Appendix B10.docx

APPENDIX B10

CATEGORY 3: OUTPATIENT SERVICES

LESBIAN, GAY, BISEXUAL, TRANSGENDER, AND QUEER (LGBTQ+) OUTPATIENT CONTINUUM

EVALUATION CRITERIA AND QUALIFICATIONS

Instructions:

When completing the evaluation criteria and qualifications below, please refer to the applicable Scope of Work (SOW) and Attachment (if applicable) of the RFSQ packet for detailed program requirements, objectives, target populations, service delivery expectations and compliance criteria:

· SOW Reference: A10 - Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) Outpatient Continuum

· Attachment Reference: Attachment B – Standardized Scope of Work Language Ensure that your responses align with the expectation outlined in the SOW and Attachment (if applicable). These documents provide essential context and guidelines for your submission.

Responses for Section 1 Responses for Section 1 should include direct entries and/or completion of applicable checkboxes to affirm experience. Supporting documentation must be provided in the Miscellaneous Supporting Documents section. Reference specific page numbers where relevant information is located.

Indicate experience providing a range of Specialty Mental Health Services (SMHS), including Intensive, Outpatient, and Wellness services. Describe how your organization has met the needs of clients across various life domains such as education, employment, living situation, personal wellbeing, interpersonal relationships, substance use, and community functioning.

Target Populations ☐ Youth (ages 6 through 20) ☐ Transitional Aged Youth (ages 16 through 25)

☐ 2SLGBTQIA+

Additional Specialties ☐ Substance Use Treatment ☐ Justice Involved ☐ Child Welfare Involved

Levels of Care ☐ Outpatient ☐ Intensive Outpatient ☐ Wellness

Geographic Locations Select where services would be provided.

☐ North County (Palo Alto, Los Altos and Los Altos Hills, Mountain View, and Sunnyvale) ☐ Central County (San Jose, Cupertino, Santa Clara, Los Gatos, Monte Sereno, Saratoga, and Campbell) ☐ East County (San Jose [Foothills, Berryessa] and Northeast San Jose/Milpitas areas) ☐ South County (Gilroy, Morgan Hill, and the unincorporated area of San Martin) Supporting Documentation: Insert Miscellaneous Supporting Document Page Number

Confirm ability to meet the following requirements and provide supporting information:

☐ Certification ☐ Documentation ☐ Billing requirements ☐ Child and Adolescent Needs and Strengths (CANS) certification and administration ☐ Pediatric Symptoms Checklist-35 (PSC-35) training and administration ☐ CalAIM behavioral health requirements (medical necessity criteria, documentation re-designs, co-occurring treatment, standardized screening and transition tools, Behavioral Health Current Procedural Terminology [CPT] coding transitions, payment reform, etc.)

Supporting Documentation: Insert Miscellaneous Supporting Document Page Number

Indicate the applicable staff titles and qualifications required to deliver services as part of the support team:

☐ Paraprofessional Staff: [Specify] ☐ Licensed or Waivered Practitioner of the Healing Arts (LPHA): [Specify] ☐ Mental Health Rehab Specialist (MHRS): [Specify] ☐ Medical Board-Certified: [Specify] ☐ Other: [Specify] Supporting Documentation: Insert Miscellaneous Supporting Document Page Number

☐ Seeking Safety ☐ Motivation Interviewing ☐ Cognitive Behavioral Therapy (CBT) ☐ Trauma- Focused CBT ☐ Individual Placement Services (IPS) ☐ Other Substance Use Treatment EBP: [Specify] ☐ Other trauma informed EBP: [Specify] Supporting Documentation: Insert Miscellaneous Supporting Document Page Number

Select the applicable items below to confirm your organization’s capacity for data collection, reporting, and continuous quality improvement.

· Organization’s Capacity and Data Collection Process ☐ Capacity and processes are in place to administer and collect the required outcome evaluation data, including the assessment/outcome tools and performance measures currently utilized by staff.

☐ Data results are used to inform clinical practices, service quality, and CQI.

· Data Monitoring and Evaluation ☐ Staff regularly monitors and evaluates data, including client/family satisfaction surveys, pre-/post-service tests, and the implementation of culturally responsive services and practices.

☐ Program reports, CQI projects or processes, and data collection methods demonstrate commitment to ongoing evaluation and outcome improvement.

· Ongoing Evaluation and Outcome Improvement ☐ Plan in place for ongoing evaluation of program effectiveness, including data collection, analysis, and strategies for continuous improvement.

☐ Provision of quarterly staffing reports to the Behavioral Health Services Department (BHSD) using County-provided or other tools.

· Data-Driven Practice and Service Quality ☐ Data results are regularly used to inform and improve clinical practices and service quality.

Supporting Documentation: Insert Miscellaneous Supporting Document Page Number

Responses for Section 2 require a ‘Written Response Submission’ for each criteria.

Describe your organization’s vision, mission, and/or values that are inclusive of promoting behaviors and practices towards a more equitable, diverse, and inclusive organizational mindset. Describe your organization’s leadership model of inclusivity, and what tools and support are provided to improve your organization’s ability to identify and mitigate bias, respect differences, build empathetic relationships, and manage conflict.

Describe your experience in providing a continuum of services with intensive, outpatient, and wellbeing levels of care, and your ability to support co-occurring substance use needs when delivering services within a program.

Describe your ability to provide and ensure cultural competency, outreach, and engagement requirements are met:

· Capacity to provide culturally, ethnically, and linguistically appropriate services to the target population(s), including capacity for all County threshold languages.

· Address barriers when staff are not available to meet the County threshold languages.

· Current and future actions and changes to ensure diversity and inclusion in service delivery.

· Capacity to provide gender affirming care and a welcoming environment for youth and family.

Describe your organization’s ability to deliver EBPs, PPs, and CDEPs with fidelity, tailored to the target population. Include your capacity to provide ongoing training, supervision, and support for both new and existing staff to ensure fidelity and sustainability of EBPs, PPs, CDEPs.

Describe your organization’s experience in care coordination and your capabilities to provide a warm handoff. Include your approach to training staff in these areas.

• Detail your organization’s ability to step-down or step-up clients to an appropriate level of care based on client needs.

• If services are not available within your organization, describe how you facilitate linkage to appropriate step-up or step-down services, as determined by the child and family’s needs.

• Explain your process for ensuring a feedback loop with all relevant parties to support client care.

Historical data analysis will be reviewed by BHSD Program Subject Matter Experts (SMEs) and rated according to the criteria laid out in this RFSQ.

Offeror’s electronic health record (EHR) system capacity and responses as listed in Appendix H will be reviewed by BHSD EHR Subject Matter Experts (SMEs) and rated according to the criteria laid out in this RFSQ.

Financial records will be reviewed by the Health System Finance Department and rated according to the criteria laid out in this RFSQ.

RFSQ-BHS-FY25-0066: Children, Youth, and Family System of Care Services Page 1 of 5 APPENDIX B10: Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) Outpatient Continuum Evaluation Criteria and Qualifications CATEGORY 3: Outpatient Services