone Number: 919-942-2803 E-Mail: trish.h(cfhrecovery.orq aa) Indicate the type of Human Service Needs Priority, if program applicable: Priority Area #1: safety-net services for disadvantaged residents ❑ Priority Area #2: education, mentorship, and afterschool programming for youth facing a variety of challenges Priority Area #3: programs aimed at improving health and nutrition of needy residents bb)Indicate the type of program for which you are requesting funding (Check all that apply to this program) Program Category Youth Adult Elderly Disabled Public Housing Neighborhoods/Residents Affordable Housing Affordable Healthcare X X X X X Education X X X X X Family Resources X X X X X Jobs/Jobs Training Food Transportation Other: Please specify cc)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, briefly describe the coordinated/collaborative efforts. • UNC CECMH (Center for Excellence in Community Mental Health) — When PBCN staff screen a client who has severe and persistent mental illness, such as Bipolar Disorder or psychosis, a referral is made to UNC CECMH. The majority of Compeer referrals come from staff at the UNC CECMH in the Dept. of Psychiatry. • Club Nova — Many Compeer Friends are also members of Club Nova. Club Nova staff also help coordinate Compeer referrals. • Juvenile Court — FAN receives many of its referrals through Juvenile Court, and provides feedback and reports to Juvenile Court Counselors regarding parent involvement in FAN services and improved functioning at home, school and in the community for their children. • Orange County Department of Social Services (DSS) — FAN collaborates with DSS by providing parent skills building training to parents referred by DSS social workers, utilizing the "Common Sense Parenting" best practices curriculum and providing one-on-one support to help referred clients be compliant with court or department orders. DO NOT SUBMIT THIS PAGE 1/31/2017 11:11:58 AM Page 26 of 3 DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION • Orange County/Chapel Hill-Carrboro Schools — As with Juvenile Court and DSS, FAN receives referrals from school personnel for its services; and attends IEP meetings as warranted and provides supports to parents in order to improve their children's functioning in school. • KidSCope — FAN partners with this agency to provide professional development for FAN staff and provide trainings in FAN's "Common Sense Parenting" to their parents of toddlers/preschoolers with emotional-behavioral challenges, reinforcing the concept that mental illness is treatable and early intervention works. • Family Success Alliance — FAN accepts referrals from FSA for individuals in Zone 4 who are in need of FAN services. FSA staff are co-located at the MHAT office, and assist each other with resource and referral information for the families each program serves. • Orange County Care Review — A FAN staff member attends Care Review meetings to support the family's voice when a parent is applying for out-of- home placement for their child with at-risk behaviors. • Orange County Collaborative — A FAN staff member attends monthly collaborative meetings, which is a working group designed to learn from other members, identify gaps and needs for mental health services delivered to youth under age 18, and work in partnership with the committee to develop ways to fill the identified gap in treatment services and skills building to parents, youth, and families. • Volunteers for Youth — FAN partners with Volunteers for Youth to help youth who are court-involved comply with community service hours, as well as provide support and training opportunities to parents of youth in their mentoring and restitution programs. DO NOT SUBMIT THIS PAGE 1/31/2017 11:11:58 AM Page 27 7 DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Program Description (3 pages OR LESS) Please provide the following information about the proposed program: Summarize the program services proposed and how the program will address a Town/County priority/goal? In 2016 Freedom House welcomed the programs and staff of Mental Health America of the Triangle (MHAT) into our agency and thus expanded the breadth and depth of our services to those suffering from mental illness and their families. Our programs directly address the second-highest Town/County priority as outlined in the 2012 assessment, Human Services Needs in Chapel Hill: Affordable Health Care, with a focus on mental health options and substance abuse programs. The Pro Bono Counseling Network (PBCN) provides free mental health counseling services to individuals in need, regardless of their ability to pay, via a network of licensed, volunteer therapists. The PBCN fills a current and growing need within the community by providing free counseling to uninsured and underinsured individuals suffering from mental health concerns including depression and anxiety. The eight free sessions are often enough to get a person back on their feet. PBCN also offers the Pro Bono Counseling Network Education Series. The annual series provides a minimum of six clinical continuing education workshops on topics that are relevant to PBCN therapists and is completely free of charge for volunteer therapists. The series is offered for a fee to all clinicians in the area and serves as a recruiting tool for new volunteer therapists while enhancing the clinical skills of area therapists. Mental illness is often accompanied by isolation, where individuals withdraw from family, friends, even activities they once enjoyed. Individuals who have the support of a caring, committed friend are more likely to stay engaged with their treatment and other meaningful activities in their life. They are also less likely to deteriorate or require hospitalization, all of which saves money and promotes recovery for those living with a severe mental illness. Since 1995, the Compeer Program has addressed this stigma, isolation, and loneliness of mental illness through the power of companionship. Trained volunteers commit a minimum of one hour per week for one year to a Compeer "friend" who lives with a mental health condition, typically someone with a severe and persistent mental illness (SPMI) such as Schizophrenia or Bipolar Disorder. The clients (friends) are stable and at the critical point in their recovery in which they are reestablishing relationships and connections within the community. The Compeer program has recently expanded to create the Compeer for Seniors program, aimed specifically to address the isolation, loss of independence, loneliness and psychological distress in older people. Family Advocacy Network—The Family Advocacy Network (FAN) began in 2000 in response to the need for a child-focused, family-driven System of Care to meet the mental health needs of the community's children. Since then, through the work of program staff Family Advocates, we continue to provide critical support and assistance to parents raising school-age children with emotional or behavioral issues, DO NOT SUBMIT THIS PAGE 1/31/2017 11:11:58 AM Page 28 of DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION mental health issues, learning differences, high-functioning Autism, substance abuse problems, and other challenges. Family Advocates offer one-on-one and group support, advocacy, parenting skills training, and community resources to parents who are children with emotional or behavioral issues. They also work 1:1 and in group settings with parents of at-risk youth who have mental health/substance abuse conditions. The goal is to strengthen parenting skills, reduce parent/youth conflicts, set goals and teach parents skills to reduce or eliminate risk factors. To effectively reach the community, FAN Advocates maintain a strong presence in juvenile and dependency court proceedings, court planning, and truancy courts. They also participate in Child and Family Team (CFT) meetings, Individual Education Plan (IEP) meetings, one-on-one family meetings, and frequently communicate with court counselors, DSS social workers, educators, as well as providers in face-to-face conversations, telephone and email contact. FAN is a best practice program model utilizing evidence based curricula with clients and has a lengthy history serving Orange County families. dd)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. All programs are year-round, established community programs. The PBCN Program Coordinator screens clients for eligibility within 24-48 hours of initial client contact. After eligibility is determined and a clinical intake is accomplished, the Program Coordinator matches the client with a therapist within 1-2 weeks or sooner. Once the client is matched with a therapist, the therapist and client determine the frequency and schedule of the 8 free counseling sessions. Compeer volunteers make a minimum of a one-year commitment to meet weekly for at least one hour with their Compeer friend. Volunteers also complete a monthly report. Each year, Compeer friends, volunteers, referring mental health professionals, and Compeer staff complete the Compeer Inc. Annual Survey. When parent-advocate contact is initiated either by a parent contacting the FAN program as a self-referral or through one of the other referral sources, a FAN Advocate conducts an assessment to determine the need. While many parents need intensive case management-like assistance over a period of months, an even greater number of parents need short-term help with family problem-solving, which can be accomplished via FAN's family consultation services. ee)Describe the community need or problem to be addressed in relation to the Chapel Hill Human Services Needs Assessment, Orange County BOCC Goals and Priorities, Town of Chapel Hill Council Goals, Carrboro goals, or other community priorities (i.e. Council/Board Goals). Reference local data (using the provided links, i.e. Chapel Hill Human Services Needs Assessment)to support the need for this program. The Affordable Care Act has improved access to mental health services for many; however, since Medicaid was not expanded in NC, a large proportion of people remain uninsured and without access to these services. Or, if they have some health DO NOT SUBMIT THIS PAGE 1/31/2017 11:11:58 AM Page 29 of DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION insurance, the co-pay or deductible amount, coupled with their income, prevents them from seeking mental health care. Understanding of the challenges Orange County residents who suffer from mental illness and/or substance use disorder, the Orange County Board of Commissioners established this goal as their top priority in 2016: Ensure a community network of basic human services and infrastructure that maintains, protects and promotes the well-being of all county residents. This goal specifically notes mental health as an area of focus. ff) Who is your target population of individuals to benefit from this program and how will they be identified and connected with the program? Compeer clients with severe and persistent mental illnees are referred by their mental health professional from organizations like UNC XDS/STEP Clinic/Oasis, and other therapists/psychiatrists in the community. Pro Bono clients who are uninsured or underinsured and who seek counseling for mental health contact Freedom House to paired with a volunteer therapist. Families of school-age children who have a behavioral health care need contact FAN directly for resources. gg)Describe the credentials of the program manager and other key staff. (Ex. Identify Program Manager and credentials, describe training provided to volunteers, etc.) • Program Director: Shelley Danser, LCSW • Outpatient Services Director, Carol McClelland, MA, LPC, LPCS, LCAS, CCS • Clinical Director: Heather Griffin-Dolciney, LCSW, LCAS • Medical Director: Duncan McEwen, MD • Executive Director: Trish Hussey, MA hh)Describe the specific period over which the activities will be carried out and include an implementation timeline. These programs are well-established, ongoing year-round programs on which the community depends. ii) Why is funding this program a good investment for the community? How does funding this program add value to the community? (250 words OR LESS) We are one of the few agencies that continue to provide services to homeless, uninsured and indigent clients. Community investment in behavioral health care, especially for those who are underserved, not only positively impacts the individuals and families themselves, but also impacts the community. For example, For instance, for every $1 spent on addiction treatment, the community saves $7 in criminal justice costs and $12 in related health-care costs (Alcohol and Drug Council). jj) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. The number of individuals served would be negatively impacted by a reduction in or absence of funding. DO NOT SUBMIT THIS PAGE 1/31/2017 11:11:58 AM Page 30 of 7 DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION kk) Include any other pertinent information. The Compeer Program is included in the National Registry of Evidence-Based Programs and Practices, a program of SAMHSA (Substance Abuse and Mental Health Services Administration), and is recognized by the American Psychological Association as a best-practices model. DO NOT SUBMIT THIS PAGE 1/31/2017 11:11:58 AM Page 31 of 3 DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Additional Program Information II) Target Population Complete the following tables, with numbers (not percentages) of individuals served and to be served, to the best of your ability, I Program Target Population Demographics Actual Estimated Projected 2015-16 2016-17 2017-18 Gender Male 225 257 259 Female 223 251 253 Total 448 508 512 Ethnicity African-American 96 114 116 American Indian or Alaska Native 0 Asian 7 8 8 Caucasian 315 353 354 Native Hawaiian or other Pacific Islander 0 Other: specify bi or multiracial 30 33 33 Total 448 508 512 Of the above, how many Hispanic/Latino 139 158 159 Of the above, how many non-Hispanic/Latino 309 350 353 Total 448 508 512 Age 0-5 years 6-18 years 57 66 67 19-50 years 279 313 315 51+ years 112 129 130 Total 448 508 512 Geographic Location Alamance County Chatham County Durham County 130 150 150 Wake County Orange County Breakdown Chapel Hill Public Housing 10 Town of Chapel Hill (Non-Public Housing) 128 141 133 Town of Carrboro 51 56 57 Town of Hillsborough 56 City of Mebane(Orange County) 6 Orange County(Outside Municipalities) 139 161 100 Other Total 448 508 512 DO NOT SUBMIT THIS PAGE 1/31/2017 11:11:58 AM Page 32 of DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Work Statement mm) Complete the Work Statement Chart to describe the work to be performed. This chart 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. Every program is required to have AT LEAST 1 Program Activity, which should be SMART (Specific, Measurable, Achievable, Relevant, and Time- bound. Click on SMART Goals to learn more. • Program Activities should outline major activities the agency implements to accomplish its program goals. (i.e. Deliver meals to elderly/disabled residents.) • Program Goal should explain what the program is trying to achieve/accomplish. Goals are statements about what the program should accomplish. (i.e. Deliver 100 meals per day, Monday-Friday.) • Performance Measures describe how you will evaluate the degree in which you achieved the stated goals. (i.e. Will track the number of meals delivered each day.) • Actual Program Results use program results to indicate the actual measureable achievement of goals. If goals were not met, please explain. (i.e. Delivered an average of 105 meals per day.) Work Statement Chart for Program: Community Mental Health Programs 7. Program Activity Name PBCN staff will develop and maintain a sufficiently large network of volunteer licensed mental health providers, screen and assess callers and match callers with an appropriate provider for treatment. Program Goal Uninsured or underinsured Orange County residents will experience improvement in their mental health symptoms as a result of receiving 8 free psychotherapy sessions from a volunteer PBCN therapist. Performance Measures PBCN volunteer therapists provide feedback regarding the number of sessions attended, current outcome/status of each case and availability for additional PBCN referrals. Previous Year Program Results 100 individuals received 8 free counseling sessions from a licensed mental health professional, resulting in 800 hours of volunteer treatment, for an equivalent of $80,000 in cost. Current Year Estimated Results 115 individuals received 8 free counseling sessions from a licensed mental health professional, resulting in 920 hours of volunteer treatment, for an equivalent of $92,000 in cost. Next Year Projected Results 117 individuals received 8 free counseling sessions from a licensed mental health professional, resulting in 936 hours of volunteer treatment, for an equivalent of $93,600 in cost. 8. Program Activity Name PBCN staff conduct a clinical evaluation of the client's DO NOT SUBMIT THIS PAGE 1/31/2017 11:11:58 AM Page 33 of 37 DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION needs. Based on this intake interview, PBCN staff identifies an available volunteer therapist who specializes in treatment modalities that best match the client's needs. Program Goal 75% of clients will have improved mental health status and functioning during and/or at completion of PBCN services, as reported by PBCN therapists. Performance Measures PBCN volunteer therapists provide information regarding whether their client experienced improved mental health status and functioning during and/or at completion of services. Previous Year Program Results Of the therapists who respond to the request to complete the report forms, 75% of clients experienced improved mental health status and functioning. Current Year Estimated Results Of the therapists who respond to the request to complete the report forms, 75% of clients experienced improved mental health status and functioning. Next Year Projected Results Of the therapists who respond to the request to complete the report forms, 75% of clients experienced improved mental health status and functioning. 9. Program Activity Name Compeer staff promotes the program with therapists, coordinates and facilitates match meetings and supports both the Compeer friends and volunteers as needed throughout the course of the relationship. Program Goal 75% of individuals living with severe and persistent mental illness referred to Compeer will be matched with a trained volunteer for weekly social activities. Performance Measures The number of current, new and terminated Compeer matches on a monthly basis; monthly records of volunteer hours and activities. Previous Year Program Results Of the 23 matched Compeer friends and volunteers, 60% remained engaged in weekly social outings leading to improved socialization skills, reduced isolation and reduced frequency of noncompliance with treatment. The program hosted 2 cook-outs with social activities for compeer friends and volunteers. Current Year Estimated Results Of the 28 matched Compeer friends and volunteers, 65% remained engaged in weekly social outings leading to improved socialization skills, reduced isolation and reduced frequency of noncompliance with treatment. The program hosted 2 cook-outs with social activities for compeer friends and volunteers. Next Year Projected Results Of the 28 matched Compeer friends and volunteers, 65% remained engaged in weekly social outings leading to improved socialization skills, reduced isolation and reduced frequency of noncompliance with treatment. The program hosted 2 cook-outs with social activities for compeer friends and volunteers. DO NOT SUBMIT THIS PAGE 1/31/2017 11:11:58 AM Page 34 of DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION 10. Program Activity Name Parenting Skills Classes: FAN advocated will provide small group parenting classes in English and Spanish. Program Goal Improve parent/child relationship; improve parents' skills to handle problem behaviors with positive and effective strategies; improve parent effectiveness to prevent removal of children and/or enable reunification. Performance Measures At 80% of parents of children living with a mental health condition, co-occurring mental illness or substance use disorder who complete the classes will report increased competencies in the areas of (1) reducing child's problem behavior; (2) improved family relationships; (3) conflict resolution; (4) coping skills. Previous Year Program Results 6 class series provided; 30 parents to complete. 90% of parents reported competencies in target areas. Current Year Estimated Results 11 class series provided; 55 parents to complete. 80% of parents reported competencies in target areas. Next Year Projected Results 12 class series provided; 64 parents to complete. 80% of parents reported competencies in target areas. 5.Program Activity Name Fan Consultations and Referrals. Advocated will provide support, advocacy and information/referral assistance for parents who call for help with services for their child. Advocates will spend 1-4 hours on one or more phone calls or 1:1 meetings to identify needs, services, navigation assistance, supporting and coaching parents on how to advocate for their child and services. Program Goal Improve access to services for children with mental health needs; improve parents' ability to advocate effectively and secure needed services for their children. Performance Measures Parent reports of satisfaction with information and referral assistance; feedback from parents and community agencies re: effectiveness of parent advocacy to obtain needed services. Previous Year Program Results Consultations and referrals provided to 225 families. Current Year Estimated Results Consultations and referrals provided to an estimated 255 families. Next Year Projected Results Consultations and referrals provided to an estimated 260 families. 6.Program Activity Name Compeer staff recruit, train and match volunteers, monitor progress and offer ongoing support to both volunteers and friends. Program Goal 95% of participants will report that his/her Compeer friend has had a positive impact on their lives and 75% will show improved management of their illness demonstrated by reduction in need for hospitalization and/or crisis services. DO NOT SUBMIT THIS PAGE 1/31/2017 11:11:58 AM Page 35 of 3 DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Performance Measures Results from the Compeer Inc. Annual Survey to gain information about program services, satisfaction, improved well-being and populations served. Previous Year Program Results Actual results tabulated by Compeer Inc. demonstrated positive outcomes on scales associated with increased social functioning, self-esteem, and reduced isolation at rates equal to or greater than those in 2015. Current Year Estimated Results Actual results tabulated by Compeer Inc. demonstrated positive outcomes on scales associated with increased social functioning, self-esteem, and reduced isolation at rates equal to or greater than those in 2016. Next Year Projected Results Actual results tabulated by Compeer Inc. demonstrated positive outcomes on scales associated with increased social functioning, self-esteem, and reduced isolation at rates equal to or greater than those in 2017. DO NOT SUBMIT THIS PAGE 1/31/2017 11:11:58 AM Page 36 of 3 DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Program Budget 9. Submit your program budget. You may complete the provided template (separate xls file) or you may submit your own budget file (as long as it contains the same information, in the same format, as requested in the provided template). Program Budgets are required to define budget amounts for the previous program year, current program year, and next program year for the following categories: • Revenues O Private Donations O Program Generated Revenue O Local Government Grants • Carrboro Human Services • Carrboro Other • Chapel Hill Human Services • Chapel Hill Other(DO NOT include CDBG funding here) • Orange County Human Services • Orange County Other(DO NOT Include HOME funding here) O Other Government Grants • Triangle United Way • State Government • Federal Government (CDBG/HOME/etc.) • Private Foundation Grants O Other Revenue • Expenditures O Compensation O Rent & Utilities O Supplies & Equipment O Travel &Training O Other Expenses 10. Program Budget Detail — Provide description of"other" budget items, not defined. 11. This program budget represents what percent of the agency budget? 1.7% 12. COST PER INDIVIDUAL This Cost per Individual must reflect the total program budget divided by the total number of program individuals in this application. Acts 01516 Estimated 2!01617 Projected 01 '-18 Total Cost of Program $187,199 $202,276 $196,900 Total # of Individuals 448 508 512 Cost Per Individual $417.85 $398.18 $384.57 DO NOT SUBMIT THIS PAGE 1/31/2017 1:06:25 PM Pacie 37 of DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT A PROVIDER'S OUTSIDE AGENCY APPLICATION Program Budget Operating Budget for Program PROGRAM NAME Community Mental Health Programs(PBCN, Compeer, FAN) Actual Estimated Projected Percent PROGRAM REVENUE 2015-16 2016-17 2017-18 Change Private Donations $ 2,547 $ 1,000 $ 20,000 1900% Program Generated Revenue $ 1,157 $ 2,200 $ 3,000 36% Local Government Grants: Human Services-Town of Carrboro $ 5,700 $ '5,700 $ 5,700 0% Other-Town of Carrboro - 0 Human Services-Town of Chapel Hill $ 5,500 $ 6,000 $ 6,000 0% Other-Town of Chapel Hill - 0 Human Services-Orange County $ 59,719 $ 57,939 $ 58,000 0% Other-Orange County Durham County $ 22,000 $ 23,588 $ 23,588 Durham County JCPC $ 14,000 $ 15,166 $ 14,000 -8% Other Government Grants Triangle United Way 0 State Government 0 Federal Government(CDBG/HOME/etc.) 0 Private Foundation Grants $ 25,000.00 $ 1.00 Other Revenue: Cardinal Innovations $ 79,600 $ 66,508 $ 67,000 $ 0.01 Total Program Revenue $ 190,223 $ 203,101 $ 197,288 -3% PROGRAM EXPENSES Compensation $ 153,410 $ 190,164 $ 185,000 -3% Rent&Utilities $ 6,967 $ 1,375 $ 1,400 2% Supplies&Equipment $ 10,670 $ 1,875 $ 2,000 7% Travel&Training $ 3,292 $ 1,500 $ 2,000 33% Other Expenses:Contractual Services, $ 12,860 $ 7,362 $ 6,500 -12% Insurance, Dues,Bank,Advertising IMOMINININIEMIMMINIMMEIMINE Total Program Expenses $ 187,199 $ 202,276 $ 196,900, -3% SURPLUS/(DEFICIT) FOR PERIOD: 1 $ 3,024 ( $ 825 1 $ 388 I -53%1 DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB EXHIBIT`B" Scope of Services—FY 2017-18 Outside Agency Performance Agreement Agency Name: Freedom House Recovery Center Program Name: Urgent Behavioral Health Care(Crisis and Detox), Halfway Housing and Community Mental Health Programs Funding Award: $36,000 Outline how the agency will spend Orange County's funding award. Expense Description Amount Personnel-Salaries $26,280 Personnel—FICA and Fringe $1,980 Travel/Mileage $900 Office Supplies $1,080 Program Supplies $5,760 Total $36,000 Program Services Outline the critical services(activities)the agency will employ to attain the Anticipated Outcomes below,by June 30,2018. • Freedom House Recovery Center promotes recovery and breaks the cycle of poverty, addiction and illness by providing the first step toward wellness and recovery for people in crisis in our Facility-Based Crisis and Detox Center in Chapel Hill and by providing long-term, residential care and treatment in our 22 bed halfway houses for men and women aged 18 and older in Chapel Hill. • Urgent Behavioral Health Care (Crisis & Detox Services): provide critical assessment and immediate treatment and planning services in strong response to the crises events in the lives of individuals suffering from mental illness and/or addiction with the goal of ensuring clients move to the appropriate next level of care, and diverting the number of referred clients from local emergency departments. • Chapel Hill Halfway Houses: provide long-term (3-6 months)recovery and community support services to men and women in need of addiction and recovery treatment in order to break the cycle of addicted behavior. We will collaborate with community stakeholders to identify referrals to maintain a high bed utilization rate and work with clients to develop a Personal Treatment Plan with the goal of self-sufficeny, including housing and employment, and sobriety. • Community Programs: The Pro Bono Counseling Network(PBCN)provides free mental health counseling services to individuals in need, regardless of their ability to pay, via a network of licensed, volunteer therapists. The Compeer Program addresses stigma, isolation, and loneliness of mental illness through the power of companionship. Trained volunteers commit a minimum of one hour per week for one year to a Compeer "friend" who lives with a mental health condition, typically someone with a severe and persistent mental illness (SPMI) such as Schizophrenia or Bipolar Disorder. Family Advocacy Network offers one-on-one and group support, advocacpx,narreireing skills training, and community resources to parents who are children with emotio,iahor efviOral issues. ,-- 1 SSt tI t 8/31/2017 I e B219CR785471 CEO Certified by Title: Date: f 2 21,17 - (Provider's Signat DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB 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 #of clients served in Urgent Behavioral Health Care(crisis and detox) 3,429 %of clients in Urgent Beheavioral Health Care who receive treatment and discharge 100% planning to appropriate next level of care. (3,429) %of referrred clients diverted from local hospital emergency rooms 96% (3,293) #of clients served in Halfway Houses 110 %of clients who successfully graduated from program 77% (85) Utilization rate(%)of Halfway Houses 98% (358) %of clients who secured housing upon discharge 65% (72) #of individuals who received 8 free counseling sessions from a licensed mental health 117 professional(Pro Bono Counseling Network) Of therapists reporting, %of clients experienced improved mental health status and 75% functioning. (88) #of Compeer friends and volunteers matched 28 %who remained engaged in weekly social outings. 65% (18) #Family Advocacy Network Common Sense Parenting class series provided 12 #of parents completed parenting classes 64 %of parents reported competencies in target areas 80% (51) -----DocuSigned by: T'vis&. t1ss01 -9A5B219CD785471 8/31/2017 CEO c• Certified e-. Title: EL r Date: � � (Provider's Si:r i re DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB ATTACHMENT "A" Orange County Certifications—FY 2017-18 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. AS DocuuSignneed by: t'v s&. Ck Al 8/31/2017 Certified by: BA5B219CD785471 Title: CEO Date: (Provider's Signature) (Freedom House Recovery Center,Inc.) Orange County Outside Agency Performance Agreement Page 10 of 10 Rev. 7/17 DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB AC CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) �••�' 7/10/2017 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 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 NAME: Crystal Ireland Business Insurers of Carolinas PHONE (919)968-4611 FAX (919)968-8991 (AfC.No.Ext): (A/C,No): 800 Eastowne Drive, Suite 208 EMAIL ADDRESS:cireland @business-insurers.com PO Box 2536 INSURER(S)AFFORDING COVERAGE NAIC# Chapel Hill NC 27515-2536 INsuRERARiverport- Berkley National Ins Co INSURED INSURER B:United Wisconsin Insurance Company 29157 Freedom House Recovery Center, Inc INSURERC: 104 New Stateside Drive INSURERD: INSURER E: Chapel hill NC 27516 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1771019046 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 TYPE OF INSURANCE ADD,SUBR POLICY EFF POLICY EXP POLICY NUMBER ,JMM/DD/YYYY)_(MM/DD/YYYYL LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE _ $ 1,000,000_ DAMAGE TO RENTED A III ,CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ 1,000,000 nProfessional Liability X 8527338-10 7/1/2017 7/1/2018 MEDEXP(Anyoneperson) $ 20,000 Sexual & Physical Abuse PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 Ell PRO POLICY JEI 1- 1 LOC PRODUCTS-COMP/OPAGG $ 3,000,000 OTHER: $ - AUTOMOBILE LIABILITY O aBINEDtSINGLE LIMIT $ 1,000,000 A X ANY AUTO 1 BODILY INJURY(Per person) ,$ ALL OWNED SCHEDULED AUTOS AUTOS X 8527338-10 7/1/2017 7/1/2018 BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS $X AUTOS (Per accident) Medicalpayments $ 5,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESSLIAB 1 CLAIMS-MADE AGGREGATE $ 1,000,000 DED (RETENTIONS 18527338-10 7/1/2017 v 7/1/2018 , $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N X STATUTE X ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ S00,000 B (Mandatory in EXCLUDED? Y N/A 0400158723 5/16/2017 5/16/2018 ( ) E.L.DISEASE-EA EMPLOYEE $ 500,000 DESs,RIPTIOeunder E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below A Employee Dishonesty 8527338-10 7/1/2017 7/1/2018 LIMIT 25,000 DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Orange County is also an additional insured with respect to General Liability and Automobile Liability, required by written contract. Forms attached. CERTIFICATE HOLDER CANCELLATION achambers@orangecountync.g SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Orange County THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 8181 ACCORDANCE WITH THE POLICY PROVISIONS. Hillsborough, NC 27278 , AUTHORIZED REPRESENTATIVE J Chappell/IREL01 ---- - ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(2614011