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DocuSign Envelope ID: 134C4810- 3CA5- 4008- 9E74- 2A07D3AECED8 <br />EXHIBIT A - PROVIDER'S OUTSIDE AGENCY APPLICATION <br />• Local, State, and Federal Government — CNCI works with various local, state and Federal <br />entities to advocate for positive changes in the rules, regulations and treatment of persons <br />living with mental illness. Some of these partners include: <br />■ Orange County, Town of Chapel Hill, and Town of Carrboro <br />• Managed Care Organizations (MCOs) — Cardinal and Alliance <br />• Centers for Medicare and Medicaid (CMS) <br />• NC Department of Health and Human Services including Division of Mental Health <br />and Division of Medical Assistance <br />Program Description (3 pages OR LESS) <br />Please provide the following information about the proposed program: <br />d) Summarize the program services proposed and how the program will address a <br />Town /County priority /goal? <br />Priorities Addressed by Club Nova: Critical Safety Net, Health and Nutrition, and Quality of Life <br />The Clubhouse Model is one of the most comprehensive, integrated programs in the United States offering <br />persons with mental illness access to the supports and opportunities needed to rebuild their lives. <br />Club Nova addresses the risks of mental illness while providing supports and opportunities to live <br />meaningful lives of one's choice in the community. Specifically, we provide the following: <br />• Community Support <br />Assistance in accessing and navigating quality healthcare. Addresses shorter life expectancy and <br />serious health problems. <br />Housing supports to secure and maintain safe, affordable, dignified housing. Averts homelessness. <br />100 % of Club Nova members maintained housing in 2016. <br />Crisis prevention and intervention. Saves lives and avoids costly ER and hospitalization costs. <br />• Assistance in securing and maintaining benefits and entitlements. Provides more economic security. <br />• Health and wellness with nutritious, affordable meals that are prepared by members and staff. <br />Addresses hunger and helps mitigate health problems. <br />• Outreach. Combats isolation and reduces risk of crisis, ER visits, and hospitalization. <br />• Transportation. Essential in members accessing Club Nova and the full range of opportunities and <br />supports. <br />• Employment. Addresses high unemployment for our members and increases economic security. <br />• Supported Education. Addresses education that has been interrupted by mental illness. <br />• Work Ordered Day. Provides a sense of community, common purpose, and opportunities to contribute. <br />Builds confidence, self- worth, and skills. <br />• Evening /Weekend /Holiday Program. Addresses isolation and social connectedness. <br />e) Describe the community need or problem to be addressed in relation to the Chapel Hill <br />Human Services Needs Assessment, Orange County BOCC Goals and Priorities, Town of <br />Chapel Hill Council Goals, Carrboro goals, or other community priorities (i.e. Council /Board <br />Goals). Reference local data (using the provided links, i.e. Chapel Hill Human Services <br />Needs Assessment) to support the need for this program. <br />GOALS AND PRIORITIES CLUB NOVA ADDRESSES <br />Orange County Board of County Commissioners: Supporting affordable housing; providing affordable and healthy <br />meals; providing transportation to low income residents living with mental illness especially those unable to access <br />PROGRAM INFORMATION 2/9/2017 1:51:06 PM Page 13 of 26 <br />