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DocuSign Envelope ID: D90F57F1-8076-4358-9941-F62552053F84 <br /> I <br /> TY <br /> Outside Agencies/Human Services <br /> Please use the drop down menu below to select which function area best aligns with your agency and <br /> program(s) in which you are requesting funding. Please select only one from the drop down menu <br /> below. <br /> Behavior Health <br /> If you selected other,please tell us what function area best aligns with your organization: <br /> Please indicate three program <br /> goals/performance measures below. <br /> A few notes: <br /> • If you use percentages, please put the actual number equivalence. <br /> • Please ensure your performance measures are outcome based and not outputs. <br /> Provide evidence-based therapeutic interventions <br /> Program Goal# 1 to improve the mental health and wellness of <br /> children and families identified through outreach <br /> activities <br /> Performance Measure #of individuals (families and providers) reached <br /> (How will you accomplish your goal?) through outreach activities in the community <br /> Actual Results n/a <br /> (Outcome) <br /> Ending F718-19 <br /> Projected Results 30 individuals reached <br /> (Outcome) <br /> Ending FY2020 <br /> Projected Results 50 individuals reached <br /> (Outcome) <br /> Ending FY2021 <br /> Provide and complete evidence-based therapeutic" <br /> Program Goal#2 interventions to improve the mental health and <br /> wellness of children and families <br /> Performance Measure #and% of children (and families) completing <br /> (How willyou accomplish your goal?) , M therapeutic interventions <br /> Actual Results <br /> 80, or 84%, of the 88 children referred <br /> (Outcome) y <br /> Ending FY18-19 ,x . <br /> Projected Results 88, or$0%, of the'110 estimated children' <br /> (Outcome) y <br /> Ending FY2020 ri ?' S41, <br /> Projected Results 98,,or 82%, of the 120 estimated children <br /> (Outcome) aa � x 3 <br /> Ending FY2021 <br /> t <br /> Program infortnation P a g e 13 o f 2 8 <br />