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DocuSign Envelope ID:636AFD33-DA5C-4B55-88DC-03C0863BAFE3 t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> • KidSCope — FAN partners with this agency to provide professional development for <br /> FAN staff and provide trainings in FAN's "Common Sense Parenting" to their <br /> parents of toddlers/preschoolers with emotional-behavioral challenges, reinforcing <br /> the concept that mental illness is treatable and early intervention works. <br /> • Family Success Alliance — FAN accepts referrals from FSA for individuals in Zone <br /> 4 who are in need of FAN services. FSA staff are co-located at the MHAT office, and <br /> assist each other with resource and referral information for the families each <br /> program serves. <br /> • Orange County Care Review — A FAN staff member attends Care Review <br /> meetings to support the family's voice when a parent is applying for out-of-home <br /> placement for their child with at-risk behaviors. <br /> • Orange County Collaborative —A FAN staff member attends monthly collaborative <br /> meetings, which is a working group designed to learn from other members, identify <br /> gaps and needs for mental health services delivered to youth under age 18, and <br /> work in partnership with the committee to develop ways to fill the identified gap in <br /> treatment services and skills building to parents, youth, and families. <br /> • Volunteers for Youth — FAN partners with Volunteers for Youth to help youth who <br /> are court-involved comply with community service hours, as well as provide support <br /> and training opportunities to parents of youth in their mentoring and restitution <br /> programs. <br /> h) Describe what would happen if requested funding is not awarded at all or if a reduced <br /> allocation is recommended. <br /> Since the FAN Program's inception in 2000, demand for program services continues to <br /> grow exponentially each year. FAN services are essential to parents raising children with <br /> at-risk behaviors rooted in mental health conditions. Referrals for services come from a <br /> variety of resources — the juvenile court system, DSS, schools, treatment providers, <br /> churches, other community agencies, friends or family members who have previously and <br /> successfully utilized FAN services, and self-referrals. FAN has always adapted to fit the <br /> needs of the community, though limited staff and resources have prevented them from fully <br /> meeting the demonstrated need. JCPC funding does not include support for FAN's <br /> Common Sense Parenting classes or for the increasing number of referrals for short-term <br /> consultation and assistance accessing and navigating needed services for their children. <br /> We are seeking a small amount of new funding from Orange County ($5,000) to increase <br /> our ability to provide these classes. Parenting classes were cut from 15 in FY14-15 to only <br /> 6 in FY15-16 due to staff reductions. <br /> i) Include any other pertinent information. <br /> Program/Project Information <br /> j) Complete the Target Population and Program Beneficiary Demographics Chart <br /> k) Complete the Schedule of Positions Chart for Program Staff <br /> I) Disclosure of Potential Conflicts of Interested must be signed <br /> m) Complete the Work Statement Chart to describe the work to be performed, and be sure to <br /> attach copies of all data collection tools that will be used to verify achievement of program <br /> goals and objectives. Describe who will be responsible for monitoring progress. <br /> Information to Complete <br /> j.) Target Population <br /> Main Application 5/25/2016 9:20:28 AM .. g of 20 <br />