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EXHIBIT A <br />AGENCY REQUEST FOR FUNDING FROM Indian River COUNTY <br />FISCAL YEAR 2019/2020 <br />A. Program Cover Page <br />Agency: <br />Mental Health Association in Indian <br />Amount requested from Indian River County for 2019/2020: <br />River County <br />Contact Person: <br />Dr. Nicholas Coppola <br />Title: <br />CEO <br />Address: <br />820 37th Place <br />Dollar increase / (decrease) in request: <br />Vero Beach, FL 32960 <br />Website Address: <br />www.mhairc.org <br />Program Title: <br />MHA Walk -In & Counseling Center <br />Telephone: 772-569-9788 <br />Fax: 772-569-2088 <br />E -Mail: nick@mhairc.org <br />pp <br />:prtify that information contained in this application accurately reflects the activities of this agency and <br />at the expendit ru es or portions thereof for which County funds are being requested are not reimbursed <br />any\otheource. <br />r; <br />,Signafur� <br />Nicholas Coppola DO MBA Chief Executive Officer <br />Print name and title <br />Brief-d'sc'r,iption of'fhe Program for which funding is requested: <br />Funding is -requested to help support the services provided at the Mental Health Association Walk -In & <br />Counseling Center. At the Walk -In & Counseling Center, Indian River County residents of all ages are <br />given immediate access to mental health care through walk-in services such as mental health screening, <br />crisis intervention, consultation about the mental health needs of a loved one, assistance with resources <br />for needed care, and information/referral services. We also clinically consult about mental health needs <br />by phone. Our WIC is the only Mental Health agency in the county that provides free immediate access to <br />mental health screening and crisis intervention. We also provide by appointment mental health treatment <br />on a sliding fee schedule for those who have no insurance and are at 300% or below the poverty level <br />and cannot qualify for hospital district indigent services. Services by appointment include individual and <br />family psychotherapy, psychiatric evaluations, medication management, group therapy, psycho- <br />educational classes, and skill building coaching for children and teens ages 4-17. We have a medication <br />assistance program through which our indigent clients are able to receive free medications. We also link <br />our psychiatric care clients to medication assistance programs through pharmaceutical companies. We <br />remain one of the few IRC agencies treating children under the age of 6. Additional no charge services <br />we provide to the Indian River community are a bi-monthly Mood and Anxiety Support group, Case <br />Management services, completion of support applications as FL Access site, and a Medical Security <br />Program that, as a safeguard, registers the care needs and support system for adults with severe and <br />persistently mental illness and/or other functional impairment. Services are provided Monday- Fridays <br />from 8:30am- 5:30pm. The Walk -In Center is located at 820 37th Place, Vero Beach, FL 32960. Public <br />transportation is accessible to the center. <br />ouuuuaiy report <br />Amount requested from Indian River County for 2019/2020: <br />$30,000.00 <br />Total Proposed Program budget for 2019/2020: <br />$1,680,542 <br />Percent of total Program budget: <br />1.8% <br />Current Funding (2018/2019) <br />$23,421 <br />Dollar increase / (decrease) in request: <br />$6,579.00 <br />Percent increase / decrease in request: <br />28% <br />n ieyuest increases z) -/o or more, oneny expiarn why: <br />EXHIBIT A <br />