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•-1 11 v� rikJr1rur nGJUUfkL,..7 <br /> DI'JISION Of YOUTH SERVICES <br /> NOTE: 4 C ipie s with Original <br /> Simat•i.res Regtired, COMMUNITY-RASED ALTERNATIVES <br /> PROGRAM AGREEMENT <br /> County: pGE Date Sub,tiitted: 1119187 <br /> -Name of Program: Phillips-Culbreth Project <br /> Address c/o Orange-Person-Chatham Mental Health Center Effective Date: 1/7./87 <br /> 333 McMasters St., Chapel Hill, NC 27514 I. D. Number: <br /> Contact Parson or Program Director:Ames R. Cameron <br /> Address same as above <br /> Phone 929-0471 <br /> * Type of Program: : <br /> Clients Served Clients Served <br /> Residential in FY Non-Residential in FY 86-87 <br /> Group Home ._..� Youth Services Bureau <br /> Shelter Care XX Alternative School 20-50 <br /> Special Foster Care Volunteer Program <br /> ED Client Capacity Other <br /> 20-50 # of Clients to be Served During Funding Period <br /> Referral Sources: School Core Team, Guidance Counselors, Principals, Teachers, and <br /> self. <br /> Goal of Program: Identify and intervene with adolescents who may have drug or alcohol- <br /> related problems. <br /> Statement of Measurable Objectives: <br /> Core Team--one hour per site per week 2 hours <br /> Parent/Student Consultation--one hour per site per week 2 hours <br /> Individual counseling--two hours per site per week 4 hours <br /> Case management--one hour per site per week 2 hours <br /> Additional responsibilities may include co-facilitation of group; <br /> support of school staff resources; assistance to concerned parents. <br /> Information Maintained For Effectiveness Measurement: <br /> 1. Demographic information <br /> 2. Evaluation by Youth Task Force Evaluation Committee <br /> 3. Self-evaluation of project by Adolescent Substance Abuse Specialist. <br /> * New programs - Please attach a program description describing day to day activities <br /> of program participants. <br /> Continuation programs - Please describe any major changes from last year's approved <br /> program description. <br /> DYS (Rev. 2/12/82) <br />