2017-590-E Finance - Duke HomeCare & Hospice - Outside Agency Performance Agreement

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DocuSign Envelope ID:E522oFFc+634-4A11~w62-1e5A3eEe57A4 EXHIBIT "B" Scope ot Services -----FY2Ol7-l8 Outside Agency Performance Agreement Agency Name: Duke University l-Iealth Systems, Inc. d/b/u Duke II000e Caro& Hospice Program Name: Duke 1-lospice Children's Bereavement Funding Award: $1,100 Outline how the agency will spend Orange County's funding award. Expense Description Amount Wages _ __— _ __ _____ __ $600 Grief skills program supplies including duplication expenses and classroom supplies $56 Camp ReLEAF supplies and activites $450 Program Services Outline the critical services(activities)the agency will employ to attain the Anticipated Outcomes below,by June 30,2018. • Grief Education and Support to 24 children—to include individual, family and group support o Consultation with schools when requested o Development of effective coping skills • Camp ReLEAF I weekend grief support for 10 children o Enrollment in weekend intensive grief support designed for ages 6-14 o Grief activities designed to enhance skills to understand grief/ompouoc o Education and support to enhance coping skills Anticipated Outcomes The Anticipated Results column must include quantifiable results in the form 01 nuITber of persons/units served within Orange County,only(all Towns and municipalities). If you use percentages,you must also provide the total number of participants within that measure's dv,oripbvno,foronew�ierpe,hvnnox,,n"rx,vn� Anticipated Performance Measures Results Initial Grief Risk Assessment and Intervention 24 children Enrollment in grief support group/family intervention 80% Evaluation/Self-Report success measur x 95% Enrollment in Camp ReLEAF 50% Satisfaction 95% Recommendation of Serives 95% / DocuSigned by: u�" " � '=v�» Qk �� v 8/31/2017 � oc^o Executive Di a�y ',vo^o,` _ Certified by: �� , �� . Title: 4»*i Date: '/- 2�— /~7 (Provider's Signature)