2018-413-E Finance - Duke Home and Hospice Care outside agency agreement

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DocuSign Envelope ID: E8DFACF7 -45BE- 435E- 9B5A- BB177E968F07 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION 2. AGENCY INFORMATION (Be Very Brief and Concise) Please provide the following information about your agency (2 pages OR LESS): a) Years in Operation, Date of Incorporation (Month/Year): 1979 b) Agency's Purpose /Mission (no more than a few sentences): The mission of the Duke Hospice Bereavement Services (DHBS) is to facilitate a safe and healing grief process for persons who are adjusting to a loss due to death. It is a direct clinical service outreach into the community for Duke HomeCare & Hospice. c) Types of Services the Agency Provides (bullet format): Duke Hospice Bereavement Services provides (DHBS) support to grieving people. There are two service lines provided through DHBS; hospice bereavement support and community bereavement support. The hospice benefit requires that hospice services offer grief support and education to hospice family members and operate a program through which grieving family members of hospice patients can receive counseling, information and resources to assist them in coping with the death of a loved one. In addition to the hospice level of care, DUBS extends its support to the community by offering individual grief support, access to workshops and grief groups, education and resources to help any member of the community adjust to living life after the death of a loved one. Services to both program lines include: • Grief support through individual counseling and grief group support • Community education available to any civic or religious group which requests that type of support • Crisis intervention after the sudden death in the work place • School based interventions including education and workshops for administrative staff, teachers, social workers, counselors • School based interventions including training of social workers and counselors to respond to grief in the school. • School based grief support groups with an emphasis on providing training and supervision for school social workers and counselors to feel better equipped to address symptoms of grief which may occur in schools. • Annual memorial services to commemorate people lost to death. These services are open to the community. • Annual Camp ReLEAP for children kindergarten through 8"' grade. An annual overnight camp to assist children in adjusting to the death of a significant person and to develop coping skills to better understand and manage their own grief responses. • Family grief support groups to provide education to parents /guardians and children to enhance communication and understanding of the impact of grief on the family system. Agency Information 1/1912018 12:42:41 PM Page 3 o f 1 1