Appendix A.docx

Santa Clara County –Behavioral Health Services Department RFP-BHS-FYXX-XXXX: RFP Title

APPENDIX A

County of Santa Clara – Behavioral Health Services Department RFSQ-BHS-FY25-0176: Behavioral Health Training Services

COVER SHEET

Agency or Name:

Mailing Address:

City, State, and Zip Code:

Telephone Number: Fax Number:

Name & Title of Contact Person:

Telephone Number: Fax Number:

Email Address:

SECTION I : Minimum Qualifications and Training Categories

1. Minimum Qualifications Offerors must meet the following minimum qualifications to be eligible for consideration. Offerors who do not meet these qualifications will not proceed to the evaluation phase:

· Behavioral Health Training Experience ☐ At least two years of experience providing behavioral health trainings for community or governmental agencies.

· Consultation Experience ☐ At least two years of experience providing consultation services to municipal and governmental agencies and community stakeholders.

· Additional Qualifications (Meet at least two):

☐ Hold a current, valid, and unrestricted license, registration, or certificate in a field related to the subject matter of the course.

☐ Possess a master’s degree or higher in a field related to the subject matter of the course.

☐ Have training, certification, or experience teaching subject-matter related to the course.

☐ Have at least two years of experience in a field related to the subject matter of the course.

☐ I confirm that my organization meets the above minimum qualifications.

2. Training Categories Select all trainings from the categories below that are of interest. Check the corresponding box(es) for each applicable training. The County intends to create a single Qualified Pool (QP) for training services, which shall then be utilized in Phase Two to extend invitations for further engagement.

CATEGORY 1: Evidence Based Practice Trainings

☐ : Motivational Interviewing Trainings ☐ : American Society of Addiction Medicine (ASAM) ☐ : Solutions Focused Brief Therapy Trainings ☐ : Co-occurring Disorder Trainings ☐ : Clinical Supervision Trainings ☐ : Cognitive Behavioral Therapy Trainings ☐ : Trauma-Informed Care ☐ : Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Trainings ☐ : Short-Term Residential Therapeutic Program (STRTP) Trainings ☐ : Taking Action Trainings ☐ : Assertive Community Treatment (ACT) Trainings ☐ : Transition to Independence Process (TIP) Trainings ☐ : Reflective Practice Trainings ☐ : Substance Use Disorders and Treatment Trainings ☐ : Substance Use Relapse Prevention & Psychoeducation ☐ : Drug Medi-Cal (DMC) Organized Delivery System (ODS) Regulatory Compliance Training ☐ : Eating Disorders Trainings ☐ : Dialectical Behavioral Therapy Trainings ☐ : Parent-Child Interaction Therapy (PCIT)Trainings ☐ : Suicide Prevention Trainings ☐ : Law and Ethics Trainings ☐ : Telehealth Trainings ☐ : Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Trainings ☐ : Therapeutic Foster Care (TFC), Intensive Home Based Services (IHBS), Intensive Care Coordination (ICC), and/or EPSDT Documentation Trainings ☐ : Integrated Core Practice Model (ICPM) Trainings ☐ : Child and Family Team (CFT) Trainings

☐ : Other: ________________________________________

CATEGORY 2: Cultural Humility and Ethnic Services Trainings

☐ : Disability Awareness Trainings

☐ : Age Specific Trainings ☐ : Cultural and Linguistically Appropriate Services (CLAS) Trainings ☐ : Population Specific Trainings ☐ : Faith-Based Recovery Trainings ☐ : Other: ________________________________________

CATEGORY 3: 2SLGBTQIA+ Affirming Care Trainings

☐ : Foundational Concepts ☐ : Age Specific Trainings ☐ : School Focused Trainings ☐ : Family Focused Trainings ☐ : Gender Identity Specialty

☐ : Clinical and Therapeutic Interventions ☐ : Peer Support Trainings ☐ : Intersection / Culturally Specific

CATEGORY 4: Quality Practice Trainings

☐ : Adult Needs and Strengths Assessment (ANSA) Trainings ☐ : Child and Adolescent Needs and Strengths (CANS) Trainings

☐ : Compassion Fatigue Trainings ☐ : Family and/or Group Therapy Trainings ☐ : Crisis Intervention & De-escalation Trainings ☐ : 5150 ☐ : Continuous Improvement/Green Belt ☐ : Stigma Reduction ☐ : Case Management

CATEGORY 5: Collaborative Care Professional Trainings

☐ : Peer Support Trainings ☐ : Forensic, Diversion, and Reintegration (FDR) Trainings ☐ : Cardiac Life Support Trainings

☐ : Wellness and Self Care Trainings

SECTION II: Affirmations and Certifications

Offeror understands, agrees, and warrants:

A. That Offeror has carefully read and fully understands the information that was provided by the County to serve as the basis for submission of this response;

B. That Offeror has the capability to successfully undertake and complete the responsibilities and obligations of the response being submitted;

C. That all information contained in the response is true and correct to the best of Offeror’s knowledge;

D. That Offeror signed a non-collusion affidavit herewith attached with the response;

E. That Offeror did not receive unauthorized information from any County staff or consultant during the response period except as provided for in the RFSQ packet, addenda thereto, or Periscope Q&A timeframe;

F. That by submission of this response, the Offeror acknowledges that the County has the right to make any inquiry it deems appropriate to substantiate or supplement information supplied by the Offeror, and Offeror hereby grants the County permission to make said inquiries, and to provide any and all requested documentation in a timely manner; and

G. That Offeror offers and agrees to furnish the goods and services specified in the response.

No response shall be accepted which has not been signed in ink in the appropriate space below.

I hereby certify that I am an authorized representative of the above agency and to the best of my knowledge and belief that:

The data in this response is true and accurate; the Offeror has investigated all aspects of the RFSQ; the Offeror is aware of the applicable facts pertaining to the RFSQ process, procedures, and requirements; the Offeror has read and understands the RFSQ; the Offeror has the capability to successfully undertake and complete the responsibilities and obligations of their response being submitted; the agency will be able to meet all of the minimum response requirements as specified in this RFSQ; and the Offeror will comply with the necessary certifications and assurances if a contract is awarded.

This shall constitute a warranty, the falsity of which entitles the County to pursue any remedy authorized by law, including the right to declare any contract made as a result thereof to be void.

By signing below, the submission of a response shall be deemed a representation and certification by the Offeror that it has investigated all aspects of the RFSQ; that it is aware of the applicable facts pertaining to the RFSQ process, its procedures and requirements; and that it has read and understands the RFSQ. No request for modification of the response shall be considered after its submission on the grounds that the Offeror was not fully informed as to any fact or condition.

1. If Offeror is an INDIVIDUAL, sign here:

Date Offeror’s Signature

Offeror's Typed Name and Title

2. If Offeror is a CORPORATION, the duly authorized officer(s) shall sign here:

The undersigned certify that they are respectively:

and

Title

Title of the CORPORATION named below; that they are designated to sign this response form by resolution or by the Secretary of State's certificate of authorization, for and on behalf of the below named CORPORATION, and that they are authorized to execute same for and on behalf of said CORPORATION.

Corporation Name (type or print)

By:

Date:

Title:

By:

Date:

Title: