FY22 JCPC Coastal Horizons Family Preservation ProgramDocuSign Envelope ID:417lC3E1-3E71-4112-A1FC-F589CD834A9C
WoprAp,-
North Carolina Department of Public Safety
Intensive Intervention - Program Agreement
SECTION I A
SPONSORING AGENCY AND PROGRAM INFORMATION
FUNDING PERIOD:
FY 21-22
DPS/JCPC FUNDING # (cont only)
865-XXXX
COUNTY:
New Hanover
AREA:
Eastern Area
Multi -County:
No
Multi -Components
Yes
NAME OF PROGRAM:
Alternatives to Commitment: Family Preservation Program
SPONSORING AGENCY:
Coastal Horizons Center, Inc.
SPONSORING AGENCY
615 Shipyard Blvd.
PHYSICAL ADDRESS:
Wilmington NC 28412
SPONSORING AGENCY
615 Shipyard Blvd.
MAILING ADDRESS:
Wilmington NC 28412
TYPE:
Non -Profit
32427
FEDERAL ID #156-0950370
Home Based Family Counseling
Program Manager Name & Address (same person on signature page)
Name:
Sarah Nelson
Title:
TOTAL COST OF
COMPONENT ID #
NAME OF PROGRAM COMPONENT
PROGRAM TYPE
Wilmington
Zip:
28412
EACH COMPONENT
32427
Intensive Family Preservation Services
Home Based Family Counseling
$ 66,418
32455
Problematic Sexual Behavior -Cognitive Behavioral
Sexual Offender Treatment
$ 29,132
Therapy
Total cost of components:
$ 95,550
Program Manager Name & Address (same person on signature page)
Name:
Sarah Nelson
Title:
ATC Program Director
Mailing
Address:
615 Shipyard Blvd.
City:
Wilmington
Zip:
28412
Phone:
(910) 202-3155
Fax:
1 (9 10) 202-5772
E-mail: snelson@coastalhorizons.org
Contact Person (if different from program manager)
Name:
S. Estes
Title:
Treatment Operations Director
Mailing
Address:
615 Shipyard Blvd.
City:
Wilmington
TZip:
28412
Phone:
(910) 202-3155 Fax: 1 (910) 202-5772 E-mail: restes@coastalhorizons.org
Program Fiscal Officer (cannot be program manager)
Name:
Jennifer Burns
Title:
Controller
Mailing
Address:
615 Shipyard Blvd.
City:
Wilmington
Zip:
28412
Phone:
(910) 343-0145 Fax: E-mail: jburns@coastalhorizons.org
Form structure last revised 12/31/2012
Department of Public Safety
DocuSign Envelope ID:417lC3E1-3E71-4112-A1FC-F589CD834A9C
SECTION I B
PROGRAM COMPONENT DESCRIPTION
COMPONENT ID #
COMPONENT INFORMATION
32427
NAME OF COMPONENT: Intensive Family Preservation Services
BRIEF DESCRIPTION: Coastal Horizons provides intensive family preservation modeled off
the Homebuilders Program that is highly successful at reducing out of home placement and
providing support in times of crisis. This program eliminates existing service gaps in the
continuum of care, while diversifying family centered treatment. The model requires caseloads
to remain on average 2 families with ten hours of treatment per week completed by one
professional. Services are rendered in the home for 4-6 weeks.
COMPONENT ID #
COMPONENT INFORMATION
32455
NAME OF COMPONENT: Problematic Sexual Behavior -Cognitive Behavioral Therapy
BRIEF DESCRIPTION: The Problematic Sexual Behavior -Cognitive Behavioral Therapy model
is an Evidence Based Program that is highly successful in reducing the recidivism rate for
juveniles who fully participate in treatment. This program would work to address the problematic
sexual behaviors of the juvenile and concurrently help the caregiver understand problematic
sexual behavior, learn about appropriate supervision, help strengthen family relationships and
improve communication.
Form structure last revised 12/31/2012
Department of Public Safety
DocuSign Envelope ID:417lC3E1-3E71-4112-A1FC-F589CD834A9C
SECTION II
COMPONENT STATISTICAL INFORMATION
Multi -Components Yes
Component Service Statistics
PROGRAM COMPONENT INFORMATION - APPLICATION YEAR
Component Name: Intensive Family Preservation Services
Component ID #
32427
What is this component's maximum client capacity at any given time?
2
Frequency of client contact per month:
12
Anticipated Average Length of
Stay:
32
Days
y
Total Component Cost:
$66,418
- by
Estimated # to be served during funding period:
15
Estimated Average Cost Per Youth:
$4,428
Actual number of youth admitted FY 19-20:
0
Applies to
0
Number of admissions Juvenile Justice Referred
0% of total admissions
continuation
programs only.
0
Number of admissions Law Enforcement Referred
0% of total admissions
0
Number of admissions District Court Referred
0% of total admissions
Form structure last revised 01/09/2012
Department of Public Safety
DocuSign Envelope ID:417lC3E1-3E71-4112-A1FC-F589CD834A9C
SECTION III
COMPONENT SUMMARY
NAME OF COMPONENT:
Intensive Family Preservation Services
1. Statement of the Problem: In concise terminology, describe how the program will address continuum need(s) in
the county.
What are the Intensive Intervention needs the program intends to address?
How will the program effectively serve juveniles at different levels of involvement with juvenile justice?
Describe the gap in continuum of services for the population you will serve.
Currently, in New Hanover and Pender County there are minimal evidence -based family counseling programs that are
able to meet the network needs. New Hanover and Pender County's continuum of care for youth has gaps that keep
youth and families from being safeguarded in their home communities. These gaps cause many Juvenile Justice
involved families to be underserved or have behaviors that escalate until higher levels of care become needed. Many
of these youth are disqualified from other enhanced levels of care for a myriad of reasons. The existing array of
services is insufficient to meet the community-based family service needs of youth that do not qualify for mental
services because they have not engaged in lower levels of care despite current high-risk behaviors or do not qualify
based on sub -clinical mental health needs. Other gaps are families that need shorter periods of treatment. Most
models of community-based services last for three to six months and employ models not supported by the Office of
Juvenile Justice. A third, and critically impacted portion, are privately insured families. These families find themselves
in a vulnerable position because their insurance companies do not cover the needed care or have deductibles that are
too high for families to financially support their child's care. This leaves families being unable to comply with legal
requirements because they are unable to meet their child's legal, behavioral, and mental health needs. This program
has been able to meet youth on Post -Release and start engaging with the family prior to discharge.
2. Target Population: Describe the target population, including age, and the steps taken to insure that the target
population is served.
This program will serve youth from six to seventeen years old. The service will be open to male and female clients.
The following clients will be appropriate for services:
1.AI1 adjudicated juveniles 10 years and up, including juveniles who are ages 18 up to age 20 and still under the
jurisdiction of juvenile court.
2.Juveniles who have received a Level 11 Disposition.
31evel III juveniles who are transitioning from a Youth Development Center
4.Select Level I adjudicated juveniles, with a Medium/High Risk or Medium/High Needs score may be referred.
3. Program Goal(s): Provide a brief statement to describe the overall purpose and effect of the program.
The overarching goal of the program is to form an enhanced network of services to decrease delinquent and criminal
behaviors, reduce unnecessary out -of -home placements, and offer concrete supports to families during time of needs.
Coastal Horizons Center's mission is to promote choices for healthier lives and safer communities. This program will
advance the mission of our organization by helping to ensure that some of the most marginalized juveniles have their
mental health and behavioral health needs met.
The developers of this model describe the goals as followed: HOMEBUILDERS® provides intensive, in-home crisis
intervention, counseling, and life -skills education for families who have children at imminent risk of placement in state -
funded care. It is the oldest and best -documented Intensive Family Preservation Services (IFPS) program in the United
States. Our goal is to prevent the unnecessary out -of -home placement of children through intensive, on-site
intervention, and to teach families new problem -solving skills to prevent future crises.
Form structure last revised 12/31/2012
Department of Public Safety
DocuSign Envelope ID:417lC3E1-3E71-4112-A1FC-F589CD834A9C
SECTION III
COMPONENT SUMMARY
NAME OF COMPONENT:
Intensive Family Preservation Services
(Institute for Family Development, http://www.institutefamily.org/programs_IFPS.asp, 2015).
4. Measurable Objective(s): State in measurable terms (%) the intended effect of the program on specific
undisciplined and/or delinquent behaviors. Example: anticipated reductions in court referrals, runaway behavior,
disruptive behavior at school, anticipated improved school attendance and academic achievement. These objectives
must include impact on participants.
81 % Clients will successfully or satisfactorily complete services as intended by the program design/service plan.
72% Clients will have no new adjudications for a complaint with an offense date after the admission date.
81 % Clients successfully/satisfactorily completing the program will have no new adjudications in the 12 months
following completion.
81 % Clients and families will demonstrate enhanced family functioning as a result of program services.
81 % Clients will comply with the permanency plan as described in the individual service plan.
72% Clients will have no new complaints with an offense date after the admission date.
81 % Clients successfully/satisfactorily completing the program will have no new complaints in the 12 months following
completion.
81 % Clients will reduce specific problem behaviors presented at referral and targeted in the individual service plan.
100% Clients will demonstrate improvement in replacement behaviors targeted in the individual service plan.
5. Elevated Risks and Needs: Describe how you will address one or more of the Elevated Risk and Needs of
adjudicated juveniles referenced in the Intensive Intervention services Request for Proposals.
Be sure to identify the specific risk and/or needs item(s) you will address.
New Hanover County trends higher than the state on the most current Risk and Needs reports produced by the
Division of Juvenile Justice in regards to family criminality, mental health needs assessment, and peer relationships.
These are all elevated risks that can be addressed through the funding of the Intensive Family Preservation model for
this county. As stated before this is a comprehensive model that is able to address parenting needs, school behaviors,
and teach skills for mood regulation and anger management. This program will allow Court Counselors to have greater
access to evidence -based treatment, with proven supports. Additionally, this program will give Court Counselors more
access to an organization that they have an established partnership, and that has a wealth of resources housed in one
agency.
Form structure last revised 12/31/2012
Department of Public Safety
DocuSign Envelope ID:417lC3E1-3E71-4112-A1FC-F589CD834A9C
SECTION IV
COMPONENT NARRATIVE (attach for each component)
NAME OF COMPONENT:
Intensive Family Preservation Services
1. Location: List physical address(es) and describe where program services are delivered.
The program is a community based program, and will primarily be delivered in the recipient's home. Other acceptable
service delivery places would include services delivered to meet the holistic needs of the child and/or family such as
school, mental health facility, court, Division of Juvenile Justice facility, detention center, and other relevant
collaborative services. The corporations physical address is 615 Shipyard Blvd, Wilmington, NC 28412.
2. Operation: Describe the daily/weekly schedule of program operation.
The IFPS worker and their supervisor will adhere to the fidelity of the Homebuilders Model while providing routine and
crisis care available twenty-four hours a day, seven days a week, 365 days per year. Each family will always receive
minimally forty hours of face-to-face contact and have no less than on average three visits per week. The family will
develop a service plan with their Child and Family team. The service plan will serve as the guiding mechanism for how
their services will be tailored. Scheduled hours will be flexible to meet the needs of youth and families, and this will
include night and weekend hours. For this reason, the worker will only carry two cases at a time per the fidelity of the
model.
3. Staff Positions: Describe paid or volunteer position qualifications, (certifications, degrees, work experience) and
position(s) responsibilities relative to this component.
This time-limited service ultimately strives to help parents to have the skills to maintain their child in the home, and to
develop the necessary skills to keep all parties safe. Our professionals are trained in ten hours of trauma focused
Cognitive Behavioral Therapy, thirteen initial hours of North Carolina's System of Care Model, Motivational
Interviewing, eleven hour of crisis intervention including eight hours of NCI, twelve hours of Person Centered Thinking,
and multiple other related trainings for behavioral healthcare specialists. These trainings are intended to be the starting
point of investment in the youth and families that we serve. The staff will additionally attend the first five day training
offered through the state for the Homebuilders model. The funding will pay for .75 FTE time, dedicated position
assigned to the program. This staff member will have a minimally a Bachelors, and preferably a Master's degree in a
social services field and at least one year of relevant work or internship experience. The program will have an IFPS
supervisor that is trained in the model as well. This position will not be fully funded through this funding stream.
Additionally, the department has a medical records and data collection administrative position that is connected to the
program.
4. Service Type SPEP: Describe implementation to include:
Primary Service: Family Counseling; Secondary Service: None
Evidence -Based Program Name: Homebuilder's Intensive Family Preservation Services
Target Weeks: 4; Target Hours: 40
5. Admission Process: Describe the specific referral, screening, admission process (including timeline), the staff
responsible for making decisions about admissions and reasons why a referral may not be accepted.
Please describe:
a) The specific referral, screening, and admission process, including at a minimum, the staff involved with the decision
process.
b) Interaction with Juvenile Court Counselors, other juvenile justice staff, and youth development centers, if applicable,
including frequency, ongoing meetings, and other means of communication.
Form structure last revised 12/31/2012
Department of Public Safety
DocuSign Envelope ID:417lC3E1-3E71-4112-A1FC-F589CD834A9C
SECTION IV
COMPONENT NARRATIVE (attach for each component)
NAME OF COMPONENT:
Intensive Family Preservation Services
Coastal Horizons Center values a collaborative process with referring youth that stresses the importance of timely
admission, and to the correct level of care. Based on the Homebuilder's model, youth must be accepted into services
and have their first appointment with a staff member within forty-eight hours of referral. If the program does not have
any available positions then the referring Court Counselor will learn immediately that there are no available spaces,
and when the next projected opening will occur. If a youth is being referred from Youth Development Center then the
worker will attend the meeting and these youth will receive priority with spaces on the worker's caseload.
Coastal Horizons Center has been an active participant in local JJSAMHP committees as well as Juvenile Crime
Prevention Councils. These meeting serve as a vehicle to continue communication with vested stakeholders, and
understand the perception of services being offered. Our program intends to follow the expectations generally held by
most JJSAMHP partnerships such as notifying the referring Court Counselor at time of referral, communication once
an intake has been scheduled, providing any assessments or screens completed at intake within five days of intake, a
pre -closure meeting is held one week from discharge, and termination and aftercare paperwork is shared within one
week of discharge.
6. Termination Process: Describe the termination process, to include:
a) The staff responsible for making decisions.
b) The process for making the decision to terminate.
c)The criteria for a successful termination, satisfactory termination, unsuccessful completion, and non-compliant
termination.
The Homebuilder's model requires a pre -closure meeting to occur on the week of the twenty-first day of service. This is
the time when a determination to extend to six weeks typically occurs. At this time, the service plan will be updated to
reflect progress made and aftercare recommendations. A discharge summary will be made available one week from
the discharge date or sooner as requested.
The specialist will maintain open communication with the court counselor regarding the family's progress with the
service. During the Pre -Closure meeting, open conversation will be had with all parties involved regarding
termination.
Successful termination requires the minimum number of hours have been completed, progress has been made
towards goals developed at the start of services, and no new complaints have been received.
How are the Juvenile Court Counselor and/or other juvenile justice staff involved in the termination process?
The court counselor is actively involved in the termination process. The court counselor is invited to the termination
meeting with the juvenile and their family. The court counselor is provided with a copy of the closing letter, case
closure form (indicates goals and contact information for referrals) and weekly progress form (indicates weekly contact
hours and areas addressed), and a discharge summary within seven days of discharge.
7. Referring Agency Interaction: Describe the interaction with Juvenile Court Counselors and/or other juvenile
justice staff, including how client progress will be communicated.
During the duration of services the Court Counselor will receive at least weekly phone communication, all crisis or
behaviors that impact probationary status will be communicated in a period not to exceed twenty-four hours, and face-
to-face meetings will be accommodated as requested or as needed to coordinate care.
8. Intervention/Treatment: Describe specifically:
Form structure last revised 12/31/2012
Department of Public Safety
DocuSign Envelope ID:417lC3E1-3E71-4112-A1FC-F589CD834A9C
SECTION IV I COMPONENT NARRATIVE (attach for each component)
NAME OF COMPONENT: I Intensive Family Preservation Services
What will the component do to address intensive intervention continuum needs and/or redirect inappropriate youth
behavior?
How will the component address the identified needs of the youth and family?
What interventions will typically be utilized in this component?
How will parents/guardians be involved?
What is the therapeutic element within the service?
The Institute for Family Development states "HOMEBUILDERS® also works with youth and their families to correct
problems that contribute to delinquency, while allowing the youths to remain in the community. Staff help clients find
the right school setting, attend classes regularly, adhere to curfews, comply with the court, participate in constructive
activities with peers, and learn to manage anger and conflict without getting into trouble. Therapists also help parents
learn to deal with the stress of raising a difficult adolescent (http://www.institutefamily.org/programs_lFPS.asp, 2015)."
The model provides family and individual supportive counseling as appropriate to the education and licensure status of
the staff. The model allows flexibility where to place emphasis between the child or caregiver, however, at least one
caregiver must be actively involved in the services.
The model's key elements are:
Intervention at the crisis point: Services start when the families are in crisis. Client families are seen within 24-48 hours
of referral.
Treatment in the natural setting: Services take place in the client's home or the community where the problems are
occurring and, ultimately, where they need to be resolved.
Accessibility and responsiveness: Specialists are on call to their clients 24 hours a day, 7 days a week. Families are
given as much time as they need, when they need it. This accessibility also allows close monitoring of any dangerous
situations.
Intensity: Services are time-limited and concentrated in a period targeted at 4 weeks. The service is designed to
resolve the immediate crisis, and teach the skills necessary for the family to remain together. Each family receives an
average of 40 to 50 hours of direct service.
Low caseloads: Specialists carry only 2 to 3 cases at a time. This enables them to be accessible and provide intensive
services. Low caseloads also allow therapists the time to work on specific psycho -educational interventions, as well as
the basic hard service needs of the family. The services are concentrated to take advantage of the time when families
are experiencing the most pain, and have the most motivation to change.
Research -based interventions: Specialist utilize a range of research -based interventions, including crisis intervention,
motivational interviewing, parent education, skill building, and cognitive/behavioral therapy.
Flexibility: Services are provided when and where the clients wish. Specialists provide a wide range of services, from
helping clients meet the basic needs of food, clothing, and shelter, to the most sophisticated therapeutic techniques.
Specialists teach families basic skills such as using public transportation systems, budgeting, and where necessary,
dealing with the social services system. They also educate families in areas commonly associated with counseling,
such as child development, parenting skills, anger management, mood management skills, communications, and
Form structure last revised 12/31/2012
Department of Public Safety
DocuSign Envelope ID:417lC3E1-3E71-4112-A1FC-F589CD834A9C
SECTION IV
COMPONENT NARRATIVE (attach for each component)
NAME OF COMPONENT:
Intensive Family Preservation Services
assertiveness.
9. Best Practice Model: Describe what evidence based/support model(s) or practice the program will use.
North Carolina Child Welfare worked in partnership with Institute of Family Development to employ a state Intensive
Family Preservation model based on the Homebuilders program. Our team works with Child Welfare to implement this
program, and receive fidelity review with the child welfare state consultant. The Homebuilders model has stringent
requirements that staff work with two families on average with the ability to only take a third family during the discharge
week of an existing family. This heightened level of commitment to a small caseload ensures that families are creating
strong therapeutic alliance, greater accessibility to their worker, and allow for progress at a much faster rate. The
model is based on working with families for four weeks with the ability to extend to a maximum period of six weeks at
the request of the referring agency in consultation with the worker. National Research has shown that this model is one
of the most effective models to deliver home based family preservation services (Kirk, Raymond S., and Diane P.
Griffith. 2003. "Intensive Family Preservation Services: Demonstrating Placement Prevention Using Event History
Analysis." Social Work Research 28:5-18) and it is endorsed by the OJJDP website.
Form structure last revised 12/31/2012
Department of Public Safety
DocuSign Envelope ID:417lC3E1-3E71-4112-A1FC-F589CD834A9C
SECTION II
COMPONENT STATISTICAL INFORMATION
Multi -Components Yes
Component Service Statistics
PROGRAM COMPONENT INFORMATION - APPLICATION YEAR
Component Name: Problematic Sexual Behavior -Cognitive Behavioral Therapy
Component ID #
32455
What is this component's maximum client capacity at any given time?
6
Frequency of client contact per month:
6
Anticipated Average Length of
Stay:
133
Days
y
Total Component Cost:
$29,132
- by
Estimated # to be served during funding period:
16
Estimated Average Cost Per Youth:
$1,821
Actual number of youth admitted FY 19-20:
0
Applies to
0
Number of admissions Juvenile Justice Referred
0% of total admissions
continuation
programs only.
0
Number of admissions Law Enforcement Referred
0% of total admissions
0
Number of admissions District Court Referred
0% of total admissions
Form structure last revised 01/09/2012
Department of Public Safety
DocuSign Envelope ID:417lC3E1-3E71-4112-A1FC-F589CD834A9C
SECTION III
COMPONENT SUMMARY
NAME OF COMPONENT:
Problematic Sexual Behavior -Cognitive Behavioral Therapy
1. Statement of the Problem: In concise terminology, describe how the program will address continuum need(s) in
the county.
What are the Intensive Intervention needs the program intends to address?
How will the program effectively serve juveniles at different levels of involvement with juvenile justice?
Describe the gap in continuum of services for the population you will serve.
In New Hanover and Pender Counties there has been an increase in illegal sexual activity by juveniles. This growing
issue has not been addressed by current community programs. Juveniles who are dealing with problematic sexual
behavior are often mislabeled and do not receive appropriate services. Problematic sexual behaviors are defined as
"developmentally inappropriate sexual behaviors [that] occur at a greater frequency or a much earlier age than would
be developmentally or culturally expected, become a preoccupation for the child, and/or reoccur after adult intervention/
corrective efforts" (Elkovitch et al., 2009, p. 589). Chaffin (2008) reports that there is a misconception that juveniles
dealing with problematic sexual behaviors are difficult to change and require long-term extensive treatment. On the
contrary, by utilizing Problematic Sexual Behaviors -Cognitive Behavioral Therapy to address the issues with both the
juvenile and the parent/caregiver, the juvenile is able to make progress and ideally eliminate any future problematic
sexual behavior. This program will be individualized within the family, which allows for more direct care and
addressing of concerns. The program follows specific treatment modules, which also include restitution and apology.
This model will work to improve communication and work to enhance parent-child interaction. By utilizing a short-term
model (18 modules), juveniles have been show to meet criteria for a `cure' and are able to function safely and healthily
in the community (Carpentier et al., 2005). The program will also utilize case management services, which will allow
for the wrap-around of services. This wrap-around will help address any concerns within the family that do not directly
relate to the PSB, but impact the juvenile and family functioning. The case management services will continue after
the completion of the treatment model for an additional 3-4 weeks as needed.
Currently in the area there is a gap in directive care to address problematic sexual behavior in juveniles. By utilizing
this model of care, the juvenile and their family will receive specific individualized care that will help reduce the risk and
potential for reoffending. The gap also occurs due to a misunderstanding of problematic sexual behaviors and often
identifying the juvenile as a sexual offender prematurely. By utilizing this model, there will be additional education
provided to the family and in turn with community partners who also work with the juvenile and their family.
2. Target Population: Describe the target population, including age, and the steps taken to insure that the target
population is served.
This program will serve youth from thirteen to eighteen years old. The service will be open to male and female clients.
The following clients will be appropriate for services:
1.All adjudicated juveniles 10 years and up, including juveniles who are ages 18 up to age 20 and still under the
jurisdiction of juvenile court.
2.Juveniles who have received a Level II Disposition.
31evel III juveniles who are transitioning from a Youth Development Center
4.Select Level I adjudicated juveniles, with a Medium/High Risk or Medium/High Needs score may be referred.
3. Program Goal(s): Provide a brief statement to describe the overall purpose and effect of the program.
The goals for the program will be to help the juvenile and their family develop an understanding of PSBs, underlying
causes, what to look for, how to respond, and how to move forward. The program will work to improve family
functioning and relationships. The program will help the juvenile identify key strategies to utilize to prevent PSBs from
happening in the future.
Form structure last revised 12/31/2012
Department of Public Safety
DocuSign Envelope ID:417lC3E1-3E71-4112-A1FC-F589CD834A9C
SECTION III
COMPONENT SUMMARY
NAME OF COMPONENT:
Problematic Sexual Behavior -Cognitive Behavioral Therapy
4. Measurable Objective(s): State in measurable terms (%) the intended effect of the program on specific
undisciplined and/or delinquent behaviors. Example: anticipated reductions in court referrals, runaway behavior,
disruptive behavior at school, anticipated improved school attendance and academic achievement. These objectives
must include impact on participants.
80% Clients successfully/satisfactorily completing the program will have no new adjudications in the 12 months
following completion.
80% Parents/legal guardians will actively participate in treatment as required.
80% Clients will demonstrate improvement in replacement behaviors targeted in the individual service plan.
80% Clients will reduce specific problem behaviors presented at referral and targeted in the individual service plan.
80% Clients will have no new adjudications for a complaint with an offense date after the admission date.
80% Clients will have no new complaints with an offense date after the admission date.
80% Clients will reduce sexually aggressive or inappropriate behaviors.
80% Clients successfully/satisfactorily completing the program will have no new complaints in the 12 months following
completion.
80% Clients will successfully or satisfactorily complete services as intended by the program design/service plan.
5. Elevated Risks and Needs: Describe how you will address one or more of the Elevated Risk and Needs of
adjudicated juveniles referenced in the Intensive Intervention services Request for Proposals.
Be sure to identify the specific risk and/or needs item(s) you will address.
New Hanover County and Pender County trend higher than the state on the most current Risk and Needs reports
produced by the Division of Juvenile Justice in regards to problem sexual behavior, family criminality, mental health
needs assessment, and peer relationships. These are all elevated risks that can be addressed through the funding of
the Problematic Sexual Behavior -Cognitive Behavioral Therapy model for these counties. As stated before this is a
comprehensive model that is able to address problematic sexual behaviors, identify potential causes, make plans to
reduce/eliminate instances of problematic sexual behaviors, and improve family functioning. This program will allow
Court Counselors to have greater access to evidence -based treatment, with proven supports. Additionally, this
program will give Court Counselors more access to an organization that they have an established partnership, and that
has a wealth of resources housed in one agency.
Form structure last revised 12/31/2012
Department of Public Safety
DocuSign Envelope ID:417lC3E1-3E71-4112-A1FC-F589CD834A9C
SECTION IV
COMPONENT NARRATIVE (attach for each component)
NAME OF COMPONENT:
Problematic Sexual Behavior -Cognitive Behavioral Therapy
1. Location: List physical address(es) and describe where program services are delivered.
This program is an office -based program with a community component. The therapy aspect of PSB -CBT will be
completed in the Wilmington Health Access for Teen (WHAT) Clinic office. Due to the current pandemic, if virtual
services are needed, that can be accommodated. The physical address is 4005 Oleander Drive, Wilmington, NC
28403.
The case management component is a community based program, and will primarily be delivered in the recipient's
home. Other acceptable service delivery places would include services delivered to meet the holistic needs of the child
and/or family such as school, mental health facility, court, Division of Juvenile Justice facility, detention center, and
other relevant collaborative services. The corporations physical address is 615 Shipyard Blvd, Wilmington, NC 28412.
2. Operation: Describe the daily/weekly schedule of program operation.
The PSB -CBT Family model requires weekly sessions to be completed over a 18 week period. The family sessions
will last between sixty and ninety minutes. The family sessions will work to best accommodate the scheduling needs of
the family. The case management component will provide crisis care to the family twenty-four hours a day, seven days
a week, 365 days per year. Scheduled hours will be flexible to meet the needs of youth and families, and this will
include night and weekend hours.
3. Staff Positions: Describe paid or volunteer position qualifications, (certifications, degrees, work experience) and
position(s) responsibilities relative to this component.
Coastal Horizons Center will employ and utilize staff for this program that are consistent with the regulations set forth
by the local JCPC and NC DHHS. The therapist will be a Master's level clinician who is either provisionally or fully
licensed. The therapist will have prior experience working with CBT and trauma. The therapist will have a strong
working knowledge of Child Advocacy Centers, PSB, and family therapy. The therapist will be a .4 FTE.
4. Service Type SPEP: Describe implementation to include:
Primary Service: Cognitive Behavior; Secondary Service: None
Evidence -Based Program Name: Problemmatic Sexual Behavior - CBT
Target Weeks: 18; Target Hours: 36
5. Admission Process: Describe the specific referral, screening, admission process (including timeline), the staff
responsible for making decisions about admissions and reasons why a referral may not be accepted.
Please describe:
a) The specific referral, screening, and admission process, including at a minimum, the staff involved with the decision
process.
b) Interaction with Juvenile Court Counselors, other juvenile justice staff, and youth development centers, if applicable,
including frequency, ongoing meetings, and other means of communication.
Coastal Horizons Center values a collaborative process with referring youth that stresses the importance of timely
admission, and to the correct level of care. The family will be contacted to begin the intake process. The family will
complete the intake assessments with the therapist. Once the intake process is completed, the family will be able to
start services within a week. If a youth is being referred from Youth Development Center then the worker will attend
the meeting and these youth will receive priority with spaces on the worker's caseload.
Form structure last revised 12/31/2012
Department of Public Safety
DocuSign Envelope ID:417lC3E1-3E71-4112-A1FC-F589CD834A9C
SECTION IV
COMPONENT NARRATIVE (attach for each component)
NAME OF COMPONENT:
Problematic Sexual Behavior -Cognitive Behavioral Therapy
Coastal Horizons Center has been an active participant in local JJSAMHP committees as well as Juvenile Crime
Prevention Councils. These meeting serve as a vehicle to continue communication with vested stakeholders, and
understand the perception of services being offered. Our program intends to follow the expectations generally held by
most JJSAMHP partnerships such as notifying the referring Court Counselor at time of referral, communication once
an intake has been scheduled, providing any assessments or screens completed at intake within five days of intake, a
pre -closure meeting is held one week from discharge, and termination and aftercare paperwork is shared within one
week of discharge.
6. Termination Process: Describe the termination process, to include:
a) The staff responsible for making decisions.
b) The process for making the decision to terminate.
c)The criteria for a successful termination, satisfactory termination, unsuccessful completion, and non-compliant
termination.
The PSB -CBT model has a distinct timeline for completing services. The court counselor will be provided with bi-
monthly updates on the juvenile and family progress with the program. The court counselor will be invited to a
termination meeting with the therapist, case manager, juvenile and family to identify on-going recommendations and
needs for the family. The case manager will work with the court counselor to complete referrals and ensure the family
is able to start services. IF there are any barriers that arise, the court counselor will be updated within twenty -fours of
the discovery of the barrier.
How are the Juvenile Court Counselor and/or other juvenile justice staff involved in the termination process?
The court counselor will be included in any child and family team meetings to discuss family's progress with PSB -CBT.
As the family reaches the last 2 modules, the court counselor will be invited to the final session to learn the progress
that was made and any future recommendations. The court counselor will be given the opportunity to share any
concerns, needs, and progress the juvenile has made.
7. Referring Agency Interaction: Describe the interaction with Juvenile Court Counselors and/or other juvenile
justice staff, including how client progress will be communicated.
During the duration of services, the Court Counselor will receive at least bi-monthly phone communication, all crisis or
behaviors that impact probationary status will be communicated in a period not to exceed twenty-four hours, and face-
to-face meetings will be accommodated as requested or as needed to coordinate care. The court counselor will
receive weekly email updates to document if the family participated and any potential concerns.
8. Intervention/Treatment: Describe specifically:
What will the component do to address intensive intervention continuum needs and/or redirect inappropriate youth
behavior?
How will the component address the identified needs of the youth and family?
What interventions will typically be utilized in this component?
How will parents/guardians be involved?
What is the therapeutic element within the service?
The PSB -CBT model utilizes a social -ecological approach to address protective factors. The model works to create:
healthy boundaries supported and modeled, protection from harm and trauma, parental guidance and supervision,
Form structure last revised 12/31/2012
Department of Public Safety
DocuSign Envelope ID:417lC3E1-3E71-4112-A1FC-F589CD834A9C
SECTION IV
COMPONENT NARRATIVE (attach for each component)
NAME OF COMPONENT:
Problematic Sexual Behavior -Cognitive Behavioral Therapy
healthy friendships, open communication about feelings with a trusted adult, successful experiences/skills, and
adaptive coping skills. The PSB -CBT model utilizes 12 modules that specifically help the juvenile and parent/caregiver
learn and understand PSB and what comes next as a preventative process. The model also includes a juvenile justice
guest speaker, who will provide additional information from a legal standpoint.
This model requires parent/caregiver participation. The family modality is weekly and includes individual juvenile time,
individual parent time, and a combined time at the end of the session.
9. Best Practice Model: Describe what evidence based/support model(s) or practice the program will use.
This is a cognitive—behavioral therapy (CBT) program for children that is designed to eliminate problematic sexual
behavior. The program is rated Effective. Children in the CBT treatment group who demonstrated problematic sexual
behavior displayed no statistically significant differences, compared with control group children, in sexual and
nonsexual offenses at the 10 -year follow up, indicating that the treatment was effective at reducing these behaviors.
This program is one of two OJJDP endorsed programs for this population.
Form structure last revised 12/31/2012
Department of Public Safety
DocuSign Envelope ID:417lC3E1-3E71-4112-A1FC-F589CD834A9C
SECTION V Terms of Agreement
This Agreement is entered into by and between Department of Public Safety (hereinafter referred to as DPS), and New
Hanover County, (hereinafter referred to as the County), the County's Juvenile Crime Prevention Council (hereinafter
referred to as the JCPC) and Coastal Horizons Center, Inc. (hereinafter referred to as the Sponsoring Agency).
DPS, the County, the JCPC and the Sponsoring Agency do mutually agree as follows:
Term of Agreement
This Agreement shall become effective Jul 1, 2021 and shall terminate Jun 30, 2022.
Payment to Sponsoring Agency
All parties agree that services will be delivered as described in the approved Program Agreement and that funds will be
disbursed in an amount not to exceed the amount $95550 for the term of this agreement, unless amended by an
approved Program Agreement Revision.
Availability of Funds:
All parties to this Agreement agree and understand that the payment of the sums specified in this Program Agreement
budget, or most recently approved Program Agreement Revision, is dependent and contingent upon and subject to the
appropriation, allocation, and availability of funds for this purpose to DPS.
Responsibilities of the Parties
DPS shall:
1. Disburse funds monthly to County Governments, for payment to the Sponsoring Agency, from the fund
appropriation by the General Assembly;
2. Reserve the right to suspend payment to the County for any non-compliance by the Sponsoring Agency with any
reporting requirements set forth in DPS JCPC Policy and Procedures;
3. Notify in writing the County and Sponsoring Agency immediately if payments are suspended and again once
payments resume;
4. Pay only for work as described in the Program Agreement, or most recently approved Program Agreement
Revision, provided by the Sponsoring Agency and approved subcontractors;
5. Provide technical assistance, orientation and training to the Sponsoring Agency, the County and the JCPC;
6. Monitor Sponsoring Agency's funded program(s) in accordance with DPS JCPC Policy 3. Operations: Program
Oversight and Monitoring; and
7. Notify parties entering into this Agreement of all due dates in a timely manner in order for reports to be submitted
by the established due date.
The Sponsoring Agency shall:
1. Comply with all laws, ordinances, codes, rules, regulations, and licensing requirements that are applicable to the
conduct of its business, including those of Federal, State, and local agencies having jurisdiction and/or authority;
Form structure last revised 12/20/2013
Department of Public Safety
DocuSign Envelope ID:417lC3E1-3E71-4112-A1FC-F589CD834A9C
2. Comply with all Federal and State laws relating to equal employment opportunity;
3. Keep as confidential and not divulge or make available to any individual or organization without the prior written
approval of DPS any information, data, instruments, documents, studies or reports given to or prepared or
assembled by the Sponsoring Agency under this Agreement;
4. Acknowledge that in receiving, storing, processing or otherwise dealing with any confidential information it will
safeguard and not further disclose the information except as otherwise provided in this Agreement;
5. Comply with DPS JCPC Policy and Procedures and the North Carolina Administrative Procedures;
6. Secure local match as required, if applicable, pursuant to 14B NCAC 11 B.0105, for approved JCPC funds;
7. Create and adopt individualized guidelines specific to the funded program, while also adhering to DPS JCPC
Policy and Procedures for all funded programs and for the specific program type for which they receive funding;
8. Ensure that state funds received are spent in accordance with the approved Program Agreement, or most recently
approved Program Agreement Revision, and be accountable for the legal and appropriate expenditure of those
state funds;
9. Maintain reports, records, and other information to properly document services rendered and outcomes; also
maintain an ability to send and receive electronic communication;
10. Have the capacity to use DPS electronic, internet-based system for tracking clients served;
11. Use generally accepted accounting procedures that guarantee the integrity of the expenditure of funds, maintain
reports, records, and other information to properly account for the expenditure of all State funds provided to the
Sponsoring Agency;
12. When refunds are requested from the North Carolina Department of Revenue for sales and/or use taxes paid by
the agency in the performance of the Program Agreement, or most recently approved Program Agreement
Revision, as allowed by NCGS §105-164.14(c), the agency shall exclude all refundable sales and use taxes from
reportable expenditures submitted to the County and DPS;
13. Submit Program Agreement Revisions, Third Quarter Accounting, Final Accounting and annual detailed
expenditures through NCALLIES. These reports must be in accordance with the submission process as outlined in
DPS JCPC Policy and Procedures and with the due dates established by DPS;
14. Make personnel, reports, records and other information available to DPS, the County, the JCPC, and/or the State
Auditor for oversight, monitoring and evaluation purposes;
15. Submit any other information requested by the JCPC, County or DPS;
16. Be responsible for the performance of all subcontractors as described in the JCPC Program Agreement, or most
recently approved Program Agreement Revision;
17. Indemnify and hold harmless DPS, the State of North Carolina, the County and any of their officers, agents and
employees, from any claims of third parties arising out of any act or omission of the Sponsoring Agency in
connection with the performance of the Program Agreement or most recently approved Program Agreement
Revision;
18. Receive permission and budgetary approval from DPS prior to using the Program Agreement, or most recently
approved Program Agreement Revision, as a part of any news release or commercial advertising and
acknowledge DPS funding in partnership with the County;
19. Comply with DPS trainings and requirements regarding the United States Department of Justice national
standards to prevent, detect, and respond to prison rape under the Prison Rape Elimination Act (PREA);
Reference: 14B NCAC 118, and in compliance with DPS JCPC Policy 2: Operations: Program Operational
Requirements
20. Be deemed an independent contractor in the performance of services described in the Program Agreement, or
most recently approved Program Agreement Revision, and as such shall be wholly responsible for the services to
be performed and for the supervision of its employees;
21. Represent that it has, or shall secure at its own expense, all personnel required in performing the services as
described in the Program Agreement. Such personnel shall not be employees of, or have any individual
contractual relationship with, DPS;
Form structure last revised 12/20/2013
Department of Public Safety
DocuSign Envelope ID:417lC3E1-3E71-4112-A1FC-F589CD834A9C
Sponsoring Agency and Use of Contractor(s)/Subcontractors
The Sponsoring Agency may engage with independent contractors as needed to perform services or support services
described in the Program Agreement. When independent contractors (funds are included in line item 190 of the
budget) are providing services as described in the Program Agreement, the sponsoring agency must:
22. Upload a signed Contract for Professional Services into NCALLIES once the Program Agreement (or
Program Agreement Revision) is approved by DPS;
23. Be responsible for the performance of all contractors or subcontractors as described in the Program
Agreement, or most recently approved Program Agreement Revision;
24. Hold any contractor or subcontractor to which the Sponsoring Agency provides State funds accountable for
the legal and appropriate expenditure of State funds, and to all applicable laws and DPS JCPC Policies and
Procedures; and
25. Ensure that all contractors or subcontractors provide all information necessary to comply with the standards
set forth in the Program Agreement or most recently approved Program Agreement Revision.
The JCPC shall:
1. Ensure the Sponsoring Agency uses JCPC funds for only the purposes DPS has approved in the JCPC Program
Agreement or most recently approved JCPC Program Agreement Revision;
2. Comply with DPS JCPC Policy and Procedures and the North Carolina Administrative Code; N.C.G.S. §1436-801
(a);143B-602;143B-851
3. Review and locally approve Program Agreement Revision(s) received from the Sponsoring Agency and submit to
the County in a timely manner;
4. Review and locally approve Third Quarter Accounting forms and submit to the County in order to meet the due
date established by DPS (applicable only to JCPC funded agencies);
5. Submit any other information requested by the County or DPS; and
6. Monitor the Sponsoring Agency's currently funded JCPC program(s) in accordance with DPS JCPC Policy 3.
Operations: Program Oversight and Monitoring
Reference: 14B NCAC 118.0202 and DPS JCPC Policy 1, 7, 8, 9, 10, and 11.
The County shall:
1. Ensure the Sponsoring Agency is appropriately licensed, and either local public agencies, 501(c) (3) non-profit
corporations or local housing authorities (applicable only to JCPC funded agencies);
2. Use funds only for the purposes DPS has approved in the Program Agreement or most recently approved
Program Agreement Revision;
3. Disburse funds monthly and oversee funds to the Sponsoring Agency in accordance with 14B NCAC 11 B.0108
4. Comply with DPS JCPC Policies and Procedures and the North Carolina Administrative Procedures;
5. Review and locally approve Program Agreement Revisions received from the Sponsoring Agency for final
approval from DPS; and
6. Review and locally approve Third Quarter and jointly submit Final Accounting forms for the JCPC and all funded
programs according to the procedures and due dates established by DPS.
Reference: 14B NCAC 11 B; DPS JCPC Policy 3, 7, 8, 9, 10, and 11
Headings: The Section and Paragraph headings in these General Terms and Conditions are not material parts of the
agreement and should not be used to construe the meaning thereof.
Form structure last revised 12/20/2013
Department of Public Safety
DocuSign Envelope ID:417lC3E1-3E71-4112-A1FC-F589CD834A9C
Choice of Law: The validity of this Program Agreement and any of its terms or provisions, as well as the rights and
duties of the parties to this Program Agreement, are governed by the laws of North Carolina. The parties, by signing
this Program Agreement, agree and submit, solely for matters concerning this Program Agreement, to the exclusive
jurisdiction of the courts of North Carolina and agree, solely for such purpose, that the exclusive venue for any legal
proceedings shall be Wake County, North Carolina. The place of this Program Agreement and all transactions and
agreements relating to it, and their situs and forum, shall be Wake County, North Carolina, where all matters, whether
sounding in Program Agreement or tort, relating to the validity, construction, interpretation, and enforcement shall be
determined.
Assignment: No assignment of the Sponsoring Agency's obligations or the Sponsoring Agency's right to receive
payment hereunder shall be permitted. However, upon written request approved by the issuing purchasing authority,
DPS may:
(a) Forward the Sponsoring Agency's payment check(s) directly to any person or entity designated by the
Program Manager, or
(b) Include any person or entity designated by Sponsoring Agency as a joint payee on the Sponsoring Agency's
payment check(s).
In no event shall such approval and action obligate DPS or County Government to anyone other than the Sponsoring
Agency, and the Sponsoring Agency shall remain responsible for fulfillment of all Program Agreement obligations.
Beneficiaries: Except as herein specifically provided otherwise, this Program Agreement shall inure to the benefit of
and be binding upon the parties hereto and their respective successors. It is expressly understood and agreed that the
enforcement of the terms and conditions of this Program Agreement, and all rights of action relating to such
enforcement, shall be strictly reserved to DPS, the County Government, and the Sponsoring Agency. Nothing
contained in this document shall give or allow any claim or right of action whatsoever by any other third person. It is the
express intention of DPS and County Government that any such person or entity, other than DPS or the County
Government, or the Sponsoring Agency receiving services or benefits under this Program Agreement shall be deemed
an incidental beneficiary only.
Property Rights
Intellectual Property: All deliverable items produced pursuant to this Program Agreement are the exclusive property of
DPS. The Sponsoring Agency shall not assert a claim of copyright or other property interest in such deliverables.
Physical Property: the Sponsoring Agency agrees that it shall be responsible for the proper custody and care of any
property purchased for or furnished to it for use in connection with the performance of this Program Agreement and will
reimburse DPS for loss of, or damage to, such property. At the termination of this Program Agreement, the Sponsoring
Agency, County Government, and JCPC shall follow the guidelines for disposition of property set forth in Administrative
Code and JCPC policy.
Reference: 14B NCAC 11B.01 10; DPS JCPC Policy 9. Fiscal Accounting and Budgeting: Final Accounting Process
Disbursements and Internal Controls
Reversion of Unexpended Funds
Form structure last revised 12/20/2013
Department of Public Safety
DocuSign Envelope ID:417lC3E1-3E71-4112-A1FC-F589CD834A9C
Any remaining unexpended funds DPS disbursed to the County for the Sponsoring Agency must be refunded/reverted
back to DPS at the close of fiscal year or upon termination of this Agreement.
Accountability for Funds
Audit Requirement - Local Government or Public Authority Requirements
Local Government or Public Authorities in accordance with N.C.G.S. §159-34 must have an audit performed in
conformity with generally accepted auditing standards. The audit shall evaluate the performance of a unit of local
government or public authority with regard to compliance with all applicable Federal and State agency regulations. This
audit, combined with the audit of financial accounts, shall be deemed to be the single audit described by the, "Federal
Single Audit Act of 1984".
Audit Requirement — Non -Governmental Entities: An audit, when required by law, or requested by the County or
DPS shall be performed in conformity with generally accepted auditing standards and audits of non-governmental
entities, both for-profit and not-for-profit, and must meet the requirements of OMB Circular A-133. At a minimum, the
required report shall include the financial statements prepared in accordance with generally accepted accounting
principles, all disclosures in the public interest required by law, and the auditor's opinion and comments relating to
financial statements. The audit report must be submitted to the State Auditor's office as required by law, to the County
and DPS, and to other recipients as appropriate within nine (9) months after the end of the program's fiscal year.
Oversight
Access to Persons and Records: The State Auditor shall have access to persons and records as a result of all
Program Agreements entered into by State agencies or political subdivisions in accordance with N.C.G.S. §147-64.7.
Additionally, as the State funding authority, DPS shall have access to persons and records as a result of all Program
Agreements entered into by State agencies or political subdivisions.
Record Retention: Records shall not be destroyed, purged or disposed of without the express written consent of
DPS. State basic records retention policy requires all records to be retained for a minimum of five years or until all
audit exceptions have been resolved, whichever is longer. If the Program Agreement is subject to Federal policy and
regulations, record retention may be longer than five years since records must be retained for a period of three years
following submission of the final Federal Financial Status Report, if applicable, or three years following the submission
of a revised final Federal Financial Status Report. Also, if any litigation, claim, negotiation, audit, disallowance action,
or other action involving this Program Agreement has been started before expiration of the five-year retention period
described above, the records must be retained until completion of the action and resolution of all issues which arise
from it, or until the end of the regular five-year period described above, whichever is later.
No Overdue Tax Debt — Not for profit organizations ONLY must comply with this section. This form must be
uploaded in NCALLIES when submitting a Program Agreement. The Sponsoring Agency shall be responsible for
the payment of all State, local, and Federal taxes. Consistent with N.C.G.S. § 143C-6-23 (c), not for profit
organizations shall file with DPS and the County a written statement completed by that Sponsoring Agency's board of
directors or other governing body, stating whether or not the Sponsoring Agency has any overdue tax debts, as
defined by N.C.G.S. 105-243.1, at the Federal, State, or local level. This written statement, Certification of No
Overdue Tax Debts, shall be completed by the Sponsoring Agency to certify when there are no overdue taxes. If the
agency has overdue taxes, the Sponsoring Agency must notify DPS at the time of Program Agreement submission.
Form structure last revised 12/20/2013
Department of Public Safety
DocuSign Envelope ID:417lC3E1-3E71-4112-A1FC-F589CD834A9C
Conflict of Interest — Not for profit organizations ONLY must comply with this section. This form must be
uploaded in NCALLIES when submitting a Program Agreement. Consistent with the N.C.G.S. §143C-6-23 (b), not
for profit organizations shall file with DPS and the County a copy of that Sponsoring Agency's policy addressing
conflicts of interest that may arise involving the Sponsoring Agency's management employees and the members of its
board of directors or other governing body. The policy shall address situations in which any of these individuals may
directly or indirectly benefit, except as the Sponsoring Agency's employees or members of its board or other
governing body, from the Sponsoring Agency's disbursing of State funds and shall include actions to be taken by the
Sponsoring Agency or the individual, or both to avoid conflicts of interest and the appearance of impropriety. The
policy shall be filed before the County or DPS may disburse any funds. The Sponsoring Agency shall also complete
the DPS Conflict of Interest Policy Statement (Form DPS 13 001) and upload the statement and the Sponsoring
Agency's policy addressing conflicts of interest to the JCPC Program Agreement upon submission.
Proof of 501(c) (3) — Not for profit organizations ONLY must comply with this section. This document must be
uploaded in NCALLIES when submitting a Program Agreement. Not for profit organizations must upload proof of
the Sponsoring Agency's 501 (c) (3) status.
Amendment: This Agreement may not be amended orally or by performance. Any amendment must be requested in
writing by the Sponsoring Agency through submission of a Program Agreement Revision and executed by duly
authorized representatives of DPS, the County Government, JCPC and Sponsoring Agency.
Severability: In the event that a court of competent jurisdiction holds that a provision or requirement of this Program
Agreement violates any applicable law, each such provision or requirement shall continue to be enforced to the extent
it is not in violation of law or is not otherwise unenforceable and all other provisions and requirements of this Program
Agreement shall remain in full force and effect.
Termination for Cause: If, through any cause, the Sponsoring Agency shall fail to fulfill its obligations under this
Program Agreement in a timely and proper manner, DPS shall have the right to terminate this Program Agreement by
giving written notice to the Sponsoring Agency and specifying the effective date thereof. In that event, all finished or
unfinished deliverable items prepared by the Sponsoring Agency under this Program Agreement shall, at the option of
DPS, become its property and the Sponsoring Agency shall be entitled to receive just and equitable compensation for
any satisfactory work completed on such materials, minus any payment or compensation previously made.
Notwithstanding the foregoing provision, the Sponsoring Agency shall not be relieved of liability to DPS for damages
sustained by DPS by virtue of the Sponsoring Agency's breach of this agreement, and DPS may withhold any
payment due the Sponsoring Agency for the purpose of setoff until such time as the exact amount of damages due
DPS from such breach can be determined. The filing of a petition for bankruptcy by the Sponsoring Agency shall be
an act of default under this Program Agreement.
Termination without Cause: DPS, the County Government, or the Sponsoring Agency may terminate this
Agreement at any time and without cause by giving at least thirty (30) days advance written notice to the other. If this
Program Agreement is terminated by DPS as provided herein, the Sponsoring Agency shall be reimbursed on a pro
rata basis for services satisfactorily provided to DPS under this Program Agreement prior to Program Agreement
termination.
Waiver of Default: Waiver by DPS of any default or breach in compliance with the terms of this Program Agreement
by the Sponsoring Agency shall not be deemed a waiver of any subsequent default or breach and shall not be
construed to be modification of the terms of this Program Agreement unless stated to be such in writing, signed by an
authorized representative of DPS, County Government, the JCPC and the Sponsoring Agency.
Form structure last revised 12/20/2013
Department of Public Safety
DocuSign Envelope ID:417lC3E1-3E71-4112-A1FC-F589CD834A9C
Force Majeure: Neither party shall be deemed to be in default of its obligations hereunder if and so long as it is
prevented from performing such obligations by any act of war, hostile foreign action, nuclear explosion, riot, strikes,
civil insurrection, earthquake, hurricane, tornado, or other catastrophic natural event, pandemic, or act of God.
Survival of Promises: All promises, requirements, terms, conditions, provisions, representations, guarantees, and
warranties contained herein shall survive the Program Agreement expiration or termination date unless specifically
provided otherwise herein, or unless superseded by applicable Federal or State statutes of limitation.
END OF SECTION V — Terms of Agreement
Form structure last revised 12/20/2013
Department of Public Safety
DocuSign Envelope ID:417lC3E1-3E71-4112-A1FC-F589CD834A9C
SECTION VI: BUDGET NARRATIVE
Alternatives to Commitment: Family Preservation Program
Fiscal Year
FY 21-22
$35,256
Intensive Family Preservation Supervisor
Item #
Justification
Expense
In Kind Expense
120
IFPS Supervisor ($25 per hour, 4 hours per week)
$5,200
120
IFPS Worker ($22.60 per hour, 30 hours per week)
$35,256
120
Therapist ($24 per hour, 14 hours per week)
$17,600
180
IFPS Worker's fringe benefits (75% of their benefit package)
$8,814
180
IFPS Supervisor's fringe benefits
$1,500
180
Therapist fringe benefits
$800
220
Flex funding spending averaging $300 per family as indicated
by Homebuilder's model
$4,400
260
Work supplies including cell phone coverage
$3,000
260
PSB Supplies
$1,000
310
Mileage reimbursement (38 cents for worker's personal vehicle)
$2,000
320
Cell phone and WiFi expenses for staff specialist
$800
390
Initial and on-going professional development training
$1,500
390
Training for PSB -CBT
$8,000
390
5100 Administration Cost, Fair Share Portion, Program
Assigned Cost (IFPS portion)
$3,948
390
5100 Administration Cost, Fair Share Portion, Program
Assigned Cost (PSB -CBT)
$1,732
TOTAL
$95,550
Job Title
Annual Expense
Wages
Annual In Kind
Wages
Intensive Family Preservation Specialist
$35,256
Intensive Family Preservation Supervisor
$5,200
Therapist
$17,600
TOTAL
$58,056
Form structure last revised 12/31/2012
Department of Public Safety
DocuSign Envelope ID:417lC3E1-3E71-4112-A1FC-F589CD834A9C
SECTION VII Program: Alternatives to Commitment: Family Preservation Program
Fiscal Year: FY 21-22 Number of Months: 12
I. Personnel Services
120 Salaries & Wages
180 Fringe Benefits
190 Professional Services"
*Contracts MUST be attached
Cash
$69,170
$58,056
In Kind
Total
$69,170
$58,056
$11,114
$0
II. Supplies & Materials $8,400 $8,400
210 Household & Cleaning
220 Food & Provisions
230 Education & Medical
240 Construction & Repair
250 Vehicle Supplies & Materials
260 Office Supplies and Materials
280 Heating & Utility Supplies
290 Other Supplies and Materials
$4,400
$4,000
$0
$4,400
$0
$0
$0
$4,000
$0
$0
III. Current Obligations & Services
$17,980
$17,980
310 Travel & Transportation
$2,000
$2,000
320 Communications
$800
$800
330 Utilities
$0
340 Printing & Binding
$0
350 Repairs & Maintenance
$0
370 Advertising
$0
380 Data Processing
$0
390 Other Services
$15,180
$15,180
IV. Fixed Charges & Other Expenses
$0
410 Rental or Real Property
$0
430 Equipment Rental
$0
440 Service and Maint. Contracts
$0
450 Insurance & Bonding
$0
490 Other Fixed Charges
$0
V. Capital Outlay
$0
[This Section Requires Cash Match]
510 Office Furniture & Equipment
$0
530 Educational Equipment
$0
540 Motor Vehicle
$0
550 Other Equipment
$0
580 Buildings, Structure & Improv.
$0
Total
$95,550
$95,550
Form structure last revised 12/31/2012
Department of Public Safety
DocuSign Envelope ID:417lC3E1-3E71-4112-A1FC-F589CD834A9C
SECTION VIII SOURCES OF PROGRAM REVENUE (ALL SOURCES)
FY 21-22 New Hanover County Funding ID: 865-XXXX
Sponsoring Agency: Coastal Horizons Center, Inc. Program: Alternatives to Commitment: Family
Preservation Program
$95,550 DPS/JCPC Funds * This is the amount approved in your application
0% Local Match Rate Is the Local Match Rate 10%, 20% or 30%?
County Cash
(Specify Source)
Local Cash
(Specify Source)
Local Cash
(Specify Source)
Local In -Kind
(Specify Source)
Other
(Specify Source)
Other
(Specify Source)
Other
(Specify Source)
Other
(Specify Source)
$95,550 TOTAL $0
$0
Required Local Match
Match Provided
by:
gqDocuSigned
6/21/2021
798FE7A4BD9F419...
Authorizing Official, Department of Public Safety
Date
Thefollowing signature certifies that this program agreement has been locally approved by the Board of County Commissioners.
(DocuSigned by: ' "L
E
6/17/2021
60...
Chair, County Board of Commissioners or County Finance Director
Date
The following signature certifies that this program agreement has been locally approved by the Juvenile Crime Prevention
Council.
DocuSigned by:
(� (hVr lU*" if
6/15/2021
3DDSE15 MA2540C...
Chair, Juvenile Crime Prevention Council
Date
DocuSigned by:
ct.V"4' Wsm
Es
6/15/2021
9C24517D0499464...
Program Manager
Date
Form structure last revised 12/31/2012
Department of Public Safety
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DocuSign
Certificate Of Completion
Envelope Id: 4l7lC3El3E714112AlFCF589CD834A9C Status: Completed
Subject: DPS eSignature Request for New Hanover 865-23524 Alternatives to Commitment: Family Preservation Pro
Source Envelope:
Document Pages: 31 Signatures: 4 Envelope Originator:
Certificate Pages: 5 Initials: 0 DPS-DJJ Community Programs
AutoNav: Enabled 3040 Hammond Business PI
Envelopeld Stamping: Enabled Raleigh, NC 27603
Time Zone: (UTC -05:00) Eastern Time (US & Canada) djjdp.applicationsupport@ncdps.gov
IP Address: 207.4.107.21
Record Tracking
Status: Original
6/15/2021 11:29:35 AM
Signer Events
Sarah Nelson
snelson@coastalhorizons.org
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 6/15/2021 11:54:07 AM
ID: c53de3c3-8f52-47d8-82f3-eaff339b1ff2
J H Corpening II
julius.h.corpening@nccourts.org
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 6/15/2021 5:13:44 PM
ID: 3ffbOb0e-accc-4fOf-841 b-3e28bd2f7a94
Lisa Wurtzbacher
Iwurtzbacher@nhcgov.com
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 6/17/2021 9:35:19 AM
ID: 776595b7-ce55-486f-a798-4c3efaa3fa4a
Cindy Porterfield
cindy.porterfield@ncdps.gov
Director of Juvenile Community Programs
NC Dept of Public Safety
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Holder: DPS-DJJ Community Programs Location: DocuSign
djjdp.applicationsupport@ncdps.gov
Signature Timestamp
..d by: Sent: 6/15/2021 11:29:37 AM
[Do,"S!
aVaat utSbin Viewed: 6/15/2021 11:54:07 AM
9c24517oo499464... Signed: 6/15/2021 11:55:05 AM
Signature Adoption: Pre -selected Style
Using IP Address: 70.62.75.146
Co ... s9"ed nr: Sent: 6/15/2021 11:55:07 AM f' CbVruu," N Viewed: 6/15/2021 5:13:44 PM
3°D8E15D4A2540C... Signed: 6/15/2021 5:13:54 PM
Signature Adoption: Pre -selected Style
Using IF Address: 204.152.2.232
D—Si... dbv: Sent: 6/15/2021 5:13:56 PM
Viewed: 6/17/2021 9:35:19 AM
741AAc4c4DDE460... Signed: 6/17/2021 10:05:50 AM
Signature Adoption: Pre -selected Style
Using IP Address: 70.63.86.17
by: Sent: 6/17/2021 10:05:52 AM
[DI-Sig"Id
"' '` ' -P."tow Viewed: 6/21/2021 9:53:55 AM
798FUMBDU419... Signed: 6/21/2021 9:54:10 AM
Signature Adoption: Pre -selected Style
Using IF Address: 199.90.60.4
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Electronic Record and Signature Disclosure
Electronic Record and Signature Disclosure created on: 4/3/2018 2:57:43 PM
Parties agreed to: Sarah Nelson, J H Corpening II, Lisa Wurtzbacher
CONSUMER DISCLOSURE
From time to time, NC Dept of Public Safety (we, us or Company) may be required by law to
provide to you certain written notices or disclosures. Described below are the terms and
conditions for providing to you such notices and disclosures electronically through the
DocuSign, Inc. (DocuSign) electronic signing system. Please read the information below
carefully and thoroughly, and if you can access this information electronically to your
satisfaction and agree to these terms and conditions, please confirm your agreement by clicking
the a€ -I agreea€TM button at the bottom of this document.
Getting paper copies
At any time, you may request from us a paper copy of any record provided or made available
electronically to you by us. You will have the ability to download and print documents we send
to you through the DocuSign system during and immediately after signing session and, if you
elect to create a DocuSign signer account, you may access them for a limited period of time
(usually 30 days) after such documents are first sent to you. After such time, if you wish for us to
send you paper copies of any such documents from our office to you, you will be charged a
$0.00 per -page fee. You may request delivery of such paper copies from us by following the
procedure described below.
Withdrawing your consent
If you decide to receive notices and disclosures from us electronically, you may at any time
change your mind and tell us that thereafter you want to receive required notices and disclosures
only in paper format. How you must inform us of your decision to receive future notices and
disclosure in paper format and withdraw your consent to receive notices and disclosures
electronically is described below.
Consequences of changing your mind
If you elect to receive required notices and disclosures only in paper format, it will slow the
speed at which we can complete certain steps in transactions with you and delivering services to
you because we will need first to send the required notices or disclosures to you in paper format,
and then wait until we receive back from you your acknowledgment of your receipt of such
paper notices or disclosures. To indicate to us that you are changing your mind, you must
withdraw your consent using the DocuSign a€ -Withdraw Consenta€TM form on the signing page
of a DocuSign envelope instead of signing it. This will indicate to us that you have withdrawn
your consent to receive required notices and disclosures electronically from us and you will no
longer be able to use the DocuSign system to receive required notices and consents electronically
from us or to sign electronically documents from us.
All notices and disclosures will be sent to you electronically
Unless you tell us otherwise in accordance with the procedures described herein, we will provide
electronically to you through the DocuSign system all required notices, disclosures,
authorizations, acknowledgements, and other documents that are required to be provided or
made available to you during the course of our relationship with you. To reduce the chance of
you inadvertently not receiving any notice or disclosure, we prefer to provide all of the required
notices and disclosures to you by the same method and to the same address that you have given
us. Thus, you can receive all the disclosures and notices electronically or in paper format through
the paper mail delivery system. If you do not agree with this process, please let us know as
described below. Please also see the paragraph immediately above that describes the
consequences of your electing not to receive delivery of the notices and disclosures
electronically from us.
How to contact NC Dept of Public Safety:
You may contact us to let us know of your changes as to how we may contact you electronically,
to request paper copies of certain information from us, and to withdraw your prior consent to
receive notices and disclosures electronically as follows:
To contact us by email send messages to: david.pozun@ncdps.gov
To advise NC Dept of Public Safety of your new e-mail address
To let us know of a change in your e-mail address where we should send notices and disclosures
electronically to you, you must send an email message to us at david.pozun@ncdps.gov and in
the body of such request you must state: your previous e-mail address, your new e-mail address.
We do not require any other information from you to change your email address..
In addition, you must notify DocuSign, Inc. to arrange for your new email address to be reflected
in your DocuSign account by following the process for changing e-mail in the DocuSign system.
To request paper copies from NC Dept of Public Safety
To request delivery from us of paper copies of the notices and disclosures previously provided
by us to you electronically, you must send us an e-mail to david.pozun@ncdps.gov and in the
body of such request you must state your e-mail address, full name, US Postal address, and
telephone number. We will bill you for any fees at that time, if any.
To withdraw your consent with NC Dept of Public Safety
To inform us that you no longer want to receive future notices and disclosures in electronic
format you may:
i. decline to sign a document from within your DocuSign session, and on the subsequent
page, select the check -box indicating you wish to withdraw your consent, or you may;
ii. send us an e-mail to david.pozun@ncdps.gov and in the body of such request you must
state your e-mail, full name, US Postal Address, and telephone number. We do not need
any other information from you to withdraw consent.. The consequences of your
withdrawing consent for online documents will be that transactions may take a longer time
to process..
Required hardware and software
Operating Systems:
WindowsA@ 2000, WindowsA@ XP, Windows
Vista,&@; Mac OSA@ X
Browsers:
Final release versions of Internet Explorer,&@
6.0 or above (Windows only); Mozilla Firefox
2.0 or above (Windows and Mac); Safaria„¢
3.0 or above (Mac only)
PDF Reader:
AcrobatA@ or similar software may be required
to view and print PDF files
Screen Resolution:
800 x 600 minimum
Enabled Security Settings:
Allow per session cookies
** These minimum requirements are subject to change. If these requirements change, you will be
asked to re -accept the disclosure. Pre-release (e.g. beta) versions of operating systems and
browsers are not supported.
Acknowledging your access and consent to receive materials electronically
To confirm to us that you can access this information electronically, which will be similar to
other electronic notices and disclosures that we will provide to you, please verify that you were
able to read this electronic disclosure and that you also were able to print on paper or
electronically save this page for your future reference and access or that you were able to e-mail
this disclosure and consent to an address where you will be able to print on paper or save it for
your future reference and access. Further, if you consent to receiving notices and disclosures
exclusively in electronic format on the terms and conditions described above, please let us know
by clicking the a€ -I agreea€TM button below.
By checking the a€ -I agreea€TM box, I confirm that:
• I can access and read this Electronic CONSENT TO ELECTRONIC RECEIPT OF
ELECTRONIC CONSUMER DISCLOSURES document; and
• I can print on paper the disclosure or save or send the disclosure to a place where I can
print it, for future reference and access; and
• Until or unless I notify NC Dept of Public Safety as described above, I consent to receive
from exclusively through electronic means all notices, disclosures, authorizations,
acknowledgements, and other documents that are required to be provided or made
available to me by NC Dept of Public Safety during the course of my relationship with
you.