HomeMy WebLinkAboutE-4 - Staff Report - City of Hope Chronic Disease Self Management ProgramCONSENT ITEM
E-4
TO: HONORABLE MAYOR AND MEMBERS OF THE CITY COUNCIL
VIA: SERGIO GONZALEZ, CITY MANAGER
FROM: MIKI CARPENTER, COMMUNITY RESOURCES DIRECTOR
DATE: DECEMBER 2, 2019
SUBJECT: ACCEPT SUPPORT FROM CITY OF HOPE FOR CHRONIC DISEASE SELF-
MANAGEMENT PROGRAM
BACKGROUND:
The City of Azusa has been awarded a grant towards promoting evidence-based health from the City of
Hope Partners in Care Foundation’s Chronic Disease Self-Management Education Program (Program)
which will be administered through the Community Resources Department. The grant, which covers the
2019-20 licensing fee and $1,000 towards six Program workshop supplies and refreshments, is approved
through this action.
RECOMMENDATIONS:
Staff recommends the City Council take the following actions:
1)Accept a grant award covering the 2019-20 licensing fee and $1,000 towards six (6) Evidence-
Based Health Program Workshops; and
2)Authorize the City Manager to sign the Grant Agreement; and
3) Approve necessary budget amendment and adjust the current fiscal year budget accordingly.
ANALYSIS:
The Community Resources Department, in its efforts to create community-based social service and
wellness programs, has focused on building relationships with organizations that support programs such
as the City of Hope Partners in Care Foundation’s Chronic Disease Self-Management Education
Program (Program). City of Hope has pledged support for: (1) City of Azusa’s licensing fee for
participation in the Program for one year (2019-2020); and (2) $1,000 to cover all six Program
workshop supplies and refreshments.
APPROVED
CITY COUNCIL
12/2/2019
City of Hope – CDSMP
December 2, 2019
Page 2
Community Resources will be required to conduct a minimum of six (6) workshops. These workshops
will be focused on improving quality of life for people with chronic health conditions. An example of
some of the benefits provided by this Program are as follows:
• Decreased pain and health distress
• Increased energy and less fatigue
• Increased physical activity
• Decreased depression
• Better communication with physicians
• Decreased social role limitations
• Increased confidence in managing chronic disease
FISCAL IMPACT:
Upon Council acceptance of the grant, Staff will amend the budget consistent with the grant award
amount.
Prepared by: Reviewed and Approved:
Nikki Rosales Miki Carpenter
Senior Management Analyst Director of Community Resources
Reviewed and Approved:
Sergio Gonzalez
City Manager
Attachment:
1. City of Hope - Chronic Disease Self-Management Education Program Letter/Agreement
1500 East Duarte Road
Duarte, CA 91010-3000
www.cityofhope.org
November 4th 2019
City of Azusa
320 N Orange Place
Azusa, CA 91702
Re: Chronic Disease Self-Management Program
Dear Miki
City of Hope is pleased to support City of Azusa in promoting evidence-based health through the Partners in Care
Foundation’s Chronic Disease Self-Management Education Program (“Program”). In support of the Program, City of
Hope will provide funding for: (1) the licensing fee for participation in the Program for one year (2019 – 2020); and
(2)$1,000 to cover all six Program workshop supplies and refreshments. Payment will be made to your organization
prior to the first Program workshop.
As a condition of receipt of the support described herein, City of Azusa must comply with all requirements of the
Affiliate Agreement with Partners in Care Foundation attached hereto and conduct at least six Program workshops.
City of Azusa agrees to share with City of Hope any Program data generated by City of Azusa and allows City of Hope
to use such data for its reporting and publication purposes. City of Azusa further agrees to allow City of Hope and
Partners in Care Foundation to use City of Azusa’s name, logos and trademarks in the form(s) provided or approved
by City of Azusa’s in any Program-related marketing or publicity. City of Azusa will be solely responsible for its
Program activities and compliance with the terms of the Affiliate Agreement and shall hold City of Hope harmless
from any liability arising out of City of Azusa’s conduct of the Program or breach of the Affiliate Agreement.
We are excited to offer City of Azusa this opportunity to participate in this important program. Please take a
moment to review these terms, and if they meet with City of Azusa’s approval, we ask that an authorized
representative of City of Azusa sign this letter and return the signed letter to me at snyanzi@coh.org. If you have
any questions regarding this letter, please contact Susan Nyanzi at 626-218-2797.
Sincerely
Susan Nyanzi DrPH, MCHES Astrid Micken-Williams, DrPH, CHES
COH_CDSM Program Coordinator Project Director
Conrad N. Hilton-City of Hope Partnership
Agree and accepted
Name
Signature: ___________________________ Title:_____________________________
Name: ______________________________ Date: ____________________________
ATTACHMENT 1
Partners in Care Foundation
Evidence-Based Program Affiliate Agreement
Partners in Care Foundation, a California nonprofit public benefit corporation, located at 732 Mott Street, Suite
150, San Fernando, California, 91340 (hereinafter referred to as “Partners”), and City of Hope National
Medical Center (“Affiliate”), with its offices located at 1500 E. Duarte Road CA 91010 have agreed to
enter into this Affiliate Agreement (“Agreement”) under which Affiliate agrees to provide: 1) Quality delivery of
the Partners’ administered evidence-based health promotion Chronic Disease Self-Management Education
Programs (“CDSME”) described in Article I below [jointly referred to as “Program(s)”], 2) Ongoing reporting of
Programs information as required by the Programs or this Agreement, and 3) Cooperation with Partners, other
Partners’ affiliates and Programs’ Licensors where applicable. The further responsibilities of the parties hereto
are outlined below.
Definitions:
Program- Evidence-based, researched interventions that demonstrate reliable and consistently positive
changes in important health-related and functional measures as described in Article I.
Workshop- A structured evidence-based series provided to a targeted population (ie, chronic condition, falls
risk) to teach skills and strategies to self-manage and build confidence for healthy aging.
Program Leader Training- Instructional course to ensure that facilitators follow the guidelines and meet
program fidelity of evidence-based programs. Must be completed to be certified as a Program Leader.
Program Leader- Trained staff who facilitate Workshops in the community.
Trainer- Program Leaders who complete advanced training and are certified to train community members as
Program Leaders.
Licensor- Organization authorized to license a Workshop and/or Program Leader Training.
Data Packets- Set of forms to track information such as attendance, demographics, pre and post outcomes
and participant satisfaction.
Community Organizations - Organizations that participate in Program activities hereunder, that are not
corporate affiliates of, or otherwise related to, Affiliate
I. Programs included in this Agreement only include those checked below:
Please see Exhibit A attached hereto and made a part hereof - Program requirements.
Chronic Disease Self-Management Education Programs (“CDSME”):
(CDSMP) Healthier Living Date Added:_9/20/2019 Term Date: _9/20/2020
Tomando Control de su Salud Date Added:_9/20/2019 Term Date: _9/20/2020
Programa de Manejo Personal de la Diabetes Date Added:__________ Term Date: __________
Diabetes Self-Management Program Date Added:__________ Term Date: __________
Chronic Pain Self-Management Program Date Added:__________ Term Date: __________
Programa de Manejo Personal del Dolor Crónico Date Added:__________ Term Date: __________
Falls Prevention Programs (“FPP”):
A Matter of Balance (MOB) Date Added:__________ Term Date: __________
Tai-Chi for Arthritis Date Added:__________ Term Date: __________
EnhanceFitness Date Added:__________ Term Date: __________
Affiliate must provide yearly payment for license fees as outlined in Exhibit B.
The parties agree to the following additional terms under this Agreement.
II. Term and Termination
1. This Agreement is effective as of September 20, 2019. Unless otherwise terminated as provided herein,
this Agreement shall automatically renew every September 20th for two additional one (1) year terms.
2. This Agreement may be terminated at any time upon the written mutual consent of the parties.
3. Partners may terminate this Agreement immediately at any time upon providing written notice to Affiliate
upon the termination of Partners’ license under the Programs, as applicable.
4. Either Partners, or Affiliate, reserves the right to terminate this Agreement with 30 days prior written notice
delivered by certified mail. However, Partners or any Program developer may terminate the Agreement
immediately in writing if serious quality violations or apparent disregard for Program guidelines is found.
5. Partners may terminate this Agreement within 30 days if the Affiliate demonstrates repeated
noncompliance with the terms of the Agreement. Partners shall submit 3 written requests for compliance
before termination. Affiliate shall have the right and privilege of terminating this Agreement immediately
upon written notice to Partners in the event that the performance by either party of any term, covenant,
condition or provision of this Agreement shall jeopardize Affiliate's: (i) licensure, (ii) reputation, (iii)
participation in Medi-Cal, Medicare, or other government or commercial health care reimbursement or
payor programs, (iv) full accreditation by The Joint Commission, or any other state or nationally recognized
accreditation organization, (v) tax-exempt status, or (vi) bond financing.
III. The Affiliate will be responsible for the following:
1. Training:
a) Request approval from Partners to hold any Program Leader Training, which shall incur an additional
cost per training to the Affiliate.
b) Ensure that Program Leader Training(s) offered under Partners license include representatives of
Partners or utilize Program Trainers approved by Partners. Agree that trainings are only open to those
individuals who have completed a Leader application, screening and agreement. Example shown in
Attachment A (may be revised from time to time).
c) Ensure that any Affiliate volunteers (Leader or Trainer) complete an Information Security Awareness
Training, within 60 days of their start date and annually thereafter. Affiliate will provide Partners with
documentation evidencing Leader and Trainer completion of Affiliate's security training requirement.
Community Organizations will be responsible for completing Information Security Awareness Training.
d) Maintain fidelity by offering at least one workshop per year.
e) For MOB leaders, attend 2.5 hours of update training per year.
f) Affiliates must send copies of training certificates of completion and confirmation that Master Trainers
have passed the individual
2. Program Implementation:
a) Upon contract execution the Affiliate Contact Person shall complete the Partners Orientation Webinar.
All new Affiliate Contact Persons must complete the Webinar.
b) Ensure that Workshops at Affiliate-owned sites are only taught by persons who have successfully met
all applicable pre-requisites set by Partners or the applicable Program Licensor, completed an approved
leader/instructor training and maintained their certification per individual Program guidelines. If there
are no approved leaders available, the Program must be discontinued until a qualified leader(s) is
obtained.
c) Adhere to Partners guidelines regarding Program naming. Use the full Program name as outlined in this
Agreement as the official Program titles and acknowledge and credit the Program developer, as
provided to you by Partners, in news releases, published reports, brochures and other Program
materials.
d) Comply with all Program requirements as determined by Partners and any applicable Program Licensor.
e) Affiliate shall not modify the Program curriculum in any way without the express written permission of
Partners and the Program’s Licensor.
Affiliate shall abide by the Partners policies and procedures and any license agreement held by Partners
on behalf of Affiliate. All necessary forms for Partners-approved Program(s) should be sent or emailed
to:
Partners in Care Foundation
732 Mott Street, Suite 150
San Fernando, CA 91340
Attention: Community Wellness Department
EBPrograms@picf.org
f) Affiliate shall submit ongoing Program Data Packets to Partners for the period of the Agreement. From
time-to-time Affiliate may be asked and/or may volunteer to participate in additional data collections.
From time-to-time Affiliate data may be provided to funders of Partners in de-identified and/or
aggregate form.
g) Affiliate shall be responsible for publicizing/marketing the Program(s) at Affiliate locations; further
Affiliate shall be responsible for recruiting and registering participants for each Program held at
Affiliate-owned sites as prescribed by that specific Program, subject to the ultimate oversight of
Partners.
h) Affiliate may link their efforts with Partners.
i) Affiliate shall strictly comply with all state and federal laws and regulations regarding confidentiality of
patient medical records, including, without limitation, the Health Insurance Portability and
Accountability Act of 1996 (“HIPAA”) and the California Confidentiality of Medical Information Act
(“CMIA”). Partners shall execute the HIPAA Business Associate Addendum attached hereto as Exhibit
C.
j) Affiliate and all its Trainers and Program Leaders shall comply with all applicable laws in fulfilling its
obligations under this Agreement, including, without limitation, HIPAA and CMIA. Affiliate shall ensure
that its agents and Program Leaders do not engage in any discriminatory, abusive or harassing
behavior.
3. California Healthier Living Website
a) Affiliate is required to post all workshops to the Healthier Living website (www.cahealthierliving.org) at
least twenty (20) business days before the workshops, as defined in this Agreement.
4. Reporting:
a) By the 10th day of each month, submit a data packet for each workshop that ended in the previous
month to Partners at EBPrograms@picf.org. (For example, by September 10th, send data packets for
workshops ending in August)
b) On the 1st business day of each month, Partners shall send a web-based survey requesting workshop
information, data packets and updated leader list. Affiliate shall complete survey by the 10th of each
month. Affiliate will have access to all Community Organization data submitted hereunder.
c) Provide an annual Active Leader/Master Trainer Report (Attachment B) to Partners, listing:
i) Name and contact information for Leaders and Trainers providing Workshops or Program Trainings
under this Agreement
ii) This report is due upon signing of this Agreement upon renewal on September 20th.
d) For CDSME Leader Trainings, provide the following information for the Annual Self-Management
Resource Center Report
i) Name of organization hosting the training(s) (license holder)
ii) Name of the Trainers
iii) Number of Leaders trained
iv) Training dates
v) Number of trained Leaders still active
vi) Names of the organizations represented in the training(s)
5. Program Monitoring, Participant Information and Evaluation:
a) Provide Partners with reasonable access to all Programs at Affiliate’s locations for periodic fidelity
checks/site visits.
b) Notify Partners of any changes in Affiliate contact person and training dates not less than 30 days prior
to their occurrence.
6. Affiliate Contact Persons: Affiliate shall designate a contact person who will receive a copy of this
Agreement, help ensure that the above responsibilities are upheld, and maintain communication with
Partners. This primary contact person's name and contact information is listed below.
Susan Nyanzi Nutrition Health Coordinator 626-218-2797 snyanzi@coh.org
Name Title Phone Number Email
COO or CEO contact or Signature Authority
____________________________________________ ______________ ________
Name Title Phone Number Email
____________________________________________ ______________ ________
Name Title Phone Number Email
7. Assumption of Risk and Hold Harmless: Affiliate shall use the Program(s) at its own risk, except the
extent caused by the negligence or willful misconduct of Partners, its employees, agents or contractors, (1)
Partners will have no liability to Affiliate or to any third party as a result of its use of the Program(s), and
(2) to the extent allowed under the laws of the State of California; Affiliate will be liable for any claims
related to Affiliate’s use of the Program(s) and shall hold Partners harmless from any claims or damages
(including, without limitation, reasonable attorney’s fees and consulting and expert fees) filed or asserted
against Partners related to Affiliate’s use of the Program(s) or the actions of Affiliate’s agents or associated
trainers. Each Community Organizations will be solely responsible for any claims related to such
Community Organization's use of the Program(s) and shall hold Partners harmless from any claims or
damages (including, without limitation, reasonable attorney's fees and consulting and expert fees) filed or
asserted against Partners related to such Community Organization's use of the Program(s) or the actions of
such Community Organization's agents or associated trainers.
8. Confidentiality: Affiliate shall not use, misappropriate, release, disclose, or disseminate any trade
secrets or proprietary or confidential information of Partners and Program Licensors, to any other person
or entity except as specifically permitted by this Agreement or upon the prior written authorization of
Partners. Confidential information protected by this Agreement shall include all protectable intellectual
property of Partners or relating to all Programs. Upon termination of this Agreement, Affiliate agrees to
promptly return any confidential or proprietary information in its possession or control to Partners or, if
return is impossible or impracticable after reasonable effort, to destroy or secure all such information.
IV. Partners will be responsible for the following:
1. Holding a license for Partners approved Programs under which Affiliate may operate.
a) Affiliate understands that permission granted under this Agreement extends only to the current version
of the Program(s) available as of the effective date of Partners’ agreement(s) with Program developers
and may not apply to any subsequent versions of the Program(s). Partners will make all reasonable
efforts to provide update trainings under this Agreement; however, this may not be possible. In such
cases Partners will assess additional fees at-cost to Partners.
b) Partners has no obligation and makes no guarantee that it will continue to hold any license to any
Program in the future. Affiliate shall have no claim against Partners or any Program licensor for
Program licensor withdrawing or terminating any license to a Program in the future.
2. Providing up to two (2) hours per year for consultation, as well as access to electronic forms of education
and promotional materials, as needed for Programs. (“Technical Assistance” or “TA”). Additional fees may
apply for consultation in excess of two (2) hours per year, at $60 per hour, invoiced monthly in 15-minute
increments.
3. Securing data records submitted by Affiliates for a period of one (1) year at which time Partners will
appropriately destroy Affiliate data records either by shredding and/or by electronic purging or if destroying
or purging is not feasible, shall continue to extend the protections required under HIPAA, the HITECH Act,
the Privacy Rule, the Security Rule and other applicable laws relating to the security or confidentiality of
Protected Health Information.
4. Monitoring and maintaining the California Healthier Living website (www.cahealthierliving.org) and
providing Affiliates with access to this site. This website serves as a venue for collective learning where
Affiliates can gather the latest information regarding Program(s). This website is used to find and share
required documents, marketing and recruitment materials, and to learn about Program training and update
training dates/locations. Partners makes no guarantee that this website will be accessible, and Affiliate
acknowledges that it shall not be deemed a breach of this Agreement should these websites fail to
operate. Keep a list of Partners-certified Affiliates and trainers in California who meet minimum quality
standards for their approved Programs and meet additional quality standards as affiliates of Partners. Such
list may be published by Program developers (name of alliance agency and state).
6. Keep certified Leaders/Trainers and the Affiliate informed of latest material Program information.
7. As resources are available, Partners will provide materials to its Affiliates with a fully executed Agreement
and in good standing with Partners in an effort to assist in the development and/or sustainability of
Program infrastructure. This may include training support and approved Program materials.).
V. Insurance and Liability:
1. Partners and the Affiliate shall each maintain comprehensive general liability insurance with limits of not
less than One Million Dollars ($1,000,000) combined single limit for personal injury and property damage.
Affiliate shall provide a current certificate of insurance or other evidence of such insurance coverage to
Partners upon execution of this Agreement.
2. Partners shall indemnify and hold harmless Affiliate, Community Organizations, and each of their respective
officers, directors, employees, and volunteers from and against any and all actions, suits, judgments,
damages, proceedings, claims, demands, losses, costs, and expenses, including reasonable legal costs and
attorneys’ fees, arising from or related to any gross negligence or willful misconduct on the part of
Partners, or their respective officers, employees, agents or volunteers in connection with Programs that are
the subject of this Agreement or any claims that the Programs violate, infringe or misappropriate the
intellectual property or proprietary rights or other rights of any third parties; provided, however, that the
Affiliate acknowledges that Leaders/Trainers of the Programs that are employees of or are contracted by
the Affiliate are not employees, agents or volunteers of Partners. The Affiliate shall indemnify and hold
harmless Partners, and their respective officers, directors, employees, and volunteers from and against any
and all actions, suits, judgments, damages, proceedings, claims, demands, losses, costs, and expenses,
including reasonable legal costs and attorneys’ fees, arising from or related to: (i) any gross negligence or
willful misconduct on the part of Affiliate, its officers, employees, agents or contractors (not including any
Community Organization) in connection with Programs that are the subject of this Agreement, or (ii) the
condition or safety of the facility used by Affiliate in Affiliate's conduct of the Programs. Partners’ rights
under the prior sentence shall be in addition to Partners’ rights under Article III, Section 5. Affiliate shall
have no liability or responsibility for any acts or omissions of any Community Organization.
VI. Notices:
1. Any amendment or modification of this Agreement shall be binding only if evidenced in writing signed by
the authorized representative of both parties.
2. Unless notified to the contrary, notices shall be provided as follows:
Partners in Care Foundation, Inc., Affiliate : __________
“Partners”:
732 Mott Street, Ste. 150
Address Address
San Fernando, CA 91340
City, State, Zip Code City, State, Zip Code
W. June Simmons
Representative Name Representative Name
Chief Executive Officer
Representative Title Representative Title
(818) 837-3775 ext.102 / jsimmons@picf.org
Representative Phone/E-mail Representative Phone/E-mail
VII. Documentation
This Agreement, with its exhibits and attachments, constitutes the entire agreement of the Parties and
supersedes all prior and contemporaneous representations, proposals, discussions, and communications,
whether oral or in writing. Affiliate Agreement dated September 19, 2019 has been terminated and
replaced by this Agreement in its entirety.
VIII. Miscellaneous
This Agreement is to be construed in accordance with and governed by the internal laws of the State of
California without giving effect to any choice of law rule that would cause the application of the laws of any
jurisdiction other than the internal laws of the State of California to the rights and duties of the parties. Any
legal suit, action or proceeding arising out of or relating to this Agreement shall be commenced in federal
court in the Central District of California or in state court in the County of Los Angeles, California, and each
party hereto irrevocably submits to the exclusive jurisdiction and venue of any such court in any such suit,
action or proceeding.
Partners will not have the right to identify Affiliate as a customer, client or participant or otherwise use the
name, logos or trademarks of Affiliate or of Affiliate’s affiliates without Affiliate’s prior written consent, in
Affiliate’s sole discretion.
This Agreement (including any addenda and exhibits hereto) is the final and entire agreements between
Partners and Affiliates with respect to the subject matter hereof and merge all prior and contemporaneous
proposals, understandings, representations, warranties, promises and other communications, whether oral or
written, of the parties relating to such subject matter. This Agreement supersedes any conflicting or
inconsistent terms and conditions contained in Partners' invoice, proposal, statements of work, work orders or
other documentation. If for any reason a court of competent jurisdiction finds any provision of this
Agreement, or portion thereof, to be void, invalid or unenforceable, that provision shall be enforced to the
maximum extent permissible so as to effect the intent of the parties, and the remainder of this Agreement
shall continue in full force and effect. Failure by either party to enforce any provision of this Agreement shall
not be deemed a waiver of future enforcement of that or any other provision, and no waiver shall be effective
unless made in writing and signed by the waiving party. This Agreement shall not be altered, amended or
modified in any way except by a written instrument dated subsequent to the date of this Agreement and
signed by duly authorized representatives of each party.
In acknowledgement of the foregoing description of the services and requirements of this
Agreement, these authorized signatories do hereby attest to their acceptance of the terms and
conditions of this Agreement.
Partners in Care Foundation, Inc., Affiliate : __________
“Partners”:
732 Mott Street, Ste. 150
Address Address
San Fernando, CA 91340
City, State, Zip Code City, State, Zip Code
W. June Simmons
Representative Name Representative Name
Chief Executive Officer
Representative Title Representative Title
(818) 837-3775 ext.102 / jsimmons@picf.org
Representative Phone/E-mail Representative Phone/E-mail
Representative Signature Representative Signature
Date Date
Exhibit A
Program Requirements
In addition to the requirements outlined in the Partners Affiliate Agreement dated September 20, 2019 also
known as the “Agreement,” Affiliate agrees to the following Program responsibilities:
1) The Affiliate shall be responsible for publicizing/marketing the Programs and recruiting and registering
a minimum of 12 participants per Workshop or Leader Training.
2) For MOB, ensure that a guest healthcare professional attends one of the eight sessions (Job description
in Attachment C)
3) Partners Program data requirements may include:
a. Affiliates with experienced facilitators capable of undertaking fidelity checks shall complete a
Fidelity Observation Checklist Form for every newly trained leader.
i. CDSME: Use Attachment D-1 as a guide to administer a fidelity check on all newly
trained leaders, and all leaders annually thereafter.
ii. MOB: For all newly trained leaders, coordinate with your Master Trainer to receive a
fidelity check within the first four (4) sessions of your first workshop. The Master
Trainer shall use Attachment D-2 to complete this check.
b. For each Program held, the Affiliate shall complete a Programs Data Packet provided by
Partners. Completed data packets shall be submitted to Partners by the 10th calendar day of
each month. This packet includes, at a minimum, the following forms (Forms may be subject to
updates. Partners will give at least 30 days prior notification. Partners will be unable to provide
outcome reporting for use of incorrect forms):
i. Program Information Cover Sheet
ii. Attendance Log
iii. Participant Pre-Survey- collect demographic and pre-Program self-management skill
level/health status. (Attachment E-1 and F-1)
iv. Participant Post-Survey- collect feedback about the quality of the Program and self-
report of self-management skill level at end of the Program. (Attachment E-2 and F-2)
Failure to comply with submission deadline may include corrective action up to and including
suspension of license.
Partners reserves the right to provide updated forms as they are modified by the Program developers.
4) Notify Partners at least 30-days in advance to request adding a new Program (e.g., Tomando, A Matter
of Balance, etc.) or an additional number of workshops to this Agreement. Addition of these Programs
or additional workshops is generally permissible, but additional costs may be incurred.
5) Abiding by the following requirements and representations in the Program licensing agreements with
Partners, which are applicable to Affiliates:
a. The Affiliate conducts Programs in accordance with Programs and other applicable materials.
Affiliate may not create derivatives of the Program nor reproduce or distribute material derived
or adopted from the Program without permission.
b. Affiliate may only reproduce and distribute the Program(s) for the sole purpose of administering
the Program(s) for internal educational purposes.
c. All training materials and manuals that are produced must include the copyright language as
determined by Programs.
d. The Affiliate may not create derivatives of the Program(s) without the express written
permission of Partners. The Affiliate may not otherwise commercially exploit the Program(s) or
any material derived from or based upon the Program(s).
e. The Affiliate agrees to contact Partners for permission to reproduce or distribute the Program(s)
or any material derived or adapted from the Program(s) for any use not specifically granted in
the Agreement.
f. If the Affiliate wants to collaborate with another organization to offer training, Program
materials, or any other use of the Program(s), the Affiliate should contact Partners and to
ensure that the intended use is permitted and the organization has been licensed.
g. When working with any other organizations, the Affiliate will use these questions to help them
determine if the other organizations need a license:
i. Was the training for the leaders of this Program supplied by the Affiliate or Partners?
ii. Is (are) the T-Trainer, Master Trainer or Leaders employees or volunteers of the Affiliate
or Partners?
iii. Is your organization’s name and/or logo on all advertising and materials?
iv. Are the names of all participants sent to your organization or Partners?
v. Is your organization or Partners responsible for quality control and liability for this
Program?
If the Affiliate has answered “No” to any of these questions, the other organization needs to
obtain a license from the Program Licensor or become an affiliate of Partners. To receive more
information, contact Partners in Care Foundation, 732 Mott Street, Suite 150, San Fernando,
CA, 91340, Attention: Community Wellness Department
Exhibit B
Fees
Evidence-Based Program Licensing
Licensing fees must be paid prior to commencement of EBP
workshop
Fees
Chronic Disease Self-Management Programs
*Must purchase License to offer either program
$250 for up to 8 workshops per year
$400 for up to 16 workshops per year
EnhanceFitness $800 for the first year
$150 for each year thereafter
$200 for access to Online Data Entry
System (ODES) annually
Falls Prevention Program
Matter of Balance
Tai Chi for Arthritis