2018-507-E Finance - Club Nova outside agency agreement

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DocuSign Envelope ID: 717C8AE2- 4D6E- 4E46- A9A7- F4213973D039 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION coordination and communication; Increased community engagement. Town of Carrboro Board of Aldermen: Enhance and sustain quality of life /place for everyone. Maintain Carrboro's unique identity. Help develop a human environment that promotes trust, mutual respect, acceptance, happiness and well- being. f) Who is your target population of individuals to benefit from this program and how will they be identified and connected with the program? Club Nova works with Orange County adults living with serious mental illness (SMI), primarily schizophrenia and bipolar disorder. All members are beneficiaries. Beneficiaries are identified through outreach, community education, other providers and organizations, families, and members of the community. Our referral process ensures that Club Nova is preserved for the intended beneficiaries — adults living with serious mental illness. g) Describe the credentials of the program manager and other key staff. (Ex. Identify Program Manager and credentials, describe training provided to volunteers, etc.) All staff must have the following trainings in order to maintain our Mental Health License, be accredited by CARF, and in order to bill for Medicaid services: • CPR and First Aid — Annually • Client Rights • Confidentiality • HIPAA • Infectious Diseases and Bloodborne Pathogens • Alternatives to Restrictive Intervention and Crisis Management The following are our kev staff related to the program and their credentials: Karen Kincaid Dunn, Executive Director, BA, QP, 30+ years of direct mental health experience working with individuals living with serious mental illness through work at John Umstead Hospital and Club Nova. Club Nova Director for 24 years with 11 years in non-profit leadership' Steven Warnock, Associate Director of Program, M.Div., QP, 12 years of direct mental health experience and 21 years of non- profit programming and leadership. Marsha Pate, Associate Director of Community Relations, MEd, QP, 6 years of direct mental health experience, plus 30 years of non-profit programming and leadership Peter Mazzei, Coordinator of Membership, MSW, QP, 9 years director mental health experience and leadership. Sadie Brooks, Associate Director of Administration, 4 years direct mental health experience and 18 years administrative operations. Volunteers go through a Club Nova orientation, and are trained directly by an Associate Director and members. They are required to have confidentiality and Clubhouse Model trainings. h) Describe the specific period over which the activities will be carried out and include an implementation timeline. Implementation Timeline: Club Nova has been fully operational for 30 years. • We are open six days per week and all major holidays on the holiday. We are open 55 + hours per week. • Community Supports are provided on a daily, ongoing, and as needed basis. • Nutritious, Affordable Meals: 5 Breakfasts (Mon -Fri), 6 Lunches (Mon -Sat), 2 Dinners (Mon & Thurs), Holiday Meals. Serve 12,000 + meals annually. Members are involved in planning and preparation. • Employment, Supported Education, and Outreach are provided on a daily, ongoing basis. • Transportation: Operates two routes a day (morning and evening) Mon -Sat and major holidays. • Work Ordered Day operates Mon -Fri 8 AM -6 PM and Sat 10 AM -5 PM. PROGRAM INFORMATION 1123/2018 1:58:29 PM Page 20 of 31