"Interagency Program Memorandum of Agreement:
Linkage Agreement Between the Center and Participating Agencies

This agreement is between the Center and ___(agency name)___.

[Instructions: This statement must specify the principal expected outcomes of the collaborative.]

The Center is an interagency collaboration program whose purpose is to: 1) develop an integrated services approach based on a shared philosophy and a collaborative leadership structure; 2) provide services to children and families with agency staff who have increased authority to solve problems; 3) develop a cross-agency training institute to build commitment to interagency collaboration and provide technical assistance to managers and line staff; 4) develop an automated information network system that facilitates interagency personal information sharing, referrals, and collection of case characteristic and outcome data.

Much of the interagency casework will be carried out through members of a Multidisciplinary Team. Members of the Team will continue as employees of their current agency and retain their current job classifications while taking on new caseload responsibilities for families with children who reside in the service area.

[Instructions: This section must state the geographic/jurisdictional boundaries of the program.]

The boundaries of the service area are defined as: ___________________________

[Instructions: This section must specify the responsibilities and roles of the parties to this agreement.]

Center

Participant Services

• Provide assessment, information, and referral to all children and families who live in the service area.

• Provide case management services to eligible children and families.

Coordination

• Agree to meet with ______(agency name)_______ staff to develop appropriate referral procedures.

• Provide regular reports and consultation to _____(agency name)_____ staff regarding mutual clients under approved confidentiality procedures.

• Provide in-service collaboration skill development workshops for
  ____(agency name)_______ staff.

Confidentiality

• Provide training on Center confidentiality policy and procedure.

Multidisciplinary Team Members


_____(Agency name)_____ will designate a Multidisciplinary Team liaison/staff person to:

• Work as part of the Team and help Center staff coordinate services to families and children in the service area.

• Meet with Center staff to develop appropriate referral and communication channels between parties.

• Attend in-service training and workshops offered at the Center and elsewhere.

Confidentiality

• Agree to amend the agency's confidential procedures, as necessary, to conform with Center policy; accept the Center's release forms for mutually served families; and instruct and supervise members of the Team on any special provisions with respect to exchange of confidential information and/or records.

• Agree to enter into any necessary Memorandums of Agreement to access automated confidential files.

This agreement shall continue to ___(date)___. It may be terminated earlier by a 30-day written notice from either party for cause. Cause includes, but is not limited to, a change in state, federal, or local directive. The effective date is the date this Agreement is signed by both parties.

These responsibilities are agreed to by the following authorized signatories.

Name (Print) _________________________ Title___________________

Signature of Center Coordinator or Designee________________________

Date_______________

Name (Print) _________________________ Title____________________

Signature of Director or Designee _________________________________

Date________________"