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DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> insurance, the co-pay or deductible amount, coupled with their income, prevents <br /> them from seeking mental health care. <br /> Understanding of the challenges Orange County residents who suffer from mental <br /> illness and/or substance use disorder, the Orange County Board of Commissioners <br /> established this goal as their top priority in 2016: Ensure a community network of <br /> basic human services and infrastructure that maintains, protects and promotes the <br /> well-being of all county residents. This goal specifically notes mental health as an <br /> area of focus. <br /> ff) Who is your target population of individuals to benefit from this program and how will they be <br /> identified and connected with the program? <br /> Compeer clients with severe and persistent mental illnees are referred by their <br /> mental health professional from organizations like UNC XDS/STEP Clinic/Oasis, and <br /> other therapists/psychiatrists in the community. Pro Bono clients who are uninsured <br /> or underinsured and who seek counseling for mental health contact Freedom House <br /> to paired with a volunteer therapist. Families of school-age children who have a <br /> behavioral health care need contact FAN directly for resources. <br /> gg)Describe the credentials of the program manager and other key staff. (Ex. Identify Program <br /> Manager and credentials, describe training provided to volunteers, etc.) <br /> • Program Director: Shelley Danser, LCSW <br /> • Outpatient Services Director, Carol McClelland, MA, LPC, LPCS, LCAS, CCS <br /> • Clinical Director: Heather Griffin-Dolciney, LCSW, LCAS <br /> • Medical Director: Duncan McEwen, MD <br /> • Executive Director: Trish Hussey, MA <br /> hh)Describe the specific period over which the activities will be carried out and include an <br /> implementation timeline. <br /> These programs are well-established, ongoing year-round programs on which the <br /> community depends. <br /> ii) Why is funding this program a good investment for the community? How does funding this <br /> program add value to the community? (250 words OR LESS) <br /> We are one of the few agencies that continue to provide services to homeless, <br /> uninsured and indigent clients. Community investment in behavioral health care, <br /> especially for those who are underserved, not only positively impacts the individuals <br /> and families themselves, but also impacts the community. For example, For <br /> instance, for every $1 spent on addiction treatment, the community saves $7 in <br /> criminal justice costs and $12 in related health-care costs (Alcohol and Drug Council). <br /> jj) Describe what would happen if requested funding is not awarded at all or if a reduced <br /> allocation is recommended. <br /> The number of individuals served would be negatively impacted by a reduction in or <br /> absence of funding. <br /> DO NOT SUBMIT THIS PAGE 1/31/2017 11:11:58 AM Page 30 of 7 <br />