Appendix B4.docx

APPENDIX B4

CATEGORY 3: OUTPATIENT SERVICES

SCHOOL-BASED OUTPATIENT

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: A4 - School-Based Outpatient

· 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 serving school-aged clients, providing services on school campuses, and delivering a continuum of care within a school setting. Select all that may apply.

Target Populations ☐ Children (ages 4-5) ☐ Elementary School-Aged Youth (ages 6-10) ☐ Middle/Junior High School-Aged Youth (ages 11-13) ☐ High School-Aged Youth (ages 14-18)

Levels of Care ☐ Outpatient ☐ Intensive Outpatient ☐ MTSS Tier 3

School Districts by Region Select the region(s) and specific school district(s) where services would be provided.

☐ Central County ☐ Cambrian ☐ Campbell Union ☐ Campbell Union High ☐ Cupertino Union ☐ Franklin-McKinley ☐ Lakeside Joint ☐ Loma Prieta Joint Union ☐ Los Gatos Union ☐ Los Gatos-Saratoga Joint Union ☐ Luther Burbank ☐ Moreland ☐ Oak Grove Union ☐ San Jose Unified ☐ Santa Clara Unified ☐ Saratoga Union ☐ Santa Clara County Office of Education (SCCOE) ☐ Union ☐ East County ☐ Alum Rock Union ☐ Berryessa Union ☐ East Side Union High ☐ Evergreen Elementary ☐ Milpitas Unified ☐ Mount Pleasant Elementary ☐ Orchard ☐ North County ☐ Los Altos ☐ Mountain View-Los Altos High ☐ Mountain View-Whisman ☐ Palo Alto Unified ☐ Sunnyvale Elementary ☐ Fremont Union High ☐ South County ☐ Gilroy Unified ☐ Morgan Hill Unified

Supporting Documentation: Insert Miscellaneous Supporting Document Page Number

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

☐ Medi-Cal Certification (at designated school site) ☐ Documentation ☐ Billing requirements ☐ 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 possessed licenses and certifications:

☐ Paraprofessional Staff: [Specify] ☐ Licensed Clinical Staff: [Specify] ☐ Licensed-Waivered Staff: [Specify] ☐ Medical Board-Certified: [Specify] ☐ Other: [Specify] Supporting Documentation: Insert Miscellaneous Supporting Document Page Number

Select Evidence-Based Practices (EBPs), Community Defined Evidence-Based Practices (CDEPs), and Promising Practices (PPs).

☐ Trauma-Informed Practices (e.g. (Trauma Focused Cognitive Behavior Therapy (TF-CBT), Cognitive Behavioral Intervention for Trauma in Schools (CBITS)) ☐ Motivation Interviewing ☐ Cognitive Behavioral Therapy ☐ Solution-Focused Brief Therapy ☐ Positive Parenting Program (Triple P) Level 4 ☐ Triple P Level 5 ☐ Other: [Specify] Supporting Documentation: Insert Miscellaneous Supporting Document Page Number

Select the applicable items below to confirm your organization’s staffing and organizational strategies.

· Staffing and Continuity of Care:

☐ Organizational strategies for ensuring continuity of staffing and care.

☐ Clinical supervision plans for professional and paraprofessional staff.

☐ Compliance with Medi-Cal standards.

· Staffing Details:

☐ Organizational chart detailing leadership, management, and reporting structure.

☐ Staffing chart including position titles, linguistic and cultural skills, education, experience, and certifications.

· Staff Training, Recruitment, and Retention:

☐ Practices for staff training, recruitment, and retention.

☐ Practices for recruiting, hiring, and promoting a multi-lingual and/or culturally or ethnically diverse workforce.

· Diversity, Equity, and Inclusion (DEI) Training:

☐ Training requirements related to DEI, including LGBTQ+ awareness, cultural and linguistic capacity, racial equity.

· Additional Required Plans ☐ Plans for service delivery during a pandemic and/or emergency disasters, including cooperation with County-required COVID efforts.

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 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.

Describe your organization’s experience in providing school-based services, including your ability to collaborate with school districts, school sites, and the broader school community. Specifically, detail your experience and capabilities in the following areas:

· Integrating your program and staff into existing processes and workflows while aligning with the Multi-Tiered System of Supports (MTSS) framework at a school site.

· Communicating and developing plans to provide services year-round, including school breaks such as winter, spring, and summer.

· Collaborating with schools to deliver clinical services on campus and incorporate supportive services that address the needs of the clients.

· Collaborating with schools to provide clinical support in response to critical incidents that occur within the school or its surrounding community.

Describe your organization’s experience in care coordination, including your ability to provide a warm handoff and train staff in these practices. Detail your agency’s capacity to step down or step up to an appropriate level of care to meet client needs. Additionally, explain the processes you have in place to ensure a feedback loop is maintained with all relevant parties to support continuous client care.

Historical data analysis will be reviewed by BHSD Program Subject Matter Experts (SMEs) and rated according to the criteria outlined 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 2 APPENDIX B4: School-Based Outpatient Evaluation Criteria and Qualifications CATEGORY 3: Outpatient Services