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DocuSign Envelope ID:E522oFFc+634-4A11~w62-1e5A3eEe57A4 <br /> EXHIBIT A <br /> PROVIDERS OUTSIDE AGENCY APPLICATION <br /> Work Statement <br /> (Page 14) <br /> Goals: Duke Hospice Bereavement Services (DHBS) offers bereavement support to both hospice and <br /> community clients <br /> 1) DHBS will schedule 200 community adult client encounters in FY16 <br /> 2) DHBS will schedule 64 community child/teen encounters in FY16 <br /> 3) DHBS will schedule 345 hospice adult client encounters in FY16 <br /> 4) DHBS will schedule 26 hospice child/teen encounters in FY16 <br /> 5) Camp ReLEAF will provide an overnight camp experience for children K-8th grade <br /> 6) DHBS will provide grief education and support to local educational and civic organizations as <br /> requested <br /> Goal# Actual 15-16 Actual 16-17 Estimated 17-18 <br /> 1 277 205 150 <br /> 2 24 33 24 <br /> 3 446 491 450 <br /> 4 38 47 42 <br /> 5 10= .334 of total 16= .381 of total 1O= .334oftotal <br /> 6 17 18 13 <br /> Performance measures for all of the listed activities will be through service evaluation requested at the <br /> time of the event or at the conclusion of a series of related events. Related events would be ongoing <br /> individual or group counseling. <br /> Goal 5 Camp ReLEAF: each camper provides feedback regarding likes and dislikes of camp activities and <br /> overall participation. Each activity scored well in different age groups. There are no numbers associated <br /> with the scoring of satisfaction. Parents provide feedback about their children's reported experience <br /> with approximately 30%of campers requesting to come back the next year. 31 campers out of 34 total <br /> campers completed a group evaluation with 9696 responding favorably to the camp experience. <br /> Predominant responses from campers indicated the importance of meeting other children their age who <br /> had experience something similar which reduces the isolation, loneliness and sense of being different. <br /> Goal # Actual Estimated <br /> 3 98%satisfaction 97% 95% <br /> 100 refer services 100 refer services 95% refer services <br /> 4 95% satisfaction 96% satisfaction 95% satisfaction <br /> 98% refer services 99% refer services 95% refer services <br /> 6 94% satisfaction 96% satisfaction 95% satisfaction <br /> 100% refer 100% refer 95% refer 'services <br />