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Home My WebLink About2018-518-E DSS - Exchange Club Family Center outside agency agreementDocuSign Envelope ID: 2F546B53- F2D1- 407D- A1C7- 26EB823DOFFD OUTSIDE AGENCY PERFORMANCE AGREEMENT THIS AGREEMENT, made and entered into the first day of July 2018, ( "Effective Date ") by and between the County of Grange, a political subdivision of the State of North Carolina, 200 South Cameron Street, Hillsborough, North Carolina, 27278, ( "County ") and The Exchange Club's Family Center in Alamance County, a not - for -profit corporation, located at 200 N. Main Street, Graham, NC 27253 ( "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 Provider agree as follows: 1. Term of the Agreement. The term of this Agreement shall be a program year beginning July 1, 2018 to June 30, 2019. 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 trust be approved in writing by the County and attached to this Agreement as.Exhibit B. b. The Provider shall be solely responsible for the means, methods, techniques, sequence, safety program and procedures necessary to properly and fully complete the work set forth in the Scope of Services. 3. Funding. a. The County agrees to appropriate for the provision of services described in Exhibit A, Scope of Services and more particularly described in the Revised Program Budget, the maximum sum of $13,464.00. b. All funds appropriated shall be used for purposes described in Exhibit A. Any funds not used for the purposes stated shall be returned to the County. Any changes in the use of funds must be authorized in writing by the County prior to any expenditure of the funds by the Provider. If the funds are expended not in accordance with the Scope of Services, at the discretion of the County the Provider may be required to repay the funds to the County. c. The Provider shall be paid in four equal installments in the amount of $3,366.00. 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. The Exchange Club's Family Center in Alamance County Grange County Outside Agency Performance Agreement Revised 712018 Page I of 9 DocuSign Envelope ID: 2F546B53- F2D1- 407D- A1C7- 26EB823DOFFD 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. £ 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 11, April 15, and July 8 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. The Exchange Clubs Family Center in Alamance County Orange County Outside Agency Performance Agreement Page Z of 9 Rev. 7118 DocuSign Envelope ID: 2F546B53- F2D1- 407D- A1C7- 26EB823DOFFD 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. • Commercial General Liability • Automobile Liability • Professional Liability Limits for Coverage A - Statutory State NC & Coverage B - Employers Liability $500,000 each accident, disease policy limit and disease each employee $1,000,000 Each Occurrence $2,000,000 Aggregate $500,000 Combined Single Limit $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. The Exchange Club's Family Center in tllamance County Orange County Outside Agency Performance Agreement Page 3 of 9 Rev. 7118 DocuSign Envelope ID: 2F546B53- F2D1- 407D- A1C7- 26EB823DOFFD 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. S. 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 $ 14.25 per hour. To the extent possible, Orange County recommends that Provider 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: County: Department of Social Services Provider: The Exchange Club's Family The Exchange Club's Family Center in Alamance County Orange County Outside Agency Performance Agreement Page 4 of 9 Rev. 7118 DocuSign Envelope ID: 2F546B53- F2D1- 407D- A1C7- 26EB823DOFFD Orange County Post Office Box 8181 Hillsborough, NC 27278 Center in Alamance County 200 N. Main Street Graham, NC 27253 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. a. Governing Law. This Agreement and the duties, responsibilities, obligations and rights of respective parties hereunder shall be governed by the laws of the State of North Carolina. By executing this Agreement Provider affirms that Provider and any subcontractors of Provider are and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. By executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the services of any agent or subcontractor, on the list created by the State Treasurer pursuant to G.S. 147- 86.58. 18. Signatures. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the intent of the Parties to comply with Article I IA 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. EUocu Signed by: _ �rQftfjQ Provider SMDKEMB899412 Sarah Black, Executive Director r -- -- J L -I- Docu5ignLdby, by, County y Government 86a7994B755E477... Honme Hammersley, County Manager The Exchange Club's Family Center in Alamance County Orange County Outside Agency Performance Agreement Rev. 7118 8/29/2018 Date 8/30/2018 Date Page 5 of 9 DocuSign Envelope ID: 2F546B53- F2D1- 407D- A1C7- 26EB823DOFFD Exhibit A Provider's Outside Agency Application The Exchange Club's Family Center in Alamance County Orange County Outside Agency Performance Agreement Page 7 of 9 Rev. 7118 DocuSign Envelope ID: 2F546B53- F2D1- 407D- A1C7- 26EB823DOFFD I. COVER PAGE a) Applicant Contact Information Applicant Organization's Legal Name: The Exchange Club's Family Center in Alamance Conn Applicant Organization's Physical Address: 200 N. Main Street Graham NC 27253 Applicant Organization's Mailing Address: 240 N. Main Street Graham NC 27253 Applicant Organization's Web Address: www. facebook. com /familycenter!nAlamance0ranaee Executive Director: Sarah E.G. Black, MA, MFT Telephone Number: 336- 227 -5601 E -Mail: sarahblack348@gmail.com Tax ID Number: 56- 2227006 b) Funding Request List all FY18 -19 Human Services IiHS) Funding Being Requested — For All Pry rams and the Proposed Use of Funds (2 -3 lines or less) Program Carr brv,.: Cf�ap@I Cranae Total Count -14 Ex: Yvut AfterStfilol SRO 4500 $3o,000 , P'ta1il4 rl Parent Aide Program: salary and benefits of program $2,700 : $20,000 $20,00 $42,700 staff, mileage, supplies/ client emergency funds, rentlutilitieslo pe rations. Children's Parents Parenting Classes: salary and $2,390 $2,390 $4,780 benefits of facilitator, mileage, program/office supplies. ' v Totals $2,700 $22,390 $22,390 $47,480 c) To the best of my knowledge and belief all information and data in this application is true and current. The document has been duly authorized by the governing board of the applicant. Signature:[) t Executive Director - Date Signature: yard Chairperson Date AGENCY INFORMATION 1122/2018 10:50:53 AM Page 7 of 29 DocuSign Envelope ID: 2F546B53- F2D1- 407D- A1C7- 26EB823DOFFD 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 0■ ® a) Employees of or closely related to employees of the Town of Carrboro, the Town of Chapel Hill, or Orange County? El Z 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? C Z cj Current beneficiaries of the program for which funds are being requested? El Z d) Paid providers of goads 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 ail respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended and the Grange 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. 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. Signature: Signature: u �W L! J'Z_ E utive Direct Date I -I, a card Chairperson Date _.._.... �..._._..__......._ ......_...... -. _ ............_......_._.._ .., .. _.__._..._.. - — - ........ __................ _......_.... AGENCY INFORMATION 1122/2018 11:03:58 AM Page S of 29 DocuSign Envelope ID: 2F546B53- F2D1- 407D- A1C7- 26EB823DOFFD 1 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 (MonthlYear): 0112000 The Exchange Club's: Family Center in Alamance County (Family Center in Alamance) began as a satellite center of the Exchange Club's Family Center of Durham in 1997 and began taking, steps to operate as an independent center in 2000 when they obtained their tax exemption 501 c3 status. A year later, the Family Center in Alamance came under the umbrella of Exchange Club Centerforthe Prevention of Child Abuse of North Carolina, ce Inc. in order to grew and establish funding towards independence. Both agencies a a part of a national network of Child Abuse Prevention Centers sponsored by local f Exchange Clubs, b) Agency's Purpose /Mission (no more than a few sentences): The agency's mission is the prevention and treatment of child abuse and neglect. This mission is implemented by enhancing parent child relationships, increasing community awareness, and increasing community involvement in prevention efforts. The center currently offers 8 evidence -based or evidence - informed programs and a 24 -hour crisis line in 7 counties in the triangleltriad area (Alamance, Orange, Chatham, Person, Caswell, Guilford, and Randolph). c) Types of Services the Agency Provides (bullet format): The Family Center has 8 prevention and treatment programs currently offered to families which include: • Intensive Family Preservation Services: evidence -based counseling services to prevent out of home placement of children in child welfare, mental health, and juvenile justice systems. ■ Parent Aide Program: evidence -based in -home visitation program. • Children's Parents Parenting Classes: promising practice program. • Adolescent Parenting Program: in-home/comm unity visitation services for adolescent parents and their children, • Respite Services: temporary child care placements for families at -risk. • Parent/Teen Solutions: parenting classes for at -risk teens and their parents, • Adolescent Parent Support Program: in-home/community intensive visitation services for at-risk adolescent parents. • Juvenile Mentoring Services: in- homelcommunity mentoring program for at -risk youth. • Triple P Positive Parenting Program and Safe Care Services, evidence - based curriculums, are offered in the context of some of our in -home programming. • 24 -hour crisis line and Community Awareness Presentations. d) Agency's History with Providing These Services: The Family Center has 20 years of experience in administering grant funds and providing successful child abuse prevention services in the community, The agency has been offering Parent Aide services in Alamance County for 20 years, in Orange County for 10 years, and expanded into Caswell County in 2016. The Family Center was a part of the original randomized trial clinical study that helped to achieve the program's evidence -based status. In 2012, the Family Center further enhanced Parent Aide services outcomes by infusing the evidence- informed Triple P, Positive Parenting Program- Level 3 Primary Care, into programming. The agency was able to acid an additional evidence - informed curriculum for 0 -5 populations in 2015 called Safe Care. Both curriculums have enhanced services and increased positive outcomes. The staff at the agency are versed in the complexity of child abuse prevention and has decades of experience with in -home visitation and parenting education. The agency also Agency Information 1/22/2018 12 :44:38 PM Page 9 of 27 DocuSign Envelope ID: 2F546B53- F2D1- 407D- A1C7- 26EB823DOFFD e) operates within a System of Care framework and collaborates on many levels with various community non - profits, for profits, social service agencies, and businesses. Agency staff sit on several committees, councils, and collaborative efforts. 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?) Over the years the Exchange Club's Family Center in Alamance has tripled in size and in budget since 2001 and therefore the Board of Directors of the Exchange Club's Family Center in Alamance County and the Exchange Club Center- for the i Prevention of Child Abuse of North Carolina, Inc. worked to transition the center once again to a stand -alone center status. The Exchange Club's Family Center in Alamance was able to successfully reinstate their 501c3 status in July 2016 and has begun operations on the reinstated tax status. The transition will be complete at the end of the 2017 -2018 contract year on June 30, 2018. Sarah Black who has been the Family Center's County Director since 2006 will continue on as the Executive Director of the stand -alone Exchange Club's Family Center in Alamance County. f) Schedule of Positions (For Entire Agency) • Lull 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: 8 # of FTE - Paid Part -Time Positions: 3 # of Volunteers.-.14 # of FTE - Volunteers:2 g) Luring Wage Does this agency pay permanent employees a minimum living wade? (Yes/ No) Yes If yes, is this agency an Orange County Living Wage Certified Employe '? No If no, please explain. The agency hasn't been through the certification process but plans to in the next contract year after the transition to stand -alone center is completed. Agency Information 1/22/2018 12:44:36 PM Page 10 of 27 DocuSign Envelope ID: 2F546B53- F2D1- 407D- A1C7- 26EB823DOFFD 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? (YeslNoj No If yes, please list below: Include all programs that have funding requestslawardsltotals from Carrboro Chapel hill and Orange County governments (other than Human Services). DO NOT include federal funding sources, such as CDBG and HOME. Program FY17 -18 Award FY18 -19 quest Source Ex:- Afordable Rental �R erabilitation: - 1pr, $20,]Dfl 9` Carrboro;.. Afordab~ Housing i Ex; Agengy Admir�istrabon ;Q0[}' $1,5 QQCI Garrboro - Other, ExvTotal' ' $15; Lift $35 -000 - :Carrboro Total Funding , i i i I I ! -Aaa rows or anacn aacitlonai page, a needed. iii. Submit your agency's budget. You may complete the provided template (separate x[s 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 neat program year for the following categories: • Revenues c Private Donations a Program Generated Revenue v Local Government Grants ■ Carrboro human Services • Carrboro Other ■ Chapel Hill Human Services ■ Chapel Hill Other (DO NOT include CDBG funding here) Agency Information 1/22/2018 12:44:365 PM Page 'I I of 27 DocuSign Envelope ID: 2F546B53- F2D1- 407D- A1C7- 26EB823DOFFD Orange County Human Services Orange County Other (DO NOT Include HOME funding here) o Other Government Grants ■ Triangle United Way ■ State Government ■ Federal Government (CDBGIHOMEIetc.) ■ Private Foundation Grants o Other Revenue • Expenditures • Compensation • Rent & Utilities • Supplies & Equipment • Travel & Training • Other Expenses iii, Does your agency budget show a Surplus or Deficit? No Is there a significant change? Yes/No Yes Increase funding in current treatment programming contracts from NCDHHS has led to an overall increased budget in 2017 -18 and will continue in 2018 -19. In addition, anticipatory grants in 2018 -19 will also increase next year's budget if awarded successfully. iv. What is your agency's fiscal year? JMI 1 2017 -June 30. 2018 (Example. July 1, 2016 through June 30, 2017) Agency Information 1122(2018 12.44:36 PM Page 12 of 27 DocuSign Envelope ID: 2F546B53- F2D1- 407D- A1C7- 26EB823DOFFD AGENCY DAME: Agency Budget Operating Budget for Entire Agency The Club's Family Center in Alamance iAGENCY REVENUE Private Donations Agency Generated Revenue (fees) Local Government Grants; Human Services - Town of Carrhoro Other - Town of Carrhorc Human Services Town of chapel Hil Other - Town of Chapel Hil Human Services - Change County Other- Orange County Other -- Town of Hillsborough Other Government Grants Triangle United Way State Government Federal Government (CDBGIHOME /eta) Private Foundation Grants Other Revenue ,Total Agency Revenue AGENCY EXPENSES Compensation Rent ,& Utilities Supplies $ Equipment Travel & Training Other Expenses: Total Agency EXpenses 1i e; ._xW. SURPLUS!(DEFICIT) FOR PERIOD: FY 2018-19 Agency Budget ActiMl r, 'fl16 =,'lf E tiinated .; ;2[F17 7$ PepJected 2018.19. -Percent Change $ 5,000 $ 1,500 $ 5,000 233', $ 87 $ - $ - $ 2,000 $ 2,060 $ 2,700 35 $ 10,350 $ 10,350 $ 22,390 116 $ 6,175 $ 9,638 $ 22,390 132° $ _ $ $ $ - $ $ - $ - $ - $ 369_,807.39 $ 498,104.481 $ 742 304.00 $ - $ - $ - $ 79,872.160 $ 59,904.00 $ - $ 1,000 $ 17,655 $ 2,000 1 $ 0.8 } $ $ 474,291 364,984 $ $ 599,951 462,066 $ $ 796,784 612,973 330 33° $ 25,362 $ 30,478 $ 31,000 2° $ 16,516 $ 9,689 $ 19,775 1040 $ 34,170 $ 30,809 $ 43,224 40° $ 41,994 $ 66,110 $ 89,812 36° 483,027 `$;.599,152 $ 796,784 33° $- (8,736) $ (0)] $ - '1000 DocuSign Envelope ID: 2F546B53- F2D1- 407D- A1C7- 26EB823DOFFD i 1 3. PROGRAM INFORMATION -(Submit a separate Section 3 for each oroaram) i I Program Name: Parent Aide Program Program Primary Contact and Title: Sarah E.G. Black Executive Director Telephone Number: 336- 227 -5601 E -Mail: sarahblack348 (@gmail.com a) indicate the type of Human Service Needs Priority, if program applicable: ® Priority Area #9: safety -net services for disadvantaged residents ® Priority Area #Z: education, mentorship, and afterschool programming for youth facing a variety of challenges 0 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) Program Category ,Adplt : Elderly ;Disabled Public Housing Neighborhoods /Residen Affordable Housing Affordable Healthcare Education Family Resources X X X X X Jobs /,fobs Training X X X Food Transportation, X X X X Other: Parenting support X X X X c) Provide a bulleted list of other agencies, if any, with which your agency I coordinates /collaborates to accomplish or enhance the Projected Results in the Program(s) to be funded. For each, briefly describe the coordinated /collaborative efforts. i • Department of Social Services and Department of Health: referrals, governmental services. Agency has a Memorandum of Agreement with Orange County's Department of Social Services. I • Department of Juvenile Justice and Orange County Court System: referrals. • Orange County 1 Chapel Hill School System 1 UNC- Chapel Hill: referrals and interns. • Mental Health /Social Service Agencies/ Local Mental Health Entities: referrals and mental health services. • Exchange Clubs/Churches/Business: These entities assist the agency by providing monetary donations, concrete donations for items needed by families, and volunteers for serving families in Orange County_ PROGRAM INFORMATION 1/22/2018 12 :44:36 PM Page 13 of 27 DocuSign Envelope ID: 2F546B53- F2D1- 407D- A1C7- 26EB823DOFFD Program Description (3 pages OR LESS) Please provide the following information about the proposed program: d) Summarize the program services proposed and how the program will address a Town /County priority /goal? The Parent Aide program will provide home visitation services to families at -risk for and/or involved in child abuse and neglect. Families average 10 months in the program but services can last up to 18. Service activities include parent education, coaching, role modeling/ mentorship, assistance with concrete supports, job /education training, case management, advocacy, and assistance with transportation needs. The Parent Aide model is evidence -based and is currently listed on the California Evidence -Based Clearinghouse for Child Welfare's list as a Level 3 `Promising Research Evidence" status. The Parent Aide program provides services to many priority areas of concern for the community including: direct parent coaching and mentorship; child mentorship to address abuse and neglect dynamics; life skills/ money management skills and concrete supports which collectively increases access to safety -net services for families; transportation and other basic need issues (like food and housing); and increased positive health outcomes for families. Trauma histories have been proven over the last 30 years to lead to lower brain functioning, increased mental health issues, and increased physical health issues so addressing trauma means improving overall health (www.cdc.gov /ace /index.htm). e) Describe the community need or problem to be addressed in relation to the Chapel Hill Human Services Needs Assessment, grange County BOCC Goals and Priorities, Town of Chapel Hill Council Goals, Carrboro Board Priorities, or other community ,priorities (i.e. Council /Board Goals). Reference focal data (using the provided links, i_e. Chapel Hill Human Services Needs Assessment) to support the need for this program. Child abuse and neglect is a significant present problem in Orange County, From July 2016 to June 2017, there were 895 children reported for child abuse and /or neglect in Orange County (Duncan et al., 2018). Of the 895 children reported for abuse /neglect, 39.66 % of them were between the ages of 0 -5. As of December 2017 there were 91 children in foster care in the county (Duncan et. al, 2018). Children that end up in the foster care system often stay in the system longer than a year increasing the cost for taxpayers. From July 2016 to .tune 2017, 80.86 % of the children that were in the Orange County foster care system remained in the system for over a year (Duncan et. al, 2018). This child maltreatment data speaks to the need for population targeted intervention services in the County to address the issue of child abuse and neglect/trauma. The program will directly address these statistics by providing interventions to help families avoid new or repeat involvement with the child welfare system. The Chapel H111 Human Services Needs Assessment, Orange County BOCC Goals and Priorities, Town of Chapel Hill 2020 Council Goals, and Carrboro goals all have a common theme in their agendas; providing a safe and healthy community for their citizens. These council and county goals recognize that as much as basic needs (employment, housing, food, etc.) are important to the families of the county social detriments of health are also necessary to address in order to achieve healthy communities_ Child abuse and neglect in the community and the resulting trauma that it creates lead to unhealthy families that directly impact the achievement of the goals of the county. Goals such as "Nurturing Our Community", "Community Prosperity and Engagement" and foundational programs such as "Protect and Provide for a Safe Community' are impossible to achieve without PROGRAM INFORMATION 1122/2018 12:44.36 PM Page 14 of 27 DocuSign Envelope ID: 2F546B53- F2D1- 407D- A1C7- 26EB823DOFFD addressing the trauma risk factors of the community. Numerous individual, family, and community factors can contribute to abuse and neglect such as age, disability, mental health and substance abuse issues, poverty, low education, domestic violence, history of child abuse, and social isolation (Centers for Disease Control and Prevention, 2016). These risk factors are connected to town needs assessments and Grange County social values. Overall Orange County appears to have the following community concerns: insufficient basic needs; transportation, need for financial stability; mental illness /substance abuse rates and need for services; and community and family violence rates (Orange County Community Health Assessment, 2015; Orange County State of the County Health Report, 2016). Orange County has 12.8% of its people living in poverty according to the 2016 U.S. Census Bureau. The Small Area Income and Poverty Estimate [SAIPE] by the U.S. Census Bureau shows that Orange County has 11.4% of its youth living in poverty (2016). In Orange County, 9.8% of the population is Medicaid eligible (NC DHHS, Division of Medical Assistance [DMA], 2015)-Though Parent Aide services cannot wholly improve financial status, we will assist families with supports that will help to buffer the risk of abuse and neglect from factors relating to poverty. Domestic Violence brings a risk of trauma exposure to children in homes of the families experiencing this problem. In Orange County alone there were 1,742 domestic violence calls and 483 clients were provided with domestic violence services (North Carolina Council for Women, 2015 -16). Studies have found abused and neglected children to be at least 25 percent more likely to experience problems such as delinquency, teen ,pregnancy, low academic achievement, substance abuse, and mental illness (Kelley, Thornberry, & Smith, in U.S. DHHS Child Welfare Gateway, 2012). Delinquent crates in Orange County of youth 6 -15 is 5.39% (DPS County Databook, 2016). Many of these teens have extensive trauma histories contributing to these rates in the county. Parent Aide services address these risk factors directly in the home by providing concrete parenting education, case management, and advocacy to assist families in finding needed services to address mental health and substance abuse, and transportation assistance. f) Who is your target population of individuals to benefit from this program and how will they be identified and connected with the program? The target population of Parent Aide Program services includes 17 families in Orange County (8), Chapel Hill (8), and Carrboro (1) at risk of and/or involved in abuse and neglect. These families possess socioeconomic and cultural backgrounds that will match the diversity of the County (71 % white, 22.2% Black, 9.2% Hispanic/Latino, and 2.9% Asian per the 2016 US Census). Marketing to county referring sources (Dept. of Social Services, Dept. of Public Health, Schools, Non - profits, For- profits, businesses, mental health companies, churches, local mental health entity, etc.) will allow the agency to solicit referrals for families needing services. Self - referrals made by parents in the community will be solicited by general agency marketing efforts (social media, website, etc.). Beneficiaries are identified when the referral is received and the family agrees to services. Qualification for services (identified beneficiaries) will be determined by families that meet at least 3 risk factors on the risk scale. g) Describe the credentials of the program manager and other key staff. (Ex. Identify Program Manager and credentials, describe training provided to volunteers, etc.) The staff that will implement the program includes bachelor level professionals with experience in social work, counseling, or human services. Current staff have extensive training in child abuse and neglect, trauma, protective factors, substance abuse, mental PROGRAM INFORMATION 1/22/2018 12:44 :36 PM Page 15 of 27 DocuSign Envelope ID: 2F546B53- F2D1- 407D- A1C7- 26EB823DOFFD health, system of care, and are certified in evidence -based curriculums. All staff are provided both internal and external training opportunities to increase their capacity to effectively serve the client populations. Volunteers, or paraprofessionals can be used under the supervision of the Parent Aide Supervisor. Volunteer Parent Aides receive the same internal 12 hour training on Child Abuse and Neglect/ Parent Aide services that professional staff is given. Volunteers are also interviewed and reference /background checked to ensure safety of working with children. The current Program Supervisor, acts as the agency's Executive Director and has a Master's degree with 12 years of executive level management and administration experience, 13 years of programmatic administration and implementation, and over 17 years of clinical and service -delivery experience. h) Describe the specific period over which the activities will be carried out and include an implementation timeline. Implementation of programming will begin immediately as Parent Aide services already exist on a smaller scale in the county due to current funding levels. Home visits for programming occur weekly and last anywhere from 144 hours depending upon the risk level in the home. Services last from 6 to 18 months, with an average of 10 months. i) 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) Child abuse costs the nation $220 million every day (Prevent Child Abuse, Cost Data, 2012). Many societal problems have their roots in childhood trauma. Costs are hidden in the social service systems, healthcare costs, and poverty initiatives. This Parent Aide flexible approach allows families from different starting points to get their specific needs addressed affordably preventing duplication of funds being spent on one family in multiple systems. Children that grow up safe, nurtured, and with sufficient basic needs met will turn into successful productive citizens that contribute to society and the economy. The Parent Aide program is a very cost effective ($2700) competitive service for preventing child abuse and neglect. Most other interventions are short in duration (4 -8 weeks) and cost anywhere from $6,000-12,000 per family. J) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. If the full funding request was not allocated to the agency, the agency would reduce the number of clients served and apply for matching funds. k) What percentage of your target population is low- moderate income? Although services are open to everyone, and abuse /neglect is not just a lower socio- economic issue, referrals to our services tend to come in sources in such a way that 68% of families come from low - moderate income levels. l) What efforts do you make to seek feedback about your program from your target population (e.g. survey, evaluations, etc. ?) The agency has a Quality Improvement process that uses informal (feedback) and formal (satisfaction surveys) means to collect, analyze, and use data to inform program changes. This process occurs continually throughout the year. Client representation on agency committees are also a part of this process. m) Include any ether pertinent information. PROGRAM INFORMATION 1/2212018 12.44:36 PM Page 16 of 27 DocuSign Envelope ID: 2F546B53- F2D1- 407D- A1C7- 26EB823DOFFD Additional Program Information n) Target Population Complete the following tables, with numbers (not percentages) of individuals served and to be served, to the best of your ability, Gender: }. s Male Female Total Ethnicity . 1p „`' :..y',.tit(,,,c•.. {., African- American American Indian or Alaska Native Asian Caucasian Native Hawaiian or other Pacific Islander Other: specify Mixed Total Of the above, how many HispanictLatino Of the above, how many non- Hispanic/Latino Total rl,;Demographias Actual Estimated Projected 2016 -17 2017 -18 2018 -19 10 Families 11 ;~amilles 17PgnnWPs 1! 0 21 0 35 0 15 0 25 0 38 0 0 27 0 46 0 73 17 0 16 0 31 0 0 0 0 0 0 0 0 27 0 46 0 73 10 23 30 0 27 0 46 73 0 7 12 27 46 73 0 0 3 0 8 0 27 0 43 0 65 0 12 27 17 46 26 73 1�ge' , .. ':'� ,. .. _r: �` sf �.. _.��i .. °.� t `•t..., i'4?K,�p �',.�,,,.�...�,� t'r a �' �, i 0 -5 years 6 -18 years 19 -50 years 51 + years y, Ay• �• Total 9 0 16 0 27 0 6 0 13 0 19 0 12 14 14 17 2 110 26 15 0 0 1 27 1 46 73 Geographic L oc' atio6 Alamance County Chatham County Durham County Wake County Orange County Breakdown Chapel Hill Public Housing Town of Chapel Hill (Non - Public Housing) Town of Carrboro. 'Town of.H- iillsborough City of Mebane (Orange County) Orange County (Outside- Municipalities). PROGRAM INFORMATION 0 0 0 0 0 0 0 0 0 0 0 0 12 8 16 4 5 11 3 3 4 6 16 23 0 14 14 2 110 15 Total 27 43 73 1/22/2018 12:44.36 PM Page 17 of 27 DocuSign Envelope ID: 2F546B53- F2D1- 407D- A1C7- 26EB823DOFFD Work Statement o) Complete the Work Statement Chart to describe the worst 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 elderlyidisabled residents.) • Program Goal should explain what the program is trying to achievelaccomplish. 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 Parent Aide Program ;' 1 ,rograirii 1�vftyIaris Parent Aide Program - Program Goal Parents will improve parenting skills, parent/child interaction, and increase problem-solving skills/ family functioning. Performance Measures Protective Factors Survey (Retrospective Post), North Carolina Family Assessment Scale (Pre, Mid, Post), Adult Adolescent Parenting inventor Pre /Post), Safe Care Assessments. Previous Year Program Results 1 9 out of 10 (93 %) families. Current Year Estimated Results J 10 out of 11 (93 %) families. Next Year Projected Results 16 out of 17 (94 %) families. "')sihtti±ilVri Parent Aide Program Program Goal Parents enhance home safety, increase linkages to social/community supports, and improve their capacity to maintain their child's health. Performance Measures Protective Factors Survey (Retrospective Post), North Carolina Family Assessment Scale (Pre, Mid, Post), Adult Adolescent Parenting Inventor (Pre/Post), Safe Care Assessments. Previous Year Program Results 9 out of 10 (93 %) families. Current Year Estimated Results 10 out of 11'(93 %) families. Next Year Projected Results 16 out of 17 (94 %) families. Program Goal Performance Measures Previous Year Program Results Current Year Estimated Results Next Year Projected Results Program Goal Performance Measures Previous Year Program Results Cu ent Year Estimated Results Next Year Projected Results PROGRAM INFORMATION 2/20/2018 5:52:50 PM Page 18 of 27 DocuSign Envelope ID: 2F546B53- F2D1- 407D- A1C7- 26EB823DOFFD p) Program Budget 1. Submit your program budget. You may complete the provided template (separate As 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 (CDBGIHOMF- /etc.) • Private Foundation Grants o Other Revenue • Expenditures • Compensation • Rent & Utilities • Supplies & Equipment • Travel & Training • Other Expenses 2. Program Budget Detail — Provide description of "other" budget items, not defined. 3. This program budget represents what percent of the agency budget? 66% 4. COST PER INDIVIDUAL This Cast per Individual must reflect the total program budget divided by the total number of program individuals in this application. PROGRAM INFORMATION 1/22/2018 12:44:36 PM Page 19 of 27 gTotalast of Program $18,525 $21,988 $42,700 of Individuals 27 43 73 Cost Per Individual 1$686.11 $511.35 $584.93 PROGRAM INFORMATION 1/22/2018 12:44:36 PM Page 19 of 27 DocuSign Envelope ID: 2F546B53- F2D1- 407D- A1C7- 26EB823DOFFD Program Budget Operating Budget for Program PROGRAM DAME Parent Aide Services PROGRAM REVENUE Private Donations Program Generated Revenue Local Government Grants: Human Services - Town of Carrboro Other - Town of Carrborc Human Services - Town of Chapel Hill Other - Town of Chapel Hill Human Services - Orange County Other - Orange County Other - Town of Hillsborough Other Government Grants Triangle United Way State Government Federal Government (CDBGIHOMEIetc.) Private Foundation Grants Other Revenue Total Program Revenue PROGRAM EXPENSES Compensation Rent R Utilities Supplies & Equipment Travel & Training Other Expenses: : ,V Total Pro ram Ex' ActUai,' Estimate s# 20.17 -1 ;• .Projected y 2018 -19 Percent Change $ 2,500 $ 1,500 $ 2,500 67% $ - $ - $ - 0 $ 2,000 $ 2,000 $ 2,700 35% $ - $ - $ - 0 $ 10,350 $ 10,350 $ 20,00-0 93% $ - 1 $ - $ - 0 $ 6,175 $ 9.608 1 $ 20,000 108 % $ - $ - $ - 0 $ - $ - $ _ 0 $ - $ - $ - 0 S _ - - a $ t $ - $ - 0 $ - $ - $ - 0 $ $ - $ 1,712 [} .$:' :21,(125 $ 0 10,697 $ $ 23,4$$ 17,1$9 $ $ 46,912 40,312 100% 135% $ 1,509 $ 2,120 $ 2,325 10% $ 1,315 $ 515 $ 600 17% $ 7,504 $ 3,664 $ 2,400 -34% $ $ - $ 1,275 0 �� 1;a2� =: �;,•- �3;4gs � = �s;��a � . ti�oa °,� SURPLUSI(DEFICIT) FOR PERIOD $ 0 $ U $ D 1�vD0-/Q FY 2018 -19 Program Budget DocuSign Envelope ID: 2F546B53- F2D1- 407D- A1C7- 26EB823DOFFD 3. PROGRAM INFORMATION (submit a separate Section 3 for each program) Program Name: Children's Parents Parenting Classes Program Primary Contact and Title: Sarah E.G. Black, Executive Director Telephone Number: 336- 227 -5601 E -Mail: sarahblack348P-gmail.com qi Indicate the type of Human Service Needs Priority, if program applicable: ® Priority Area #7: safety -net services for disadvantaged residents Z Priority Area #2: education, mentorship, and afterschool programming for youth facing a variety of challenges [l Priority Area #3: programs aimed at improving health and nutrition of needy residents r) 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 NeighbvrhoodslResiden Affordable Housing_ Affordable Healthcare Education X X X X I Family Resources X X X X X Jobs /Jobs Training Food Transportation Other: Parenting support X X X X s) 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. • Department of Social Services and Department of Health: referrals, governmental services. Agency has a Memorandum of Agreement with Orange County's Department of Social Services. • Department of Juvenile Justice and Orange County Court System: referrals. • Orange County / Chapel Hill School System f UNC- Chapel Hill: referrals and interns. Mental Health /Social Service Agencies/ local Mental Health Entities: referrals and mental health Services_ j - Exchange Clubs /Churches /Business: These entities assist the agency by providing monetary donations, concrete donations for items needed by families, and volunteers for serving families in Orange County. PROGRAM INFORMATION 1/221201812:44:36 PM Page 20 of 27 DocuSign Envelope ID: 2F546B53- F2D1- 407D- A1C7- 26EB823DOFFD Program Description (3 pages OR LESS) Please provide the following information about the proposed program: t) Summarize the program services proposed and how the program will address a Town /County prioritylgoal? The Children's Parents program will provide parenting classes to families at -risk for and/or involved in child abuse and neglect. Parenting class series are twelve sessions and are one and 12 hours in duration. Professionally trained instructors use tested curricula to teach the parents. Three main models are used: Strengthening Families, Triple P, and Children's Parents. All have been evaluated for their effect on families and are promising practice or evidence -based in their ratings. The combining of evidence -based and promising practice curriculums for the classes is a purposeful effort by the agency to be comprehensive to the needs of families in the community. A growing body of research is determining that combining elements of various evidence -based models are leading to medium to large beneficial effects for strengthening families (Samuelson, 2010; Brown, Whittingham Boyd, McKinlay, and Sofronoff, 2014). Emphasis within the classes is on sharing, discussing individual situations, and practicing new skills. Each class has "homework" in order to fully integrate the knowledge back into the home. Couples are encouraged to attend. Parenting classes are offered at times and locations that are accessible by parents. Child care and meals /snacks are offered to address barriers to attendance. Topics such as: Parenting Skills, Child Development, Communication, Complex Childhood Trauma, Child Abuse and Neglect, Domestic Violence, Problem Solving, Anger Management, Creative Discipline, Family Values, Substance Abuse, Attachment/ Family Connections, and Self-esteem are discussed. A key issue with at -risk parents is their ability to understand their role as parents, understanding their own parenting history, knowing child behavior and the ability to intervene to help their children succeed. The program helps parents Increase in these skills. Parenting classes also provide an opportunity for families to practice social skills and develop social support. The classes provide services to many priority areas of concern for the community including: direct parent coaching and mentorship, life skills, and referrals to concrete supports which collectively increases access to safety -net services for families; and increased positive health outcomes for families. u) Describe time 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 Board Priorities, 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. Child abuse and neglect is a significant present problem in Orange County. From July 2016 to June 2017, there were 895 children reported for child abuse and /or neglect in Orange County (Duncan et al., 2018). Of the 895 children reported for abuselneglect, 39.66% of them were between the ages of 0 -5. As of December 2017 there were 91 children in foster care in the county (Duncan et. al, 2018). Children that end up in the foster care system often stay in the system longer than a year increasing the cost for taxpayers. From July 2016 to .tune 2017, 80.86% of the children than were in the Orange County foster care system remained in the system for over a year (Duncan et. al, 2018). This child maltreatment data speaks to the need for population targeted intervention services in the County to address the issue of child abuse and neglect/trauma. The program will directly address these statistics by providing interventions to help families PROGRAM INFORMATION 1/2212018 12 :44:36 PM Page 21 of 27 DocuSign Envelope ID: 2F546B53- F2D1- 407D- A1C7- 26EB823DOFFD avoid new or repeat involvement with the child welfare system. The Chapel Hill Human Services Needs Assessment, Orange County BOCC Goals and Priorities, Town of Chapel Hill 2020 Council Goals, and Carrboro goals all have a common theme in their agendas, providing a safe and healthy community for their citizens. These council and county goals recognize that as much as basic needs (employment, housing, food, etc.) are important to the families of the county social detriments of health are also necessary to address in order to achieve healthy communities. Child abuse and neglect in the community and the resulting trauma that it creates lead to unhealthy families that directly impact the achievement of the goals of the county. Goals such as "Nurturing Our Community" "Community Prosperity and Engagement" and foundational programs such as "Protect and Provide for a Safe Community" are impossible to achieve without addressing the trauma risk factors of the community. Numerous individual, family, and community factors can contribute to abuse and neglect such as age, disability, mental health and substance abuse issues, poverty, low education, domestic violence, history of child abuse, and social isolation (Centers for Disease Control and Prevention, 2016). These risk factors are connected to town needs assessments and Orange County social values. Overall Grange County appears to have the fallowing community concerns: insufficient basic needs; transportation, need for financial stability; mental illness /substance abuse rates and need for services; and community and family violence rates (Orange County Community Health Assessment, 2015 & Orange County State of the County Health Report, 2016). The class topics review information about violence, poverty, complex childhood trauma, substance use, education, resilience, ,physical and mental health, stress and anger management as well as more topics that increase individual awareness and empower parents to make changes in addressing their individual needs and the needs of their families. Since Orange County has 12.6% of its people living in poverty and issues of family violence (1,742 Domestic violence calls and 483 clients) (2016 U.S. Census Bureau; North Carolina Council for Women, 2015 -16) it is important to directly address these issues from an individual perspective in addition to community education efforts. v) Who is your target population of individuals to benefit from this program and how will they be identified and connected with the program? The target population of Children's Parents parenting classes are 24 parents in Orange County at risk of and/or involved in abuse and neglect. These families possess socioeconomic and cultural makeups that match the diversity of the County (71 % white, 22.2% Black, 9.2% Hispanic /Latino, and 2.9% Asian per the 2016 US Census). Marketing to county referring sources (Dept. of Social Services, Dept. of Public Health, Schools, Non- profits, For - profits, businesses, mental health companies, churches, local mental health entity, etc.) will allow the agency to solicit referrals for families needing services. Self - referrals made by parents in the community will be solicited by general agency marketing efforts (social media, website, etc.). Beneficiaries are identified when the referral is received and the family agrees to services. All families from Orange County in need of the services will qualify for the classes. w) Describe the credentials of the program manager and other key staff. (Ex. Identify Program Manager and credentials, describe training provided to volunteers, etc.) Trained staff certified in the Triple P Positive Parenting Program, Children's Parents, and Strengthening Families curriculums are the instructors/ facilitators of the classes. The main staff instructor is also the current Program Supervisor and acts as the agency's Executive PROGRAM INFORMATION 1/22/2018 12:44:36 PM Page 22 of 27 DocuSign Envelope ID: 2F546B53- F2D1- 407D- A1C7- 26EB823DOFFD Director who has a Master's degree with 12 years of executive level management and administration experience, 13 years of programmatic administration and implementation, and over 17 years of clinical and service delivery experience. Backup staff members are trained Bachelor level instructors with experience in social work, counseling, or human services. Volunteers, or paraprofessionals can be used for assistance with childcare under the supervision of the Supervisor. Volunteers receive the same internal 12 hour training on Child Abuse and Neglectl Parent Aide services that the professional staff is given. Volunteers are also interviewed and reference /background checked to ensure safety of working with children. x) Describe the specific period over which the activities will be carried out and include an implementation timeline. Implementation of programming will begin immediately as Children's Parents already exists in Alamance County due to current donations. The funding will provide for 3 12 -week sessions of Children's Parents and classes each week will be one and 1/2 hours in duration. Locations of the classes will be in Chapel Hilt and HillsboroughlEfland area. y) 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) Child abuse costs the nation $220 million every day (Prevent Child Abuse, Cost data, 2012). Many societal problems have their roots in childhood trauma_ Costs are hidden in the social service systems, healthcare costs, and poverty initiatives. Parenting classes are a necessary part of the clinical continuum of services to address risk factors for abuse /neglect in communities. The Children's Parents program is a very cost effective ($1700 per session) competitive service. Other parenting curriculums require multiple instructors, expensive training, and [art longer which leads to an average cost of $12,000- 18,000 session series. Children's Parents is purposefully designed to mitigate barriers to driving up costs and partner with community sources to add in-kind resources to assisting with session costs. This project will partner with local churches to provide in -kind space, childcare resources, and food to mitigate session costs. z) Describe what would happen if requested funding is not awarded at all or if a reduced allocation is recommended. if the full funding request was not allocated to the agency, the agency would reduce the number of clients served and apply for matching funds. aa) What percentage of your target population is low - moderate income? Although services are open to everyone, and abuselneglect is not just a lower socio- economic issue, referrals to our services tend to come in sources in such a way that 50% of families come from low-moderate income levels. bb)What efforts do you make to seek feedback about your program from your target population (e.g. survey, evaluations, etc. ?) The agency has a Quality Improvement process that uses informal (feedback) and formal (satisfaction surveys) means to collect, analyze, and use data to inform program changes. This process occurs continually throughout the year. Client representation on agency committees also are a part of this process- cc) Include any other pertinent information. PROGRAM INFORMATION 112212018 12:44:36 PM Page 2 3 of 27 i I DocuSign Envelope ID: 2F546B53- F2D1- 407D- A1C7- 26EB823DOFFD Additional Program Information I dd }Target Population Complete the following tables, with numbers (not percentages) of individuals served and to be served, to the best of your ability, I P'Po aatrogram T r icr denagrap4le Actual Estimated Projected 2016 -17 1 2017 -18 2018 -19 < 7 '7r. r ti Gender Male Female Total Ethnicity African- Americar American Indian or Alaska NaUvE Asian Caucasian Native Hawaiian or other Pacific Islander Other: specify Total Of the above, how many Hispanic/Latino Of the above, how many non- Hispanic/Latino Total Age;,. 0 -5 years 6 -18 years 19 -50 years 51+ years Total K: Geographic Location Alarnance County Chatham County Durham County Wake County Change County Breakdown Chapel Hill Public Housing Town of Chapel Hill (Non - Public Housing) Town of Carrboro Town of -Hillsborough City of Mebane (Orange County) Orange County (Outside Municipalities) 0 0 0 0 10 0 0 0 0 0 14 8 0 0 0 0 0 24 0 0 0 0 24 0 0 0 2 0 0 8 0 0 0 0 0 0 0 0 0 5 0 0 4 0 0 2 0 0 8 0 0 1 0 0 4 Total 01 01 24 E PROGRAM INFORMATION 1/22/2018 12:44:36 PM Page 24 of 2 7 1 DocuSign Envelope ID: 2F546B53- F2D1- 407D- A1C7- 26EB823DOFFD Work Statement ee) 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 9 Program Activity, which should be SMART ( §pecific, Measurable, Achievable, Relevant, and Time - hound. Click. on SMART Goals to learn mare. • Program Activities should outline major activities the agency implements to accomplish its program goals. (i.e. Deliver,meals to elderlyldisabled 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 Pro ram Children's Parents ... .......... . _ ----- - ---------- .._.__ ...._.. ..... ...... .__......_.._ - -- _.__.... PROGRAM INFORMATION 212012018 3.54:47 PM Page 25 of 27 Children's Parents Program Program Goal Parents/ Guardians will complete the parenting classes and graduate successfully at the and of the 12 weeks. Performance Measures Class Attendance Sheets and Children's Parents Parlicioation Forms. Previous Year Program Results 0% Current Year Estimated Results 0% Next Year Projected Results 17 out of 24 (70 %) parents /guardians. "'s. ...., ., ll+a�frAatix Children's Parents Program Parents/ Guardians will 'increase parenting knowledge, skills, and chltd develo ment knowledge, Program Goal Performance Measures Adult Adolescent Parenting Inventory (Pre /Post ). 0% 0% Previous Year Program Results Current Year Estimated Results Next Year Projected Results 18 out of 24 (75 %) parents /guardians. t,;f"rtigam1t1' Children's Parents Program Program Goal Parents/ Guardians will increase problem- salving skills, coping skills knowledge, and report feeling more competent in their role. Adult Adolescent Parenting Inventory (Pre /Post) and Consumer Satisfaction Surveys. 0% Performance Measures Previous Year Program Results Current Year Estimated Results 0% Next Year Projected Results 19 out cf 24 (80 %) parents /guardians. Program Goal Performance Measures Previous Year Program Results Current Year Estimated Results Next Year Projected Results ... .......... . _ ----- - ---------- .._.__ ...._.. ..... ...... .__......_.._ - -- _.__.... PROGRAM INFORMATION 212012018 3.54:47 PM Page 25 of 27 DocuSign Envelope ID: 2F546B53- F2D1- 407D- A1C7- 26EB823DOFFD ff) Program Budget 5. Submit your program budget. You may complete the provided template (separate xls fife) or you may submit your own budget fife (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 • Private Donations • 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) • Other Government Grants • Triangle United Way • State Government • Federal Government (CDBG /HOMEfetc.) • Private l=oundabon Grants • Other Revenue • Expenditures, o Compensation o Rent & Utilities o Supplies & Equipment a Travel & Training o Other Expenses 6. Program Budget Detail — Provide description of "other" budget ltsms, not defined. 7. This program budget represents what percent of the agency budget? 0.05% 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. PROGRAM! INFORMATION 112212018 12:44:36 PM Page 26 of 27 Total Cost of Program $0 $0 $4780 Total # of Individuals 0 0 24 Cost Per Individual 0 0 $199.16 PROGRAM! INFORMATION 112212018 12:44:36 PM Page 26 of 27 DocuSign Envelope ID: 2F546B53-F2D1-407D-A1C7-26EB823DOFFD Program Budget Operating Budget for Program PROGRAM NAME Children's Parents Parenting Classes PROGRAM REVENUE Private Donations Program Generated Revenue Local Government Grants: Human S e rvi ces - Town of Ca rrboro Other - Town of Carrboro Human Services - Town of Chapel Hill Other - Town of Chapel KI Human Services - Orange County Other - Orange County Other - Town of Hillsborough Other Government Grants Triangle United Way State Government Federal Government {CDBG/HOME/etc) Private Foundation Grants Other Revenue Total Program Revenue PROGRAM EXPENSES Compensation Rent & Utilities Supplies & Equipment Travel & Training Other Expenses: Total Program Expensies '%--'Actuilk� -,?Estimated Projected 2018-19 Percent ',Change $ 3,500 $ $ $ 0 $ $ 0 $ $ 0 $ $ 0 $ $ $ $ $ 2,390 0 $ $ $ - 01 $ $ 0 $ $ $ 0 $ $ $ 0 $ $ 0 $ $ $ 0 S $ $ 0 3,500 3,250 6 $ in $ $ 4,780 $ 3,461 0 0 $ - $ $ 0 $ 250 $ $ 275 0 $ $ $ 732 0 $ $ 312 0 I $ 4,780 1 01 SURPLUSI(DEFICIT) FOR PERIOD: 1 $ ILL- 1 .21 FY 2018-19 Program Budget DocuSign Envelope ID: 2F546B53- F2D1- 407D- A1C7- 26EB823DOFFD Exhibit B Provider's Revised Scope of Services and Program Budget The Exchange Club's Family Center in Alamance County Orange County Outside Agency Performance Agreement Page 8 of 9 Rev. 7118 DocuSign Envelope ID: 2F546B53- F2D1- 407D- A1C7- 26EB823DOFFD EXIIIBIT `B" Scope of Services — FY 2018 -19 Outside Agency Performance Agreement Agency Name: The Exchange Club's Family Center in Alamance County Program Dame: Parent Aide Program Funding Award: $12,464 Outline how the agency will spend Orange County's funding award. Expense Description Amount Personnel Salaa & Benefits $9,787 Mileage $1,301 Rent & Utilities $706 Supplies $214 Professional & Operational Expenses (software & personnel cost for accounting, IT, etc. ) $456 Program Services Outline the critical services (activities) the agency will employ to attain the Anticipated Outcomes below, by June 30, 2019. • Provide in -home visitation to seven families (7 with funding and 1 family with volunteer assistance) through the Parent Aide Program through professional level staff and Master's level intems. • Provide weekly home visits to at -risk families to increase safety, parenting, problem - solving, social support, and health of the family. 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 Number of (unduplicated) families enrolled in Parent Aide in -home visitation services and receiving weekly visits to reduce the risk of child maltreatment. 8 Average number of hours for weekly visits for families enrolled in Parent Aide program. 2 Average number of months families are enrolled in Parent Aide program. to, Percent of families who will increase parenting skills and parent/child interaction. 94% Percent of families who will enhance home safety and parental supervision. 94% Percent of families who will increase problem - solving skills and family functioning. 94% Percent of families who will increase linkages to social/community support. 94% Percent of families who will improve their capacity to maintain their child's health. 9411/o EXMIT "B" UocuSigned by: Scope of5ery �jAY �3 8/29/2018 Certified by: L Title: Executive Director date: B3987E44689412... (Provider's Signature) DocuSign Envelope ID: 2F546B53- F2D1- 407D- A1C7- 26EB823DOFFD Outside Agency Performance Agreement Agency Name: The Exchange Club's Family Center in Alamance County Program Name: Children's Parent Program Funding Award: $1,000 Outline how the agency will spend Orange County's funding award. Expense Description Amount Facilitator personnel salary & benefits $1,000 Program Services Outline the critical services (activities) the agency will employ to attain the Anticipated Outcomes below, by June 30, 2018. Provide 2, 12 -week long parenting classes, 1.5 hours in length, to increase parenting skills and provide parental support to 16 parents /guardians of children 0 -24 at risk for child abuse and neglect. Anticipated Outcomes The Anticipated Results column must include quantifiable results in the form of number of persons /units served within Orange Counjj. 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 Number of parents/guardians completing parenting classes and graduating successfully after 12 out of 16 or 12 weeks 75% Number of parents /guardians increasing parenting knowledge, skills, and child development 13 out of 16 knowledge I or 81% Number of parents/guardians increasing problem - solving skills, coping skills, knowledge, and 13 out of 16 I reporting feeling more competent in their role or 81% UocuSigned 4y: ls4ra, b6& Executive Director 8/29/2018 B39KEMB89B412 Certified by: . Title: Date: (Provider's Signature) DocuSign Envelope ID: 2F546B53- F2D1- 407D- A1C7- 26EB823DOFFD ATTACHMENT "A" Orange County Certifications — FY 2018 -19 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 Grange. 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 Grange 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. Docu Signed Eby: Certified Executive Director 8/29/2018 Certified by. B3BB7EA4B89B412... Title. -° Date. (Provider's Signature) The Exchange Club's Family Center in Alamance County Orange County Outside Agency Performance Agreement Page 9 of 9 Rev. 7118 DocuSion EnvelODe ID: 2F546B53- F2D1- 407D- A1C7- 26EB823DOFFD 20EXC HACLU ACORD., CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 412312018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer any rights to the certificate holder in lieu of such endorsement(s). PRODUCER BBBT Insurance Services, Inc. Post Office Box 13941 Durham, INC 27709 CONTACT Patty Degina NAME: AICNN Ext.919 281.4525 , N.):8887468761 E-MAIL de Ina bbandt.com ADDRE P 9 INSURERS AFFORDING COVERAGE NAICii INSURER A: Nonh American EIIta Insurance company 29700 919 281 -4500 INSURED Exchange Club Center for the Prevention of Child Abuse 500 W Northwest Blvd Winston Salem, NC 27105 INSURED B : Sionawood Insurance company 11828 INSURER c INSURER D s 2O 000 INSURED E: INSURER F $1,000,000 COVFRAGFS CERTIFICATE NUMBER: 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 CONTRACTOR 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. IN SR LTR TYPE Of INSURANCE ADDL IN UBR D POLICYNUMBER POLICY EFF MMID POLICY EXP MMIDDIYYYY__- LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ^I OCCUR 201839452 201839452 4/1212018 04112/2018 04/1212019 EACH OCCURRENCE $1,000,000 DAMAGE $500000 MED EXP (Arty one ) s 2O 000 PERSONAL & ADV INJURY $1,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRO- POLICY El JECT F] LOC OTHER: GENERAL AGGREGATE s3,000,000 PRODUCTS - COMPIOP AGG s3,000,000 $ A AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED x AUTOS ONLY AUTOS ONLY 041121201 COMBINED SINGLE 1JMIT Ea acciden! $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident) $ UMBRELLA LMS EXCESS LIAR OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ DEC RETENTION $ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICEOPRIET RJPARTNER /E ECUTIVEI (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WCI0000712042018A 1/27/2078 O7/27/2O1 X PER ER iE,L. EACH ACCIDENT $100.000 E. L. DISEASE -EA EMPLOYEE $100,000 E.L. DISEASE - POLICY LIMIT $500000 • • I Professional Liab Abuse /Molestation 201839452 201839452 4/1212018 411212018 0411212019 041121207 $1,000,0001$3,000,000 $1,000,0001$3,000,000 DESCRIPTION OF OPERATIONS 7 LOCATIONS F VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) rIPRTIFIC:ATF HnI nFR CANCELLATION Orange County 'Government P.O. Box 8181 Hillsborough, NC 27278 ACORD 25 (2016103) 1 of 1 #S199170481M19916880 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Lp 1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD MEBAR DocuSign Envelope ID: 2F546B53- F2D1- 407D- A1C7- 26EB823DOFFD This page has been left blank intentionally.