ࡱ> Y[X%` 9bjbj >R̟̟B8T> Z@VVVVTP$w!h#B E@VV@@ VVE @jVV@V vvd[ 0 !$  !$!$@@@@@@@ ,^@@@ @@@@ ANNEX A PROGRAM COMMITMENTS INTENSIVE FAMILY SUPPORT SERVICES AGENCY NAME:  FORMTEXT       CONTRACT NUMBER:  FORMTEXT       CONTRACT TERM:  FORMTEXT        TO  FORMTEXT       BUDGET MATRIX CODE: 35 BUDGET MODIFICATION NO:  FORMTEXT       (0 = Original) 1. Total number of families who will receive intensive support services. FORMTEXT       2. New families who will begin receiving intensive support services. FORMTEXT       3. Total number of on- site facetoface single family consultation contacts. FORMTEXT       4.  Number of off-site facetoface single family consultation contacts. FORMTEXT       5. Number of collateral contacts made on behalf of families. FORMTEXT       6. Number of multiple family support group sessions provided. FORMTEXT       7. The average unduplicated number of participants in multiple family support groups. FORMTEXT       8.  The number of psycho-education sessions provided. 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The average unduplicated number of participants at psychoeducational program sessions. FORMTEXT       10. Number of supportive telephone counseling contacts made to family members. FORMTEXT       11. Number of staff facetoface hours in the provision of inhome respite care provided. FORMTEXT       12. Number of staff facetoface hours in the provision of outofhome respite care provided. FORMTEXT       13. The average unduplicated number of families provided with respite care services. FORMTEXT       14. Units of service will be provided. 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