Attachment A10.pdf

APPENDIX A10

CATEGORY 3: OUTPATIENT SERVICES

RFSQ-BHS-FY25-0066: Children, Youth, and Family System of Care Services Page 1 of 6 APPENDIX A10: Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) Outpatient Continuum Scope of Work CATEGORY 3: Outpatient Services

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

SCOPE OF WORK

In addition to Attachment B – Standardized Scope of Work Language, the following applies:

I. Purpose A. Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) Outpatient Continuum

(hereafter referred to as “The Program”) has been designed to provide culturally appropriate specialty mental health services to the child, youth, and young adult (hereafter referred to as “client”) population of 6 through 25 years old, that focuses on increasing self-help activities and promoting health and wellbeing that will assist the individual with daily functioning.

B. The program shall provide a range of service levels that includes Outreach, Intensive, Outpatient and Wellness Services that shall meet the needs of the client when they need it and address impacts to life domains including employment, education, living situation, personal wellbeing, interpersonal relationships, and community functioning.

II. Operational and Logistical Requirements A. Offeror shall provide primarily community-based services, which may occur in the client’s residence, and/or other locations in the community as appropriate to meet the needs of the individual served.

III. Target Population A. Medi-Cal beneficiaries between the ages of 6-25 who identify as queer and/or gender diverse or questioning their sexual orientation or gender identity with serious mental illness.

B. Gender diverse, queer, transgender or questioning individuals who are homeless or at risk of homelessness, and/or are transitioning out of child-service programs (e.g., child welfare, juvenile justice, and other placement settings).

C. Gender diverse, queer, transgender or questioning individuals from underserved and unserved populations who may have co-occurring substance use needs.

D. Clients who require services that support de-stigmatizing diverse sexual orientations and gender identities to aid in their wellness and recovery.

E. A typical client in the LGBTQ+ OPC program may require support for 6-12 months at a varying frequency of one or more times a week and have, but not limited to some of the below characteristics:

1. Functional Impairment: clients experience significant difficulties in family interactions, peer interactions, and school/employment functioning. They demonstrate moderate to severe emotional regulations needs that require external supports;

2. Common Diagnoses and Presenting Behaviors (not limited to): Typical diagnoses include moderate to severe anxiety disorders, major depressive disorder, trauma-related disorders, and adjustment disorders with co-occurring developmental

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Continuum Scope of Work CATEGORY 3: Outpatient Services delays such as, but not limited to expressive and/or receptive language disorder, global developmental delay disorder, autism spectrum disorder, etc. These conditions result in marked impairment in daily functioning. Internalizing or externalizing behavioral issues contribute to moderate to severe disruptions in relationships and overall functioning;

3. Support System: Clients have access to some social and environmental support, there is a critical need for substantial strengthening and buffering of these supports to adequately meet their complex needs. Involvement with the child welfare system may also be present;

4. Care Coordination: may range from simple and occasional communication with other providers, focusing on transitions and continuity of care to requiring multi- Disciplinary Teams (MDTs) and Child Family Team Meetings CFTs), dependent on service level provision.

IV. Program Goals and Objectives A. The program shall be aligned to achieve the following goals and objectives:

1. Goals shall include, but not be limited to:

a. Increase abilities to address impacts of life domains.

b. Increase knowledge of the needs of LGBTQ+ individuals to caregivers and/or natural supports

c. Educate youth, young adults and family on prevalence of discrimination and increase family and/or natural support advocacy.

d. De-Stigmatize diverse sexual orientations and gender identities, increasing creation of affirming, supportive spaces and relationships.

e. Increase access to integrated mental health and substance use services

2. Objectives shall be achieved by:

a. Engage and educate client’s and their caregiver and/or natural supports in the treatment process to ensure voice and choice in services.

b. Increase partnership and coordination of services for the clients between system partners such as, but not limited to Department of Family and Children’s Services (DFCS), the Behavioral Health Services Department (BHSD), the Juvenile Probation Department (JPD), medical home (Primary Care Physician), educational, regional, and other community organizations.

c. Support client’s and their caregivers and/or natural supports in accessing appropriate community resources and advocacy supports to reduce discrimination in work/school environments.

d. Ensure staff education in providing queer-affirming and gender-affirming clinical care to diverse identities within the LGBTQ community.

V. Reporting and Data Collection Requirements

A. Offeror shall track the clients served in the LGBTQ+ Outpatient Continuum program

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Continuum Scope of Work CATEGORY 3: Outpatient Services and the level of service that is being provided (Outreach, Intensive, Outpatient, or Wellness) and have the ability to provide this information to the BHSD upon request.

VI. Outcomes and Measurements

A. Offeror shall achieve the following outcomes:

1. Increase access to regular jobs, mainstream education and/or technical training for young adults living with behavioral health conditions.

2. Increase identification of youth that may be clinically high risk for psychosis and link to appropriate interventions.

3. Increase support and accepting behaviors of caregivers and/or family for LGBTQ+ children and youth.

B. Offer shall use the following measurements, as appropriate:

1. Employment Status documentation – specific for IPS services

2. Prodromal Questionnaire-Brief (PQ-B) (ages 12-25)

VII. Program Description

A. Service Description

1. Offeror shall provide a range of non-stigmatizing services from Outreach, Intensive, Outpatient to Wellness level of service to children, youth, young adults, and their family who need medically necessary specialty mental health services.

a. Outreach services shall be provided to the targeted population to promote and engage children, youth, young adults, and their family with a focus on Sexual Orientation and Gender Identity and Expression (SOGIE) education, resources, and services.

b. Intensive services shall be provided to clients who demonstrate higher acuity of needs and may require higher frequency of support to address symptoms, conditions, and/or risk factors that are impacting their ability to maintain themselves in community settings. Services shall include crisis response services, as needed.

c. Outpatient services shall be provided to clients who may need support to address behavioral health challenges that impact life domains including employment, education, living situation, personal wellbeing, interpersonal relationships, and community functioning.

d. Wellness services shall be provided to clients who may need medication management and light case management short term support to sustain their wellness and recovery as the program is actively working on linking to longer term medication support with Primary Care Physician (PCP), RFSQ-BHS-FY25-0066: Children, Youth, and Family System of Care Services Page 4 of 6

Continuum Scope of Work CATEGORY 3: Outpatient Services

Managed Care Plan (MCP), or other long-term provider to ensure a warm handoff.

2. Services shall focus on wellness and recovery goals that include preparing and facilitating self-sufficiency and successful achievement of clients’ transition goals.

3. Services may include the following:

a. Provide Individual Placement and Support (IPS) services for young adults ages 18 -25, who have expressed interest and motivation in pursuing competitive employment, regardless of their employment readiness, diagnosis, symptoms, substance us history, psychiatric hospitalization, homelessness. Level of disability, or legal system involvement.

i. Designated IPS staff shall provide the evidence-based practice of IPS Supported Employment in line with the eight Practice Principles and the 25 Fidelity Standards (https://ipsworks.org/wp-content/uploads/2017/08/IPS-Fidelity-Scale-Eng1.pdf;

https://ipsworks.org/)

b. Inclusion of family involvement through the Family Acceptance type models of practice.

c. Treatment for individuals who have a mild to moderate substance use disorder such that services are integrated into their mental health services.

B. All clients ages 6-21 referred to the program shall be screened for the benefit of Intensive Care Coordination (ICC) services to support wellness, recovery, and improvement in functioning for children involved with multiple child serving systems.

ICC services are delivered within the context of the Child and Family Team (CFT) which centers on the voice and choice of the family and supports the child and family moving through phases of treatment to improve wellbeing and guided by the Integrated Core Practice Model (ICPM) ICPM Guide and ACIN 1-21-18.

C. Care Coordination

1. Offeror shall adhere to the following care coordination guidelines:

a. Ensure feedback loop, as listed in Attachment J, is provided to all relevant parties to support client care. This may include but not limited to, medical home (Primary Care Physician), Juvenile Probation, Child Welfare, school placement.

i. Feedback loop shall be inclusive of but not limited to, outcome of referral, changes to treatment, and other as needed client care information.

b. Dependent on service level provision, facilitate Multi-Disciplinary Teams (MDTs) and Child Family Team Meetings (CFTs).

https://ipsworks.org/wp-content/uploads/2017/08/IPS-Fidelity-Scale-Eng1.pdf https://ipsworks.org/wp-content/uploads/2017/08/IPS-Fidelity-Scale-Eng1.pdf https://ipsworks.org/ https://www.cdss.ca.gov/Portals/9/ACIN/2018/I-21_18.pdf

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Continuum Scope of Work CATEGORY 3: Outpatient Services

D. Program Hours of Operations

1. Offeror shall provide hours of operations that ensure accessibility for Transitional Aged Youth receiving services. Services shall be available between 8:00am to 8:00pm at minimum four (4) days a week.

VIII. Staffing Requirements

A. Offeror shall provide a multidisciplinary team inclusive of a diverse group of professionals and paraprofessionals with comprehensive knowledge of and capability to deliver high quality comprehensive services to the target population. Team members include, but not limited to:

Team Member Description

Clinician Co-occurring Enhanced Licensed Practitioner of the Healing Arts (LPHA), including waivered staff, that provides therapeutic interventions utilizing evidence-based practices to support the wellness and recovery of children in the program.

Peer/Family Specialist Bachelor level staff who provide a range of assistance with predictable behavioral routines/interventions, caregiver education, accessing community resources, and referrals and linkages to additional service needs.

(MHRS/paraprofessionals)

Psychiatrists/ Other Licensed prescribing practitioners

Prescribing, administering, dispensing, and monitoring of psychiatric medications, and medication education evaluation of clinical effectiveness and side effects of psychotropic medication; obtaining informed consent;

instruction in the use, risks, and benefits of, and alternatives for, medication.

Outreach Specialist Promote and engage children, youth, young adults, and their family with a focus on Sexual Orientation and Gender Identity and Expression (SOGIE) education, resources, and services to promote awareness and reduce stigma of behavioral health services.

Other Staffing according to EBP, best practices or promising practices:

IPS Staff:

Employment/Educational Specialist and IPS Supervisor

Employment/Educational Specialist support all phases of supported employment including intake, engagement, assessment, career profile, employment plan, job development, job placement, and job shadowing.

Specialist offers specialized benefits planning to clients

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Continuum Scope of Work CATEGORY 3: Outpatient Services referred to the program, when starting a new job, and when there are changes to the work hours and/or pay.

Specialist will also assist accessing additional support and benefits, as appropriate.