Appendix G.docx

This is a Cultural Competence Form associated with the County of Santa Clara Behavioral Health Services Department (BHSD) request for statements of qualifications (RFSQ-BHS-FY25-0176) for Behavioral Health Training Services. The form requires offerors to identify and document their organizational capacity to deliver culturally, gender, and language-specific competencies aligned with the requested services. Offerors must indicate whether cultural and linguistic staff competencies are included in their staffing work plan or identify partner agencies, including existing BHSD contracted agencies, through which they will fulfill these service requirements. The document specifically addresses competencies across multiple demographic and cultural groups, including African American/African Ancestry, Latinx, Native American/Indigenous, Asian American, Pacific Islander, and LGBTQ+ populations, as well as language capabilities in Spanish, Vietnamese, Mandarin/Cantonese, Farsi, Tagalog, Russian, and other languages.

The form establishes a minimum service requirement for availability in seven threshold languages: Spanish, Vietnamese, Mandarin, Tagalog, Cantonese, Farsi, and Russian. This Cultural Competence Form functions as an evaluation criterion for the broader RFSQ related to Substance Use Residential Withdrawal Management Services, which targets Drug-Medical beneficiaries requiring ASAM Level 3.2 residential withdrawal management. The underlying contract opportunity focuses on serving County adult residents (age 18 and above) with an average length of stay of 5-7 days, with services designed for individuals who do not require medication but require residential supervision due to inadequate home support structures.