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DocuSign Envelope ID: E85EF868-A4BB-49ED-96E1-165F3DADBAE4 XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> Work Statement <br /> m) Complete the Work Statement Chart to describe the work to be performed. <br /> This chart is used to document program activities, program goals, performance measures, <br /> and actual results. (Add more rows as needed) If this is a new program, you will only <br /> document the projected information. Every program is required to have AT LEAST <br /> Program Activity, which should be SMART(§pecific, Measurable, Achievable, Relevant, and <br /> Time-bound. Click on SMART cpatq to learn more. <br /> Work Statement Chart for Program Client Services <br /> 1. Program Crisis Support: Staff and trained volunteers ("Companions") respond to walk-in <br /> Activity clients and to calls on the 24-Hour Help Line. Companions provide emotional <br /> Name support, give resources, information, and referrals; and accompany survivors to <br /> medical, legal, and law enforcement appointments. Staff and trained volunteers <br /> facilitate support groups and workshops for survivors. <br /> Program Goal The OCRCC will provide assistance to approximately 675 individuals. <br /> Performance Staff and volunteers keep records of each client contact through web-based <br /> v'easures database. <br /> Previous Year We served 546 individuals in FY2015-2016. <br /> Prograrry Results <br /> Current Year We expect to serve about 650 individuals in FY2016-2017. <br /> Estimated Results <br /> Next Year Projected We expect to serve about 675 individuals in FY2017-2015. <br /> Results <br /> 2. Program Support Groups: Staff and trained volunteers facilitate support groups and <br /> Activity workshops for survivors. Some are traditional discussion-based groups and others <br /> Name are activileocused groups utilizing alternative healing modalities, <br /> Program Goal More than 90% of those completing support group evaluations will (1) report that <br /> participation in a support group helped them feel less alone in their experience of <br /> sexual violence and (2) report that participation in a support group increased <br /> feelings of being supported in their healing process. <br /> Performance Using a quantitative standardized scale for measuring post-traumatic stress <br /> Measures disorder (PTSD), support group participants will be given a pre- and post-test for <br /> these symptoms. Participants are also asked to provide qualitative feedback about <br /> the service(s) they utilized at the OCRCC, to evaluate their service provider, and to <br /> comment on the accessibility of our programs. The Client Services Director <br /> corn siles data after each support group and at the end of the fiscal year. <br /> Previous Year In FY2015-2016, 82% of support group participants reported that our groups <br /> Program Results helped them feel less alone in their experience of sexual violence and 100% <br /> reported that our groups made them feel more suppprted in their healing process. <br /> Current Year In FY2016-2017, we expect that at least 90% of support group participants will <br /> Estimated Results report that our groups helped them feel less alone in their experience of sexual <br /> violence and at least 90% will report that our groups made them feel more <br /> supported in their healingprocess. <br /> Next Year Projected In FY2017-2018, we expect that at least 90% of support group participants will <br /> Results report that our groups helped them feel less alone in their experience of sexual <br /> violence and at least 90% will report that our groups made them feel more <br /> I supported in their healing process. <br /> Agency Information 1/30/2017 5:14:05 PM I ■■ u, I 3 f 2 2 <br />