3-Nutrition RFP-Appendix B SOW and Technical Requirements.docx

BEHAVIORAL HEALTH NUTRITION SCOPE OF WORK AND TECHNICAL REQUIREMENTS

The State of Delaware, Department of Health and Social Services, Division of Substance Abuse and Mental Health (DSAMH) is soliciting proposals from qualified vendors to provide comprehensive nutrition education services for individuals experiencing behavioral health conditions, including serious mental illness (SMI) and substance use disorders. The selected vendor will conduct targeted screenings, offer individualized nutrition counseling, and deliver group-based nutrition education to support recovery, improve health outcomes, and address food insecurity.

Background Nutrition plays a critical role in behavioral health recovery. Individuals with SMI and substance use disorders often face elevated risks of malnutrition, food insecurity, and chronic diseases that can exacerbate psychiatric symptoms and hinder treatment engagement. Integrating nutrition services into behavioral health care is essential for promoting holistic wellness, reducing health disparities, and improving long-term recovery outcomes. Benefits of nutrition services for those with behavioral health conditions are outlined below:

• Reduces depression and anxiety symptoms: Research shows improved mood and reduced symptoms from diets rich in fruits, vegetables, and omega-3 fatty acids.

• Stabilizes mood swings: By balancing blood sugar, proper nutrition prevents the crashes that can cause irritability and mood instability.

Depression, anxiety, bipolar disorder, ADHD, schizophrenia

• Manages stress: Stress can deplete key nutrients. Nutrition services help replenish these resources, improving the body's ability to manage stress.

• Combats oxidative stress and inflammation: Diets rich in antioxidants and anti-inflammatory nutrients reduce the damage associated with mental health disorders like schizophrenia.

ADHD, chronic stress, schizophrenia, dementia

• Reduces cravings: Proper nutrition can stabilize the brain's chemistry, which helps to reduce substance cravings.

• Aids detoxification: Certain nutrients assist organs like the liver in flushing toxins out of the body.

Substance use disorders

• Improves gut health: The gut-brain axis connects the digestive system and the brain. A healthy diet supports a balanced gut microbiome, which influences mood and emotional regulation.

• Empowers long-term wellness: Nutrition counseling provides individuals with the knowledge and skills to make empowered food choices that support their mental and physical health long after treatment.

All behavioral health populations

• Addresses comorbidities: RDNs provide guidance to manage co-occurring conditions, such as diabetes or heart disease, that are common in people with behavioral health issues.

• Provides personalized care: A registered dietitian nutritionist (RDN) creates personalized plans based on an individual’s specific needs, preferences, and lifestyle.

All behavioral health populations

This initiative seeks to:

· Break the cycle of poor nutrition and behavioral health challenges

· Improve access to nutrition education and counseling

· Identify and address food insecurity and malnutrition

· Support management of nutrition-related chronic conditions

· Enhance coordination between nutrition and behavioral health services

Client Target Population

The Vendor will serve adults (age 18 and over) primarily diagnosed with a serious persistent mental illness with a co-occurring substance use disorder receiving recovery support services at a DSAMH contracted Recovery Community Center (presently at Horizon House, Inc.-Wilmington, DE) and case management services through DSAMH’s Transitional Case Management program (Newark, DE and surrounding New Castle County).

Service Functions

The primary functions of Behavioral Health Nutrition Services for the target population include:

a. Nutrition Screen and Risk Identification: Conducting screenings for:

· Food insecurity using validated tools (such as USDA Food Security Survey, Malnutrition Screening Tool, Nutrition Literacy Assessment Instrument)

· Malnutrition risk via clinical indicators, dietary intake, and anthropometric measures

· History of nutrition-related chronic diseases, including diabetes, hypertension, cardiovascular disease, and gastrointestinal disorders

b. Medical Nutrition Therapy: Nutrition counseling will be individualized to meet the unique needs of each participant, with the focus being on screening and facilitating maximal participation in supplemental food and nutrition programs, and referrals to Registered Dietitian Nutritionists (RDNs) licensed in the State of Delaware when counseling needs are more complex and need more in-depth medical management. One-on one counseling sessions shall address:

· Personalized dietary needs and preferences

· Nutritional strategies to support behavioral health recovery

· Management of chronic conditions through nutrition

· Develop individualized nutrition care plans and monitor progress

· Coordinate with behavioral health providers to ensure integrated care delivery

c. Group-Based Nutrition Education: Vendor shall deliver a structured group-based nutrition education curriculum. Vendor shall develop and implement a structured, evidence-informed curriculum tailored to behavioral health populations. Curriculum must address:

· The role of nutrition in mental health and substance use recovery

· Basic principles of healthy eating

· Budget-conscious meal planning and preparation

· Food access and navigating food environments

It is encouraged for vendor to adapt, as needed, the delivery of nutrition education services to an online, virtual format to maximize services’ delivery, as needed, given that transportation and physical limitations can be a barrier for many participants being served by DSAMH services.

Administrative Note of Reference: Screening and Medical Nutrition Therapy are presently the only services applicable for DSAMH’s Transitional Case Management participants. All service functions are applicable to participants of the designated Recovery Community Center (presently Horizon House, Inc.)

During SFY 2026, At Horizon House, nutrition screening and group education hours occur for six (6) hours each week ideally for two (2) days of services between peak hours of 11:00 AM and 2:00 PM when patient attendance is highest). Medical Nutrition Therapy is available for three (3) 6-hour days per month. For DSAMH’s Transitional Case Management participants, medical nutrition therapy is available two (2) days per month at the current vendor’s base location. Referral process will be established upon negotiation of upcoming executed contract.

Staffing Requirements The Vendor must employ or subcontract:

· Registered Dietitian Nutritionists (RDNs) or Licensed Nutritionists with experience in behavioral health settings.

· Support staff trained in screening protocols and group facilitation.

· Staff must demonstrate competency in trauma-informed care, and motivational interviewing.

Adherence to Policies and Procedures Vendor is required to adhere to all federal, state and DSAMH policies, processes, procedures, requirements, rules, laws, and regulations, including, but not limited to, those listed in this RFP. In settings where these policies do not apply in part or full, the Vendor must detail this and obtain written approval from DSAMH. Such policies include but are not limited to:

· DSAMH026 – Client Complaint and Grievance

· Criminal Background Check

· DSAMH011 – Trauma Informed Care

· DSAMH012 – Provision of Culturally and Linguistically Appropriate Services

· Human Subjects Review Board

· Inclusion

· The Drug-Free Workplace Act of 1988.

· The Americans with Disabilities Act (PL 101-336).

· State of Delaware, Office of Management and Budget, Budget and Accounting Manual. https://budget.delaware.gov/accounting-manual/index.shtml.

DSAMH reserves the right to modify, replace, or add to these policies with 60 days’ notice to Vendor. In the event of a policy modification or addition of new policy, the Vendor agrees to formulate a plan, in writing, regarding the Vendor’s compliance strategy with the modified or new policy.

Fiscal Requirements and Funding Restrictions Selected vendor will be paid on a cost reimbursement basis. Annual costs shall not exceed $50,000 (pending state general funding availability) To participate in this program:

· Vendor will be required to obtain a Unique Entity ID Number, register and provide updated information as required to the System for Award Management. Information about System for Award Management can be found at: https://www.sam.gov/.

· Vendor shall acknowledge DSAMH as a funding source in all publicity pertaining to this Scope of Work.

· Payments made will adhere to the State of Delaware, Office of Management and Budget, and Accounting Manual. https://budget.delaware.gov/accounting- manual/index.shtml.

· Vendor must be a non-profit or for-profit entity that has been in operation for over two-years and has an active Business License with the State of Delaware.

· For a Vendor that has a contract with DSAMH in place when this RFP is issued, that Vendor must have all outstanding Corrective Action Plans (CAPs) for deficiencies submitted to DSAMH for approval prior to submission.

· The funds received and expended under the executed contract must be accounted for and recorded by the selected Vendor to permit auditing and accounting for all expenditures in conformity with the terms and provisions of the executed contract, and State and Federal laws and regulations.

· The Vendor’s fiscal records and accounts, including those involving other programs which, by virtue of cost or material resources sharing, are substantially related to the executed contract, shall be subject to audit by duly authorized Federal and State officials.

· All fees paid to the Vendor shall be subject to claw back by DSAMH if such fees are determined by DSAMH or applicable governmental authority to be inappropriate for any reason.

· Cost Reimbursement Contracts are subject to Fiscal Monitoring. Vendors will be notified prior to the scheduled monitor date. The provider will be informed of the required documents for submission. The monitor process session will include review of invoices from the previous invoices submitted.

· Upon notice given to the Vendor’s Executive Director or designee, representatives of DSAMH or other duly authorized State or Federal agencies shall have the right to inspect, monitor, audit and evaluate the program’s fiscal records or other material relative to the executed contract. The Vendor must cooperate and comply with all audit activities and submit all requested materials in support of the expense and/or service being reviewed.

· Vendor is required to have an annual audit, conducted by an independent auditor, and provide DSAMH with a copy of the completed annual audit, including any related financial statements and management letters, within nine (9) months of the end of the Vendor fiscal year. Vendor must provide one bound copy via US Mail and an electronic (via the DHSS_DSAMHFiscalMonitoring@delaware.gov mailbox). Any DSAMH initiated audit shall neither obviate the need for, nor restrict the Vendor from conducting required annual corporate audits. Financial statements are to be prepared in accordance with appropriate generally accepted accounting principles. Audits must be performed in accordance with auditing standards generally accepted in the United States and Government Auditing Standards issued by the U.S. Comptroller General. When required by the amount of the Vendor’s total annual Federal award expenditures, the Vendor must comply with the requirements of the U.S. Office of Management and Budget (OMB) Uniform Grant Guidance, and its successors.

· Prohibited Costs: In determining unallowable costs listed as 1.2.1-1.2.8, DSAMH used, Subpart E of the Uniform Administrative Requirements, Cost Principles and Audit Requirements for Federal Awards. A copy of this document is available at the following link: eCFR :: 2 CFR Part 200 -- Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards. DSAMH will not pay for the following costs:

· Costs incurred before the effective date or after the termination date of any contract.

· Costs for services which have not been rendered; cannot be verified as having been provided, according to standard DSAMH monitoring and audit procedures; have not been provided by DSAMH approved agencies and programs; have been provided to persons not authorized by DSAMH; have been provided to persons of less than 18 years of age, unless such persons have been approved in writing by DSAMH as eligible to receive services under this Contract; have been paid for by Medicaid or Medicare, by other third-party payers, by or on behalf of the recipient of services; or are a benefit offered as a covered service in any healthcare plan under which the resident has been determined to be covered, or for which the resident has been found to be eligible (unless such residents are specifically approved in writing by DSAMH as eligible to receive services under this Contract).

· Costs incurred prior to the approval of the Purchase Order by the Delaware State Department of Finance.

· Costs incurred in violation of any provision of the contract.

· Costs of acquisition, renovation or improvement of facilities or land. Ongoing costs of facility maintenance and repair are distinguished from improvement and are allowable.

· Costs incurred for the purchase and maintenance of Vehicles.

· Costs of political activities, including transportation of voters or prospective voters to the polls, activities in connection with an election or a voter registration effort, contributions to political organizations and expenses related to lobbying.

· Costs of idle facilities. Idle facilities mean completely unused facilities that are excess to the organization’s current needs. Unallowable costs related to the idle facility include maintenance, repair, rent, property tax, insurance and depreciation or use allowances.

· Interest payments, late payment fees and penalties charged by Vendor because of late invoicing.

· Costs related to fines or penalties imposed on the agency or legal fees related to the defense of the agency or any of its employees in any civil or criminal action.

· Costs that violate any requirement or are identified as a prohibited activity in this scope of work

· Costs that violate any applicable Federal or State statute or regulation.

Evaluation and Performance Measures The goal of this portion of the scope is to establish sustainable systems to understand the program and its outcomes as simply as possible, integrating data collection into current systems wherever possible. DSAMH has the right to conduct any onsite evaluation and monitoring of the Vendor’s activity at any time.

The extension of the service period of the contract is based on, but not limited to, the past performance of the Vendor. The determination shall be based on, but not limited to, considerations of the following factors:

Quality Improvement Vendor shall implement a method for identifying, evaluating, and correcting deficiencies in the quality and quantity of services to be provided under any resulting contract arising out of this RFP. The quality assurance plan shall include the proposed indicators essential to assess the Vendor’s performance and the overall adequacy of services being provided to individuals in the target population.

1. Vendor must comply with HIPAA and 42 CFR, Part 2.

2. Vendor must comply with regular program and service reporting.

Presently, the Vendor shall submit monthly program reports to DSAMH_housing@delaware.gov by the 10th of each month for the preceding month of service. DSAMH shall establish the content and format structure of the report. As DSAMH reviews its various reporting mechanisms for the purpose of standardization across its behavioral health ecosystem, DSAMH reserves the right to shift the mechanism of how monthly program information is submitted which may include submission via a state contracted cloud-based survey platform. DSAMH shall provide the Vendor 60 days’ notice of any report submission changes in writing.

Measurement and Key Outcome Indicators The Vendor will be required to establish a monthly reporting process at the time of contracting and on an ongoing basis to monitor project milestones. Additional reporting measures may be asked of the Vendor ad hoc by DSAMH as needed. Below are the category measures that the Vendor shall be asked to collect:

· Screening Information-Tracks aggregate number of client screenings conducted at designated Recovery Community Center and for DSAMH Transitional Case Management, including basic client demographics (gender, age (Young People (18-24); Young Adults (25-35); Older Adults (36-60); Seniors 60+), race and ethnicity). Of those screened, percentage of those positive for food insecurity, percentage at risk for malnutrition; percentage at risk for prediabetes; percentage of persons screened enrolled in the Supplemental Nutrition Assistance Program.

· Medical Nutrition Therapy Statistics- Tracks aggregate number of client referrals to Medical Nutrition Therapy at designated Recovery Community Center and for DSAMH Transitional Case Management. This includes the number of sessions held per client (new and follow-up) and any pre and post screening outcomes. Client HIPAA de-identified success stories or challenge narratives may also be requested as qualitative analysis based on direct client experience provides a complete understanding of the service’s importance.

· Group Nutrition Education Evidence-Aggregate metrics related to group nutrition education classes held. This includes number of classes presented, number of attendees per session, and topics presented. An additional metric includes a description regarding changes to participant knowledge and practice due to Group Nutrition and resources provided.

As part of the quality improvement plan, the monthly program report must also highlight issues raised either by the Vendor as continuous improvement objectives along with recommendations to address these objectives.

DSAMH reserves the right to claw back or hold funds for program reports not submitted.

Technical Response Requirements

The Vendor’s responses to the categories below must describe how it will fulfill the requirements outlined in the scope of work. Vendor should ensure that all proposed solutions are consistent with DSAMH policies and procedures, and applicable regulations, standards, procedures, and best practices.

1. Experience and Expertise (up to 25 points)

· Submit the most recent organizational chart and current Board of Director’s roster (if applicable).

· Submit proof that Vendor has been operating for at minimum two years.

· Submit current Business License with the State of Delaware.

· Demonstrate experience providing nutrition education and counseling services, particularly within behavioral health or similar high-need populations.

· The Vendor must provide the qualifications and credentials of key personnel, along with the nature and extent of their involvement. Qualifications beyond credentials such as Registered Dietitian Nutritionists should also demonstrate experience working with individuals with behavioral health conditions. The qualifications of these individuals shall be presented (in resumes or other formats).

· Demonstrate experience of cultural competence, trauma-informed care, and experience working with high-risk populations and under-resourced communities.

1. Capacity to Meet Requirements (up to 25 points)

· Submit staffing plan to support timely and consistent delivery of services.

· If conducting this project will require hiring/recruiting of one or more individuals who are not currently employed or enrolled by the organization, detailed position descriptions, including required qualifications and experience shall be submitted.

· Describe how the Vendor will manage the training and supervision of staff. Training needs to include essential elements for staff development for the target population served.

· Describe organizational strengths and challenges that will affect the ability of the organization to implement behavioral health nutrition services within the specified timeframes.

· Identify the system in place for documentation, data collection, and reporting.

· Please provide a Letter of Support/Letter of Intent to work with the DSAMH designated Recovery Community Center, Horizon House, Inc. which shall support the space for group and individual services.

1. Program Design and Implementation (up to 30 points)

a. Programming

· Describe how the Vendor aims to conduct the services described in this SOW and how it will meet the needs of the target population. This shall include identification of the evidence-based screening tools used, approach to medical nutrition therapy and integration with behavioral health services (as applicable), and description of the proposed group-based nutrition education curriculum, including alignment with behavioral health needs. Vendors shall upload any Standard Operational Procedures, nutrition education curriculum, or other formal documents should they exist specifically for this service.

· Provide strategies for participant engagement, retention, and culturally responsive/reasonable accommodation delivery (such as nutrition educational materials, participant incentives).

· Describe how Vendor intends to comply to policies and procedures identified in this scope of work. Vendor shall upload any policies in place that support the agreeance of identified policies, processes, and regulations identified this scope of work. Selected vendor shall provide these policies annually as part of the Division’s contract monitoring process.

· The Vendor shall attach a Continuity of Operations (COOP) Plan. COOP Plans are intended to guide the Vendor as whole in the continued provisions of essential operations and the re-establishment of critical business functions during and after a disaster occurs. Vendor shall submit COOP Plans annually as part of the Division’s contract monitoring process.

b. Quality Assurance and Key Outcome Indicators

· The Vendor shall submit a quality assurance plan for identifying, evaluating, and correcting deficiencies in the quality and quantity of services proposed under this scope of work. This plan should include a description of how the fidelity of the service will be sustained (i.e. methodology, reporting mechanisms used, etc.). This plan shall include performance targets and how these will be evaluated, tracked, and reported. Additionally, this plan shall include how client satisfaction and stakeholder satisfaction will be assessed. The selected Vendor shall submit an updated quality assurance plan annually as part of the Division’s contract monitoring process.

· Describe how the requested metrics outlined in this scope of work will be collected.

c. Proposed Work Plan Submission The Vendor shall complete and submit Workplan in template provided as an Appendix D of this RFP. Upon Award of this RFP, workplan will be incorporated as an Appendix to the executed contract. The Work Plan includes:

· Areas of agreeance to service functions and requirements outlined in this Scope of Work

· Vendor shall provide the name of their organization, the organization mission, the address(es) where the Vendor will operate, how the location facilitates access for the client target population and a description of how hours will be scheduled for the project by service function.

· Vendor shall complete an Implementation Plan in chart format with milestones, target dates, and completion dates for each activity. The plan must cover start up through implementation of activities, including recruitment, hiring and orientation of key staff.

1. Sustainability and Pricing (up to 20 points) Financial sustainability shall be evaluated by review of the following information:

· Vendor must provide a copy of the last independent A-133 audit, if it is required to conduct A-133 audit according to the federal requirements). If your A-133 audit resulted in administrative findings or corrective actions, the findings/corrective actions must be included in your submission to us along with your organization’s response to those findings. Vendors that are not subject to an A-133 Audit must submit their most recent Independent Audit/Evaluation.

· Discuss any corporate reorganization or restructuring that has occurred within the last three years and discuss how the restructuring will impact the Vendor’s ability to provide services proposed.

· The Division of Substance Abuse and Mental Health reserves the right to terminate the contract, based upon merger or acquisition of the Vendor, during the contract. Vendor must include a description of any current or anticipated business or financial obligations, which will coincide with the term of the awarded RFP contract.

Pricing shall be scored based on review of the submitted Budget Workbook attached as Appendix C of this RFP. Annual costs shall not exceed $50,000 (pending state general funding availability).