ATTACHMENT A15

CATEGORY 3: FULL SERVICE PARTNERSHIP SERVICES

FORENSIC, DIVERSION, AND REINTEGRATION FULL SERVICE PARTNERSHIP

Scope of Work Purpose A. The County of Santa Clara (County) Behavioral Health Services Department (BHSD) is seeking statements of qualifications from qualified Offerors interested in providing Forensic, Diversion, and Reintegration (FDR) Full Service Partnership (FSP) program hereafter referred to as “the program”) services for clients with severe mental illness (SMI) and include co-occurring disorders[footnoteRef:1] that require outpatient services and other related needs. [1: Clients require both mental health and substance use treatment services.]

B. The Program shall provide intensive, wraparound services that are recovery-orientated, client-driven, culturally and linguistically responsive, trauma-informed, and co-occurring capable. Services intend to be “full service” in that the Program does “whatever it takes” to support clients in their recovery process.

C. Services shall be designed to improve the emotional/behavioral functioning and enhance the abilities of clients to participate in meaningful activities such as recreational, school, employment, and independent living activities. The Program shall build and nurture supports, which helps clients remain in the communities as emotionally healthy and productive members.

D. The Program shall be a step-down level for clients that either complete the Forensic Assertive Community Treatment (FACT) or Intensive Outpatient Program (IOP) programs or require more structured and comprehensive care due to the worsening psychiatric symptoms that cannot be treated using standard outpatient treatment models.

Operational and Logistical Requirements A. Offeror shall have current Medi-Cal certification or become certified to provide Medi-Cal reimbursable services on or before the contract start date. In addition, Offeror shall have Medicare certification on or become certified to provide Medicare reimbursable services on or before the contract start date.

B. Offeror shall strategically operate and Medi-Cal and Medicare-certified service delivery site within the identified County catchment areas. The site shall be considered the home base for Offeror’s staff. Even with established sites, services can be offered in the community or wherever the clients are (e.g., work, school, home, homeless shelter, jails, courts, etc.), if appropriate.

C. Offeror must have current Drug Medi-Cal (DMC) certification or have the ability to become Drug Medi-Cal certified on or before the contract start date. The Program shall maximize DMC-eligible services where appropriate and conform to the DMC Organized Delivery System model that has been developed for the County.

D. Services shall be situated within the identified County catchment areas. The four (4) primary regions of focus for Program services are North, Central, and South County regions:

1. North County: Palo Alto, Los Altos and Los Altos Hills, Mountain View, Sunnyvale;

2. Central County: San Jose, Cupertino, Santa Clara, Los Gatos, Monte Sereno, Saratoga, and Campbell;

3. East County: San Jose (Foothills, Berryessa) and Northeast San Jose/Milpitas areas; and

4. South County: Gilroy, Morgan Hill, and the unincorporated area of San Martin.

Background Information A. The Program originated from the Assembly Bill (AB) 2034 Model (Wraparound Program), which combines a recovery-oriented behavioral health services treatment approach with a harm reduction and housing support model.

B. Additionally, previous AB 109 funds were provided through the Public Safety Realignment Act, which was signed into law by Governor Edmund G. Brown, Jr. in 2011. Under AB 109, individuals newly convicted of low-level offenses without a prior history of serious or violent offenses can serve their sentences in County jails rather than State prisons and be supervised by local Probation Departments once in the community. AB 109 funding supports counties to finance local public safety Programs. In turn, prison overcrowding and recidivism rates are reduced because resources are provided to individuals to successfully reintegrate into their communities.

Target Population A. The Program shall serve high-risk, unserved and underserved, justice-involved adults (ages 18 through 59) and older adults (age 60 years and above) who are residents of Santa Clara County. Clients shall meet the following prerequisites, including but not limited to:

1. Have full-scope Medi-Cal, Medicare, or both Medi-Cal and Medicare (Medi-Medi) or be uninsured;

2. MHSA clients are supervised by County Pretrial Services, Probation, and/or Parole departments;

3. AB 109 clients released from State prison and supervised by Santa Clara County’s Probation Department;

4. Arrested, charged, or convicted of a criminal offense and diagnosed with an SMI and/or with a qualifying co-occurring disorder (mental health and substance use);

5. Possess a history of being hospitalized for mental health-related difficulties with no shown improved outcomes three (3) times within the last twelve (12) months in an acute/long-term psychiatric facility, including but not limited to:

a. 8A Main Jail Admissions (County Main Jail Complex Mental Health, 8th Floor)

b. Emergency Psychiatric Services (EPS);

c. Institutions of Mental Disease (IMD);

d. Mental Health Urgent Care (MHUC);

e. Psychiatric Inpatient Hospital County Contracted/Fee for Service (FFS) Hospital, and/or

f. Multiple encounters with crisis services (e.g., crisis residential)

6. Have a major psychiatric condition and demonstrate a need for intensive case management services by virtue of their history and current level of functioning;

7. At risk of out-of-home care;

8. Experience reductions in personal and/or community functioning;

9. Experience with unsuccessful community placement due to lack of engagement, lack of available intensive and comprehensive services, or utilization of various services without demonstrated improved outcomes;

10. Low insight into how symptoms and behaviors impact their lives;

11. Difficulty participating in structured activities and require a great deal of support;

12. Often engage in high-risk behaviors, including high-risk to recidivate (e.g., unsafe sex, sharing needles, wandering the streets);

13. Have a history of assaultive behavior and unsuccessful community placements; residence in long-term care facilities for extended periods; patterns of service that have relied almost exclusively on emergency and institutional care; utilized various services without improved outcomes; cognitive difficulties or medical co-morbidities; multiple and/or extended psychiatric hospitalizations, emergencies, or crisis;

14. From underserved cultural populations;

15. Trauma-exposed and/or distressed families;

16. Identify with Lesbian, Gay, Bisexual, Transgender, Queer, Questioning + (LGBTQ+) communities;

17. At risk for suicide, homelessness, incarceration, or hospitalization;

18. Poor adherence to treatment with medication management; and

19. Require public assistance services or benefits due to mental functioning impairments and circumstances.

B. Meet medical necessity criteria in accordance with all laws and regulations governing Medi-Cal and Medicare programs mandated by Federal, State, and Local statutes, including but not limited to:

1. California Code of Regulations (CCR) Title 9 (Chapter 11, Sections 1820.205, 1830.205, and 1830.210) and Social Security Act Title XXII Regulations;

2. State of California Department of Health Care Services (DHCS) Certification Standards - https://www.dhcs.ca.gov/provgovpart/Pages/MH-Licensing.aspx; and

3. State of California Department of Social Services (CDSS) Community Care Licensing (CCL) Standards - www.cdss.ca.gov.

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. Assess for co-occurring disorders (mental health and substance use) in clients requiring specialized services due to complex risk factors (e.g., abuse/violence, homelessness, substance use, psychological trauma, and intergenerational impacts of incarceration);

b. Improve the psychological functioning of clients using a strengths-based recovery model to stabilize symptoms and return to community-based services;

c. Facilitate wellness and recovery services and reduce clients’ subjective suffering from mental illness and complex life stressors unique to them;

d. Facilitate the increase of meaningful use of clients’ time and capabilities in school, work, and age-appropriate activities to support a sense of connection and self-worth;

e. Educate clients, families, and significant others about mental health and co-occurring disorders (mental health and substance use) and how to manage/cope with their illness(es) using the principles of recovery and wellness;

f. Empower clients to take responsibility and accountability for their wellness and recovery to reduce unnecessary stays in psychiatric hospitals, emergency room visits, and jail settings while producing similar outcomes to those in institutional care;

g. Decrease negative outcomes such as mental health stigma, incarceration, hospitalization, and homelessness; and

h. Increase the use of psychotropic medication and other means of symptom-reducing strategies by increasing education among clients/families.

2. Objectives shall be achieved by:

a. Offeror shall provide services meeting timeliness requirements as set forth by BHSD;

b. Offeror shall keep clients engaged in treatment for more than thirty (30) days after being released from custody;

c. Offeror shall incorporate the principles of “wellness and recovery” in which all services are client-centered, strength-based, and promote recovery and resiliency;

d. Offeror shall assist justice-involved individuals in developing life skills that will improve their ability to live and thrive in the community following incarceration;

e. Offeror shall ensure planned care transitions, warm hand-offs, and effective connections to community-based services, supports, and treatment for clients leaving custody;

f. Offeror shall provide behavioral health and co-occurring substance use services for clients through care coordination and utilization of EBPs, PPs, and trauma-informed practices;

g. Offeror shall assist clients in addressing substance/alcohol use and related risky behaviors (e.g., unsafe sex, criminal behaviors) as applicable;

h. Offeror shall link clients to medical healthcare, dental care, and relevant services, as applicable;

i. Offeror shall enhance the client’s understanding of the importance of medication adherence and its effectiveness, if appropriate;

j. Offeror shall link clients to substance use treatment, if appropriate;

k. Offeror shall initiate coordination and linkage with naturally occurring resources and other providers that serve adults and older adults in the County;

l. Offeror shall engage clients to actively participate in their recovery and self-monitor their milestones and goals toward self-determination, family, education, and vocational services;

m. Offeror shall engage underserved clients who have not benefited from traditional outpatient mental health services due to complex risk factors, including substance use, community violence, interpersonal family violence, general neglect, and exposure to trauma;

n. Offeror shall provide time-limited services for each client through the care coordinator as the single point of responsibility for services based on clinical care and treatment needs;

o. Offeror shall provide outreach and engagement with post-custody clients for a minimum of thirty (30) days;

p. Offeror shall improve client’s self-sufficiency through the development of a recovery plan that secures housing, food, clothing, and a stable income;

q. Offeror shall increase client’s understanding of the importance of their medication and its effectiveness;

r. Offeror shall provide culturally and linguistically proficient services that integrate and directly provide the full range of treatment modalities and rehabilitation services and resources to meet the needs of the clients and their families in the recovery process; and

s. Offeror shall ensure the maximum number of proposed clients/caseloads will be served by the end of the contracted fiscal year.

Reporting and Data Collection Requirements A. Offeror shall comply with the reporting requirements, including but not limited to:

1. California Welfare and Institutions Code (WIC), Division 1;

2. California Code of Regulations (CCR) Title 9 (State Department of Mental Health Social Rehabilitation and Medi-Cal Rehabilitation Option); and

3. California Department of Health Care Services (DHCS) Data Collection & Reporting System (DCR). The DCR allows for data and evaluation to be done regarding the effectiveness of FSP services being provided and the achievement of outcome measures. Offeror shall submit the following three (3) different types of Partner Assessments to the DHCS online interface through the FSP DCR system:

a. The Partnership Assessment Form (PAF) gathers baseline information about the client.

i. Upon initial admission to an FSP or re-establish FSP services if there has been more than one (1) year of discontinued FSP services; and

ii. No later than thirty (30) days upon client admission.

b. The Key Event Tracking (KET) records significant changes in education, living arrangements, legal issues, and emergency intervention.

i. PAF shall be completed before completing a KET; and

ii. Within five (5) days after a key event occurs during client treatment.

c. The Quarterly Assessment (3M) gathers follow-up information on the client’s areas of strength, need, and treatment focus.

i. PAF shall be completed before completing a 3M;

ii. 30 days before or after OR two (2) weeks before the due date and up to thirty (30) days after the due date; and

iii. Thirty (30) days prior or thirty (30) days after a client’s quarterly assessment is due.

4. Offeror shall ensure adherence to DCR policies and procedures established by BHSD.

5. Offeror shall be responsible for the completion and submission of data, including the following as appropriate for the program:

a. Active caseload/Length of Stay (LOS);

b. Capacity data for BHSD Adult and Older Adult Division;

c. Client and Service Information (CSI) data;

d. Client list per staff ratio;

e. Client Perception/Satisfaction Surveys;

f. Data required by County system;

g. DLA20/MORS data;

h. MHSA reports;

i. Network Adequacy Certification Tool (NACT);

j. Outreach and engagement process report;

k. Post-discharge placement/service(s) type, frequency, etc. report;

l. Readmission to the Program report;

m. Units of Service (UOS); and

n. Other data reporting requirements as determined by BHSD.

6. Ninety Plus (90+) Days Without Service Report

a. Offeror shall run a Ninety Plus (90+) Days Without Service Report that shall consist of a status update for each client listed;

b. Offeror shall submit a copy of this report to the BHSD Program Monitor within fifteen (15) working days from the end of the quarter. In addition, the BHSD Program Monitor may run the report monthly to determine capacity needs; and

c. Offeror’s report shall include the disposition for each client listed, indicating the reason the client has not been closed.

7. Enter a weekly capacity report that includes recent referrals, current enrollment, and recent discharges that reflect current and accurate Program capacity;

8. Enter client demographic information, direct and outreach services information, and other appropriate data into the BHSD’s data information system;

9. Enter Sexual Orientation and Gender Identity and Expression (SOGIE) information;

10. Enter client data into the State Client and Service Information (CSI) system;

11. Complete and submit MHSA reporting template to BHSD quarterly;

12. Collect treatment and service data for outcomes data reporting;

13. Collect and track client Milestones of Recovery Scales scores (MORS) to determine treatment effectiveness;

14. Collect, document, track, and report on data related to community outreach, education, and training services;

15. Measure justice-involved client outcomes to assist in determining areas of improvement;

16. When applicable, administer assessment tool(s) as part of the Program requirement(s) and collect and report on assessment tool data;

17. Utilize the Diagnostic and Statistical Manuel of Mental Disorders, Fifth Edition (DSM-5) and/or the International Classification of Diseases, Tenth Edition (ICD-10) for diagnoses and coding purposes; and

18. All client demographic information, service, and other appropriate data shall be entered into the County’s electronic data interchange (EDI) system.

B. Offeror shall describe the organization’s ability to use their current electronic health record (EHR) system (including the capability to exchange data with County systems) and/or the ability to implement a new EHR system as listed in Appendix H. Offeror shall provide details on how their organization shall use the County’s myAvatar system using one (1) of the following implementation types:

1. Provider Connect Enterprise (PCE) with 837 billing;

2. Provider Connect NX (PCNX) with 837 billing;

3. PCNX non-837 billing with fast service entry claims submission, or

4. Solely client information without billing, if no EHR billing is needed for the particular Program/contract.

Outcomes and Measurements A. Offeror shall achieve the following outcomes:

1. Services that meet the fidelity of the Program, including but not limited to:

a. Key outcomes (timeliness access, engagement in services, successful discharge, acute care readmission, recidivism);

b. Services to the identified target population;

c. Services to the number of clients/caseloads agreed upon by the BHSD and Offeror;

d. The number of unit of services agreed upon in the budget;

e. Staffing specifics;

f. Number of clients who have successfully graduated from the FDR;

g. Number of clients who have obtained benefits;

h. Number of clients who were linked to a primary care physician;

i. Number of clients who enrolled in educational/vocational programs;

j. Number of clients who became employed;

k. Number of clients who were not re-incarcerated;

l. Increased housing stability and decreased homelessness;

m. Decreased psychiatric hospitalization and EPS episodes;

n. Decreased number of clients who are on the Jail Assessment Coordination (JAC) list and who are held only because of inadequate residential and outpatient services;

o. Increased percentage of clients diverted from jail into appropriate levels of care;

p. Improved emotional and behavioral functioning, and ability to participate in meaningful activities; and

q. Other categories as deemed necessary by the BHSD FDR Division.

B. Offeror shall achieve the following outcome measurement methods:

1. Offeror shall provide monthly, quarterly, and annual reviews from the following data sources:

a. MORS scores;

b. Daily Living Activities (DLA) 20;

c. CSI system;

d. Vulnerability Index – Service Prioritization Decision Assistance Tool (VI-SPDAT) data;

e. County data system; and

f. NACT.

2. Measures of Success which include client remain engage in treatment services for more than thirty (30) days after being released from custody.

3. Offeror shall track the practice fidelity and client outcomes of all Evidence-Based Practices (EBPs) utilized in the program’s services.

4. Offeror shall administer the client feedback tool bi-annually (Client Satisfaction Survey).

5. Offeror shall initiate any other monthly, quarterly, and annual measurement tools and documents, which may include, but shall not be limited to Microsoft Excel and other formats as requested by the BHSD.

6. Offeror shall have a current behavioral health electronic health record (EHR) system with capability that meets the County’s standards or shall have a behavioral health EHR system in place upon start of contract. Offeror shall utilize the County-operated EHR for billing/reimbursement purposes.

C. Offeror shall achieve data submission guidelines by following the County’s data reporting requirements described in Section VI above.

Program Description A. Service Description

1. Offeror shall provide services to clients diagnosed with behavioral health and/or co-occurring disorders. Services shall be provided in a variety of settings, including outpatient clinics, the client’s place of residence, and in the community, as appropriate. Services may include the following:

a. Individualized assessments using standardized tools[footnoteRef:2], including, but not limited to, Functional Assessment Scale (FAS) and American Society for Addiction Medicine (ASAM) Six-Dimension Scale; [2: The BHSD shall offer training through the Learning Partnership Division, as needed.]

b. Care plans (treatment plan);

c. Individual, family, and group therapy;

d. Rehabilitation services (vocational readiness, education, and skills or activities of daily living);

e. Collateral services;

f. Medication support services;

g. Case management/brokerage services that include, but are not limited to, outreach and engagement, pre-release/transition assistance, home visits, community support, transportation, linkage to housing resources, detoxification, residential treatment, benefits assistance, educational and vocational resources, food, clothing, and primary care physicians;

h. Crisis intervention services;

i. Outreach services; and

j. A variety of other services assist clients in establishing a stable community living environment.

2. Offeror shall collaborate with clients to formulate individualized treatment plans that meet the specific needs of the individuals.

3. Offeror shall visit potential clients in custody to screen and determine the appropriateness of the referral, engage the client in mental health treatment, and develop a therapeutic alliance.

4. For clients in correctional or restricted facilities, outreach, and engagement efforts shall be provided prior to their release from these facilities.

5. In addition to providing evidence-based services such as Cognitive Behavioral Therapy (CBT), Trauma-Focused CBT, Solution-Focused Brief Therapy, Dialectical Behavior Therapy, and/or Motivational Interviewing, treatment shall include at least one of the following models:

a. Criminal Thinking,

b. Thinking for a Change,

c. Moral Reconation Therapy, or

d. Risk and Responsivity.

6. Offeror shall provide integrated behavioral health services, including high frequency and intensive community-based services, intensive care coordination, intensive home-based services, WRAP services, family/peer support, and twenty-four/seven (24/7) clinical crisis support. An assigned licensed therapist and a case manager shall assist with individualized case management services.

7. Offeror shall provide medication and psychiatric support services in accordance with the following policies and practices:

a. Timely access to medication services shall be provided by a licensed physician, including psychiatrists and primary care providers;

b. A process for clients to provide feedback to the prescribing physician regarding any side effects experienced;

c. Monitor medications, screen for medical complications, provide client psychoeducation, enter client case record, and provide central storage of medications;

d. Storage and containment of medications shall meet all County, State, and federal regulations; and

e. A written plan on how the organization shall ensure that clients shall obtain medications and injectables, including making arrangements with a local pharmacy for clients to receive injectable medication, as well as verbal and written medication orders from the physician(s) who has been designated to provide psychiatric services.

8. Offeror shall ensure that:

a. Clients have access to their psychotropic and physical health medications immediately upon release from custody;

b. Community placements shall be secured prior to the client’s release; and

c. Each client’s immediate physical health needs (e.g., diabetic medications, syringes, glucose meter, tuberculosis testing, etc.) have been addressed prior to and upon client’s release in order to secure community placement into a Transitional Housing Unit (THU) or Sober Living Environment (SLE).

9. Offeror shall ensure the following services are provided as follows:

a. Provide housing assistance through case management and/or housing flex funds which may include rental subsidies, residence in a drug/alcohol rehabilitation Program, etc;

b. Provide employment assistance and educational services; and

c. Provide benefits assistance (e.g., applying for SSI, SSDI, General Assistance, etc.

10. Offeror shall prioritize the outreach and engagement efforts on clients who:

a. Are in the process of or have been recently released from incarceration;

b. Have been released from an inpatient setting;

c. Refuse or struggle with treatment access, including clients who go AWOL (Absent Without Official Leave); and

d. Have symptoms so severe that they are unable to leave home.

11. Offeror shall assist clients in completing their Tuberculosis test and results for timely access to housing placements.

12. Offeror shall be responsible for transporting clients to and from scheduled appointments, including, but not limited to, medical and social security appointments.

13. Offeror shall be present for clients who require additional support during scheduled court hearings to provide treatment updates/recommendations and gather information from the court on client’s justice status.

14. Offeror shall attend weekly Community Awaiting Placement Supervision (CAPS) Meetings in which clients are scheduled for release into the community from custody.

15. Offeror shall provide a weekly status report to the BHSD FDR Division on CAPS clients who have been released into the community to the BHSD FDR Division, as well as immediately following the occurrence of an incident and when additional client information is needed.

16. Offeror shall conduct outreach to the client within twenty-four (24) hours of being remanded into custody in order to reengage the client in treatment.

17. Offeror shall present during any scheduled client court hearing to provide treatment updates/recommendations, support, advocacy, and gather information from the court on their justice-involved status.

18. Upon release from custody, Offeror shall coordinate with BHSD, Adult Custody Health, Admin Booking, Law Enforcement Partners, Pharmacies, THUs, or other Community Resource Agencies as deemed necessary.

19. Offeror shall provide a client status report (CSR) to BHSD FDR Division for justice-involved clients who have been released into the community, 1) monthly, 2) immediately after an unusual incident occurs, which shall not be more than forty-eight (48) hours after the incident, and 3) within seventy-two (72) hours when additional client information is requested by the Court, supervising justice agency (i.e., probation, pretrial, etc.) and BHSD FDR Division.

20. Offeror shall abide by the CSR Policy and Procedure established by the BHSD. Additionally, Offeror shall submit the CSRs by the first of every month. If the first falls on a weekend or holiday, Offeror shall submit the CSRs the business day prior to the weekend or holiday.

21. Offeror shall immediately submit an incident report to BHSD when an event that causes or has the capacity to cause physical or psychological injury or has the potential for a claim or litigation to occur. When submitting incident reports, Offeror shall abide by BHSD Policy and Procedure #412-122: Outpatient Behavioral Health Services Department Incident Reports for Contract Operated Programs.

22. Offeror shall immediately notify the FDR Division when an incident involving an FDR client occurs.

23. Services shall be voluntary, driven by individual client choice. The delivery of all services shall be guided by the principles of cultural competency, recovery, and residency with an emphasis on building client strengths and resources in the community, with family, and with their peer/social network.

24. Offeror shall have access to flex funds that can be used only for the client’s personal needs, including housing subsidies and felt needs that assist the client in achieving successful outcomes of the care plan. Flex funds shall not be used for staff expenditures (e.g., food, gas, supplies, entertainment events, etc.).

B. Service Expectations

1. Offeror shall work collaboratively with community navigators, community providers, other mental health agencies, substance use treatment services providers, physical health providers, educational systems, other groups that provide supportive services, and justice partners such as, but not limited to, probation, the courts, the district attorneys, and public defenders.

2. Offeror shall provide Program services in accordance with the ordinances and resolutions of the County Board of Supervisors and the applicable policies, procedures, directives, and guidelines of the County, BHSD, and the County of Santa Clara Health System (“Health System”), including, but not limited to the BHSD Provider Manual and/or the BHSD policies and procedures.

3. Offeror shall maintain fidelity to the requirements for MHSA CSS as outlined in the CCR CSS Title 9, Chapter 14, Article 6, Sections 3610-3620.10 and 3640.

4. Offeror shall ensure that Network Adequacy standards are met by ensuring that each of the outpatient services under the Program shall be available within fifteen (15) miles or thirty (30) minutes from the clients’ established residency. Clients may opt to receive services from another provider outside the specified distance and time restrictions upon providing the BHSD with written authorization.

5. Offeror shall ensure that their organization’s service plan shall meet Medi-Cal/CalAIM behavioral health requirements, including but not limited to:

a. Medical necessity criteria;

b. Documentation redesigns;

c. Co-occurring treatment;

d. Standardized screening and transition tools;

e. Behavioral health CPT coding transition; and

f. Payment reform.

C. Evidence Based Practices and Intervention Strategies

1. The Program shall provide comprehensive behavioral health services for clients with combined components of recovery-oriented, EBPs, promising practices (PPs), and trauma-informed practices.

D. Staffing Requirements

1. Offeror shall maintain adequate staffing for the program, including the following as appropriate for the program: psychiatrists, direct service staff (e.g., licensed or associate social workers and marriage and family therapists and/or associates, social worker and marriage and family interns, California Association of Alcoholism and Drug Abuse Counselor [CAADAC], peer mentors, rehabilitation counselors, etc.), nursing staff and/or psychiatric nurses, and quality assurance staff. The psychiatrist, clinical staff, and peer support staff are required positions for the Program and shall be in place before startup and remain available at all times to provide services to the clients on an ongoing basis.

2. Staffing shall be maintained at a minimum of 1:15 staff to client ratio, which shall be in place at the start of the Program.

3. The Program must be Dual Diagnosis Capable (DDC) in which staff:

a. Address the client’s relationship between mental health and substance-related disorders and effect on the client’s readiness to change;

b. Complete readiness to change assessments for both mental health and substance use conditions; and

c. Assess for relapse and recovery environmental issues through individual and group Program content.

4. Offeror shall have appropriately trained staff and meet the qualification of Licensed Practitioner of the Healing Arts (LPHA) and specific discipline requirements necessary to provide services in this RFSQ. Staffing shall be provided at the minimum licensing requirements as outlined in Title 9, Title 19, and Title 22 of Medi-Cal Regulations.).

5. Staff shall be well-versed in the evidence of symptoms of mental health problems which meet the criteria of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) or International Classification of Diseases, Tenth Edition (ICD-10) criteria for diagnosis.

6. Staff shall be specialized and experienced in working with justice-involved clients.

7. Staff shall have knowledge in working with the target population, including trauma-exposed population, clients who have been court-ordered for mental health or substance use treatment, individuals who may have extensive contact with the justice system, and those who identify as LGBTQ+.

8. Staff shall develop a collaborative partnership with BHSD, Adult Custody Health, Admin Booking, Law Enforcement Partners, THUs, or other Community Resource Agencies.

9. Offeror shall describe existing staff providing the services and program components described in this RFSQ.

10. Offeror shall provide a personnel retention plan for the program, which includes a current list of program staff within the organization, their credentials, bilingual language capacity, and the length of time the employee has been with the organization.

11. Offeror shall describe their plan to recruit and maintain appropriate staffing to meet the diverse population of Santa Clara County.

12. Offeror shall provide the approximate percentage turnover of the program’s direct service staff over the past three years. Offeror shall also describe how the organization shall provide continuity of care for families during staff turnover.

13. Offeror shall describe their ability to meet BHSD Co-occurring Standards and include a staffing table indicating each staff rate as to whether they would be co-occurring informed, co-occurring capable, or co-occurring enhanced. Offeror shall justify the rating (certifications/ training/ expertise, etc.). BHSD Co-Occurring Standards expects all paraprofessional and professional practitioners to have minimal core skills and be trained according to the following skill levels: co-occurring informed, co-occurring capable, and co-occurring enhanced.

14. Offeror shall ensure that appropriate staff attend all system wide BHSD trainings and shall participate in all required trainings specific to the needs of the Program.

15. Offeror shall ensure staff is trained in EBPs and can track the practice fidelity and client outcomes of all EBPs utilized in the Program services.

16. Offeror shall request for new staff training on the State Online DCR System to ensure a seamless transition and continuity of services. Training can be requested from the BHSD. Additionally, any State provided DCR trainings shall be attended by an agency representative.

17. Staff shall be trained and proficient in the following:

a. MHSA CSS;

b. SOGIE 101;

c. Knowledge and skills in the principles of psychosocial rehabilitation and recovery process;

d. Confidentiality;

e. Crisis Intervention;

f. Knowledge of community resources, including self-help centers and ethnic community resources;

g. Sensitivity and awareness of language and cultural influences on the individual;

h. Understanding of the behavioral health system of care;

i. Understanding of the justice system;

j. Capacity to collaborate and coordinate with local providers of health and human services; and

k. Understanding of psychopathology and physical health problems within the context of consumers’ age and culture.

18. Staffing shall be appropriate for the caseload, complexity, and scope of service.

19. Staff shall be required to obtain jail clearance to outreach to clients who are in custody.

20. Offeror shall provide quarterly staffing report to notify the FDR Contract Monitor and FDR Division Director of staffing changes.

21. Offeror shall maintain practices related to recruiting, hiring, and promoting multi-lingual staff and/or a culturally or ethnically diverse workforce. Offeror’s organization shall have training requirements related to diversity, equity, and/or inclusion (e.g., LGBTQ+, cultural and linguistic capacity, racial equity).

E. Cultural Competency

1. Offeror’s organization shall be inclusive of promoting behaviors and practices towards a more equitable, diverse, and inclusive organizational mindset. Offeror shall have a leadership model inclusivity and tools and support to improve their organization’s ability to identify and mitigate bias, respect differences, build empathetic relationships, and manage conflict.

2. The Program shall be reflective of the ethnic, cultural, and linguistically diverse populations of the County and preferences of each client.

3. Offeror shall monitor and evaluate client/family satisfaction and culturally responsive services/practices to continually improve service quality. Data shall be used to improve Program satisfaction.

4. Offeror shall have a plan to address barriers when they do not have staff who are proficient in the six (6) Santa Clara County threshold languages: Spanish, Vietnamese, Mandarin, Cantonese, Tagalog, and Farsi.

5. Offeror shall provide counseling and recovery staff with at least Spanish and Vietnamese speaking bilingual capability.

6. Offeror shall have a plan for actions and changes to ensure diversity and inclusion in service delivery.

7. Offeror’s organization shall provide outreach activities focused on reaching underserved, underrepresented, and/or multicultural populations. Furthermore, the outreach process may take place in custody settings, psychiatric hospitals, or in the community.

F. Clinical Supervision

1. Offeror shall meet reflective supervision, reflective practice, and clinical supervision requirements as follows:

a. Submission of a clinical supervision plan that includes fidelity to the chosen EBPs or PPs;

b. Provision of a consistent schedule and structured weekly reflective supervision to serve their staff regardless of licensure. Reflective supervision shall be provided by a licensed clinician who has met the requirements for clinical supervision and who has completed the one-day training on Reflective Practice Part I provided by the BHSD. This requirement also applies to the paraprofessional or other practitioners who are not on a licensure or certification track;

c. Participation in weekly reflective supervision and will have completed the one-day raining on Reflective Practice Party II provided by the BHSD;

d. Maintain a workflow that is manageable for supervisors and attending to the ratio of no more than 1:8 supervisors to supervisees;

e. Ensure the number of supervisees assigned to a supervisor will follow relevant licensure regulations and is appropriate in terms of level of expertise and experience, years of professional practice, comfort level, complexity and intensity of services, qualifications, etc.; and

f. Provision of clinical supervision activities for review during monthly or bi-monthly providers’ meetings.

G. Referrals and Admissions

1. The Program shall accept referrals that are generated through the BHSD Collaborative Court Staff, BHSD Reentry Resource Center staff, and other FDR providers. These may include referrals that are a result of:

a. A step down from a correctional facility or inpatient facility;

b. A step down from FDR Crisis Residential Services or FDR Intensive Outpatient Program;

c. A step up from other FDR Outpatient Programs;

d. A transfer from other BHSD providers due to justice-involvement and currently being supervised by Pretrial, Probation, and/or State Parole; and

e. Referrals from other Counties for clients that have benefits with Santa Clara County; and/or

f. Referrals from Adult Custody Health, the Probation Department, the Parole Department, the Pretrial Department, and other justice partners as determined appropriate by the BHS FDR Division and which would be processed by the BHSD Collaborative Court staff or BHSD Reentry Resource Center staff

2. Offeror shall assess all referrals for eligibility according to the following criteria:

a. Three (3) or more hospital, IMD, EPS admissions within the last twelve (12) months, including while in custody (e.g., housed in the 8A Unit at the Main Jail);

b. May be homeless or at risk for homelessness, or may be difficult to engage in mental health services;

c. May have unsuccessful community placements due to lack of engagement, unavailability of intensive and comprehensive services, or utilization of various services without improved outcomes;

d. May have poor adherence to medication treatment, or may have patterns of substance use; and

e. May be medically fragile or have medical co-morbidities, but not require nursing care.

3. Offeror shall accept referrals five (5) days per week, during regular scheduled business hours.

4. Offeror shall initiate contact with the client within 96 hours (4 days) of receiving a referral. Outreach shall be consistent, persistent, and purposeful, and utilize all appropriate communication methods (e.g., telephone, in-person meetings, visits to County jail(s), and written communication). The timeline also applies to outreach efforts for clients who are being remanded into custody to re-engage the client into treatment.

5. Offeror shall have a process in place to verify and confirm that the initial contacts are made within twenty-four (24) hours of the referrals.

6. Offeror shall provide a detailed policy and plan to monitor and review the initial contacts with clients to ensure quality assurance.

7. Offeror must ensure compliance with Department of Health Care Services (DHCS) Network Adequacy Requirements in ensuring timely access to services.

8. Offeror shall make decision on admission within three (3) days of the receipt of the initial referral, unless otherwise indicated by the BHSD.

9. When Offeror denies an admission, Offeror shall make a notation and notify the referring party and BHSD Program Monitor of the following:

a. the reason(s) for not admitting;

b. the disposition of the case; and

c. any referrals or recommendations made to the referring agency, as appropriate.

10. Offeror, at the request of the client, shall initiate a transfer to a clinic of the client’s choosing as soon as there is availability at that Program per P&P 412-330.

11. If a client has or is suspected to have Autism Spectrum Disorder/Intellectual Developmental Disability but is not connected to San Andrea Regional Center (SARC), Offeror’s staff shall request collateral information from school, attorney, and/or doctor upon obtaining a signed Release of Information (ROI) to provide linkage to SARC and/or additional community resources.

H. Assessment

1. Offeror shall conduct client mental health assessments with a comprehensive and coordinated team approach to determine medical necessity, detailing the client’s impairment in an important area of life functioning (health, daily activities, social relationships, and/or living arrangements).

2. Assessment shall also include a thorough background on the client’s justice involvement history, charges, gang involvement, trauma due to incarceration, criminogenic risks, etc.

3. At intake, Offeror shall conduct a housing stability assessment to determine the extent to which housing subsidies are needed to sustain the clients in housing and link them to housing as it becomes available. If a client has a history of chronic homelessness, Offeror shall complete the VI-SPDAT to determine the risk and prioritization assistance to clients.

4. Offeror shall provide medication evaluations once a client is enrolled in service while adhering to the DHCS NACT Requirements.

I. Care Coordination

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

a. Shall hold multidisciplinary team meetings at a minimum weekly, to ensure comprehensive and consistent care when providing case management with other involved service providing agencies and institutions.

b. Offeror shall utilize EBPs, PPs, and/or trauma-informed practices whenever clinical indicated and based on each client’s diagnosis. EBPs and PPs recommended for FDR Programs may include the following:

i. Motivational Interviewing;

ii. Cognitive Behavioral Therapy;

iii. Trauma-Focused CBT;

iv. Solution-Focused Brief Therapy;

v. Dialectical Behavioral Therapy WITH at least one of the following modalities for the justice-involved population: Thinking for a Change, Moral Reconation Therapy, or Risk and Responsivity;

vi. Trauma-informed approaches; and

vii. Integrated co-occurring disorder practices and peer supports such as Wellness Recovery Action Planning.

c. Review each client’s status and progress towards planned goals annually to determine possible discharge planning and/or step down to a non-justice focused Program. Offeror shall re-write clients’ goals as necessary to match the level of care needed.

d. Provide client injection(s) and related medication management services as necessary in the outpatient clinics.

e. Link clients to community-based resources as well as primary care services. A referral to a primary care physician shall be initiated within the client’s first sixty (60) days of treatment. This linkage is to ensure the client’s ongoing physical and mental health needs can be met once the client is transitioned to a lower level of care.

f. Provide a minimum of two (2) contacts per month, of which one (1) must be in person.

g. Communicate with clients and their families to ensure comprehensive and consistent care, good communication with system partners and other serving agencies, and/or institutions involved in service delivery.

h. Co-Occurring substance use treatment shall be based on harm reduction principles. If Offeror is unable to provide this treatment specialty within their scope, a referral to appropriate services shall be facilitated and collaboration between the two providers shall address any co-occurring treatment needs.

i. Offeror must ensure a warm handoff when transitioning a client into a lower/higher level of care or to another service team.

J. Program Hours of Operations

1. Offeror shall be open for services during regular office hours Monday through Friday, forty (40) hours per week, with after-hours services available to accommodate clients requiring evening and weekend appointments as well as crisis outpatient services available twenty-four (24) hours a day, seven (7) days a week to address the emergency needs of clients under the Program. Offeror shall be required to maintain coverage that shall include WIC 5150 evaluations for clients as needed.

2. Offeror shall ensure twenty-four (24)-hour coverage plan shall be on file with the BSHD Division Director. Offeror shall provide an updated agency plan for 24-hour coverage to the BHSD Division Director and the BHSD Program Monitor for approval prior to implementation at the beginning of each new fiscal year and when any changes to this plan occur.

3. Holidays: Offeror shall maintain a minimum a skeleton crew that shall facilitate the processing of referrals coming from the BHSD Reentry Center or the Collaborative Courts, crisis coverage, and the ability to initiate Lanterman-Petris-Short (LPS) protocols.

4. Offeror shall submit a Program Closure Request Form to both the designated the BHSD FDR Contract Monitor and the FDR Division Director, at least 30 business days prior to the proposed, anticipated closure period, for review and prior approval. For example, during the two-week Christmas Holiday period from Christmas Eve until the day after New Year’s Day. Closure requests not submitted at least 30 business days prior shall result in an automatic denial. During authorized closure periods, Offeror is expected to provide staff coverage that will facilitate the processing of previously completed referrals.

5. At a minimum, sixty percent (60%) to seventy percent (70%) of services shall be delivered in the community, such as at the client’s residence.

6. Offeror shall not subcontract for any Medi-Cal services. However, Offeror may subcontract non Medi-Cal services such as housing assistance, vocational support, etc.

K. Evaluations, Transitional Planning, and Discharge

1. Offeror shall facilitate transitions to other agencies for additional or more specialized support for clients requiring higher levels of care such as Crisis Residential Services.

2. Offeror shall transfer clients who have graduated from probation/parole/pretrial services to other appropriate services, such as Adult and Older Adult Division services and Supportive Housing Services, based on the client’s level of care needed.

3. Offeror shall participate in discharge planning prior to a client being released from incarceration or a locked facility.

4. Clients shall be discharged by Offeror when a client meets at least one (1) of the following criteria:

a. Upon nearing graduation or successful graduation from the justice system, which shall include linkage to other levels of care when a referral to ongoing mental health services as needed;

b. Upon mutual agreement (client and therapist) that the goals of treatment have been met;

c. Upon a good faith determination by Offeror that the individuals cannot be effectively served by the Program and will be linked to other appropriate services that meet the needs of the individual;

d. Upon transfer out of the County to another mental health Program or region, and appropriate follow-up or other service linkage have been made;

e. Long-term incarceration for over forty-five (45) days;

f. Upon client unilateral decision to terminate treatment (against medical advice);

g. Upon transfer to a higher outpatient level, such as the Forensic Assertive Community Treatment Program (FACT);

h. Upon transfer to a lower level of care, to another mental health provider;

i. Upon transfer to another County health Program, in which Offeror shall comply with a Feedback Loop Process to ensure that referral sources are notified of the status of the referral, provided the appropriate sections of the assessment, and informed of outcomes and/or next steps;

j. Upon notification of client admission into an institutionalized setting (e.g., Institute of Mental Disorder [IMD], Mental Health Rehabilitation Center [MHRC], or locked Skilled Nursing Facility [SNF]) with the BHSD 24-hour…