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DocuSign Envelope ID: E8DFACF7 -45BE- 435E- 9B5A- BB177E968F07 <br />EXHIBIT "B" <br />Scope of Services -- FY 2018 -19 <br />Outside Agency Performance Agreement <br />Agency blame: Duke University Health Systems, Inc. d/b /a Duke HomeCare chi Hospice <br />Program Name: Duke Hospice Children's Bereavement <br />Funding Award: $1,115 <br />Outline how the agency will spend Orange County's funding award, <br />Expense Description <br />Amount <br />wq es <br />$620 <br />Camp ReLEAF Supplies and activities <br />$440 <br />Grief pro ram supplies including printing expense 1 classroom su lies <br />$55 <br />Evaluation 1 Self-Report measures <br />95 % <br />- 23 children <br />Enrollment in Camp ReLEAF <br />50% <br />- 12 children <br />Program Services <br />Outline the critical services (activities) the agency will employ to attain the Anticipated Outcomes below, by June 30, 2019. <br />• Grief Education and Support to 24 Children.. <br />o Resource, Collaboration and Consultation with Change County Schools when requested <br />o Enhance current grief coping skills <br />o Support Development of grief coping skills <br />• Camp ReLEAF / overnight grief camp for 10 children <br />o Enrollment in weekend intensive grief support designed for ages 6-14 <br />o Grief activities designed to enhance skills in understanding individual grief response <br />o Education and support to develop and enhance grief coping skills <br />Anticipated Outcomes <br />The Anticipated Results column must include quantifiable results in the form of number of persons/units served within Orange County, only (all <br />Towns and municipalities). if you use percentages, you must also provide the total number of participants within that measure's description or <br />for an earlier performance measure. <br />Performance Measures <br />Anticipated Results <br />Initial Grief Risk Asessment and Intervention <br />24 children <br />Enrollment in grief support group/ family intervention <br />70 % <br />- 17 children <br />Evaluation 1 Self-Report measures <br />95 % <br />- 23 children <br />Enrollment in Camp ReLEAF <br />50% <br />- 12 children <br />Satisfaction <br />95 % <br />- 23 children <br />Recommendation of Services <br />95%-23 <br />children <br />UocuSigned by: <br />�C,Vttl/l. <br />.� r1 Director of Finance <br />`0280118B0F104B6... <br />Certified by:, i-_ ,+ez)fftTr -�_ Title: Date: <br />t (Provider's Signature) <br />