Attachment A15.pdf

ATTACHMENT A15

CATEGORY 5: BEHAVIORAL HEALTH PLACEMENT SUPPORT SERVICES

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THERAPEUTIC BEHAVIORAL SERVICES FOR YOUTH WITH

INTELLECTUAL DISABILITIES OR DEVELOPMENTAL DELAY

SCOPE OF WORK

I. Purpose

A. The County of Santa Clara (County) Behavioral Health Services Department (BHSD) is seeking statements of qualifications from qualified Offerors interested in designing and operating a Children, Youth, and Family System of Care Therapeutic Behavioral Services for Youth with intellectual disability or developmental delays (TBS-ID) program (hereafter referred to as “the program”).

B. The program has been designed to provide comprehensive, appropriate, and trauma informed therapeutic behavioral services help children, youth and young adults, ages birth through 20 years, identified with serious emotional challenges and have been dually diagnosed with an intellectual disability and/or developmental delay (hereafter referred to as “client”). Services are inclusive of their families and significant supports that utilize behavioral interventions that are recovery oriented, trauma informed, evidence-based practices (EBPs), and promising practice (PPs) to teach strategies and skills to reduce and manage challenging behaviors as well as increase positive behaviors that will allow children, youth and young adults be successful in their current environment.

C. The program is supplemental to an ongoing Specialty Mental Health service and/or Drug Medi-Cal Organized Delivery System services. TBS interventions are intensive, short-term, home or placement-based, and are 1:1 behavioral intervention designed to improve the social/emotional /behavioral functioning and enhance abilities for children, youth, and young adults to participate in meaningful activities such as recreational, school, employment, and independent living activities. Trained behavioral coaches teach the child, youth, young adults and their caregivers effective coping skills, anger management and mood regulation. Interventions are strength-based, individualized and culturally sensitive. The program should build and nurture natural supports, which help clients maintain a positive developmental trajectory.

II. Background A. The program services were designed to provide supplemental support to an ongoing

Behavioral Health service. TBS-ID was developed to ensure that TBS services are appropriately adapted to meet the specific needs of a client with an intellectual and/or developmental diagnosis in addition to a specialty mental health need.

Services provide individual interventions that are intensive, short-term, home or placement-based, and are 1:1. Trained behavioral coaches teach the child, youth, young adult, and their caregivers effective coping skills, anger management and mood regulation. Interventions are strength-based, individualized and culturally sensitive. In fiscal year (FY) 2023-2024, 132 clients were served with 71% of clients identified as

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III. 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.

B. Offeror shall strategically operate a Medi-Cal certified service delivery site within the identified County catchment areas. The site shall be considered 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, etc.), if appropriate.

C. Services shall strategically be situated within the identified County catchment areas.

The four (4) primary regions of focus for program services are North, Central, East, and South County regions:

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

IV. Target Population

A. Medi-Cal beneficiaries who are residents of Santa Clara County between the ages birth-20, currently receiving specialty mental health services (SMHS) or Drug Medi-Cal Organized Delivery System (DMC-ODS) with severe behavioral challenges that impact their current residential and/or educational placement.

B. Clients shall meet the program criteria in accordance with all laws and regulations governing Medi-Cal as mandated by federal, state, and local statues.

C. The program shall serve clients whose level of functioning, symptoms, psychiatric history, and/or hospitalizations necessitate therapeutic behavioral service intervention, and clients that are dually diagnosed with a behavioral health condition and an intellectual disability and/or developmental delay which is inclusive of, but not limited to: Developmental Disorder, Learning Disability, Intellectual Disability, Language Disorder, Cognitive Disorders, etc.

D. A typical client in the program may require support for three (3) to six (6) months at a high frequency of two or more times a week and have, in addition to their ongoing primary SMHS/DMC-ODS services, but not limited to some of the below characteristics:

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1. Functional Impairment: clients exhibit profound difficulties in family interactions, peer relationships, and academic or vocational settings. They display severe emotional dysregulation necessitating intensive external support for effective management;

2. Common Diagnoses and Presenting Behaviors (not limited to): Typical diagnoses often include severe anxiety disorders, major depressive disorder, trauma-related disorders, and adjustment disorders, all contributing to severe impairment in daily functioning. Internalizing or externalizing behavioral issues severely disrupt relationships and overall functioning. Clients struggle with maintaining appropriate behavior and have co-occurring developmental diagnosis/challenges and may have substance use;

3. Support System: Clients have some access to some social and environmental support, there is an urgent need for substantial strengthening and buffering of these supports to adequately address their complex needs. Involvement with other child serving systems such as child welfare, juvenile justice systems, San Andreas Regional Center, etc. may also be present; and

4. Care coordination: Critical need for intensive care coordination, often requiring Multi-Disciplinary Teams (MDTs) and Child Family Team Meetings (CFTs). Care plans must be regularly adjusted based on evolving needs and collaboration with primary SMHS provider.

V. 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. Reduce subjective suffering from mental health symptomology, and improve clinical/functional outcomes to prevent the need for more intensive services, such as emergency psychiatric services, crisis stabilization unit, and hospitalization for clients;

b. Improve school functioning or job performance, and increase participation in community activities;

c. Create opportunities to engage the client’s natural support systems and nurture the supportive relationship, thus increasing self-help and client/family involvement;

d. Reduce the psycho-social impact of trauma, victimization, homelessness, crisis, hospitalization, child welfare involvement, juvenile justice involvement, violence and substance use;

e. Reduce multiple foster care placements, timelines to permanency and length of stay in the child welfare system;

f. Reduce incarceration and/or juvenile justice involvement;

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g. Reduce and prevent suicide risks;

h. Increase strategies and skills of client and caregivers to manage and reduce severe behavioral challenges; and

i. Increase access to culturally informed and efficient services for clients with intellectual disability or developmental delay.

2. Objectives shall be achieved by:

a. Effectively engaging clients and their families by providing client centered, trauma informed practices that are culturally, developmentally and linguistically appropriate to ensure voice and choice in services.

b. Providing culturally appropriate, non-stigmatizing access to behavioral healthcare services to clients, that is inclusive of the underserved and unserved ethnic and cultural populations, and child welfare and juvenile justice systems;

c. Utilize a Functional Behavioral Analysis (FBA) to identify target behaviors and develop treatment goals to support client and caregiver’s needs;

d. Provide time limited, comprehensive age-specific and developmentally appropriate behavioral interventions for clients through utilization of EBPs, PPs, Community Defined Evidence Practices (CDEPs), and trauma informed practices in the least restrictive and intrusive manner that maximizes the physical, emotional, and psychological safety of the client and family being served;

e. Provide connection to at least one (1) caring adult, community, rehabilitation and education resources, in conjunction with the referring primary mental health specialty or substance use treatment provider; and

f. Collaborate with primary provider to address client substance/alcohol use and related risky behaviors as applicable.

VI. Reporting and Data Collection Requirements

A. Offeror shall comply with the reporting requirements reflected in Division 5 of the California Welfare Institutions Code (WIC) and Division 1 of Title 9 of the California Code of Regulations (CCR) when applicable.

B. Offeror shall collect and report required data, including but not limited to:

1. FBA LaAssessment;

2. Treatment Summary Reports;

3. Quarterly program outcome reporting that includes EBPs utilized, staff training and credentials;

4. Client demographic information, direct services information, and other

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5. Client and service information (CSI) data;

6. Client outcomes to assist in determining baseline and areas of improvement; and

7. Utilize the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and/or the International Classification of Diseases, Tenth Edition (ICD-

10) for diagnoses and coding purposes. Updates of these manuals shall be incorporated into the service delivery process as they become available.

C. Data Submission

1. Complete and submit program-specific reports as requested;

2. The offeror shall collect and report data including the following as appropriate for the program:

a. Initial, follow-up, transfer, and discharge FBA assessments;

b. TBS Treatment Plan;

c. TBS Discharge Summary;

d. Applicable Client Goals and Outcomes; and/or

e. Client Satisfaction data;

f. CSI data;

g. Client readmission(s) to the program (as applicable);

h. Post-discharge (e.g., placement/service(s) type, frequency, etc.); and

i. Any County data or assessment tools as required by the BHSD.

D. Offeror shall detail 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’s Electronic Health Record (EHR) Status. Offeror shall indicate current and future County EHR system needs in Appendix H, using one (1) of the following myAvatar 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.

VII. Outcomes and Measurements

A. Offeror shall achieve the following outcomes:

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1. Reduce placement disruption;

2. Increase knowledge and support from family and/or natural support systems;

and

3. Timely access to services: Adhere to timeliness and access requirements as set forth in Code of Federal Regulations (CFR) 42, Section 438 for all geographic areas of Santa Clara County. Offeror will adhere to State standards time and distance requirements. Offeror shall provide behavioral health services within ten working days. Services must be accessible within fifteen (15) miles or thirty

(30) minutes from a beneficiary’s residence.

B. Offeror shall use the following measurements:

1. TBS clinician-completed initial, follow-up, transfer, and discharge FBA and record all assessments in accordance with the California Mental Health Services Authority (CalMHSA) Clinical Documentation Guide, Behavioral Health Provider Services Department Provider Manual, BHSD Clinical Practices Guideline Manual, and staff’s training and expertise.

2. Offeror shall administer the Client Perception Survey bi-annually, and a Client Satisfaction Survey pre and post TBS.

VIII. Program Description

A. Service Description

1. 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, BHSD policies and procedures, CCR Title 9 and 22, applicable laws and regulations, and MHSA requirements.

2. Offeror shall conduct a functional behavioral analysis assessment, provide the program support services, collateral and case management/brokerage services, as determined by client needs, mental health symptoms, and program requirements.

3. Offeror shall ensure that their organization’s service plan shall meets 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

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f. Payment reform.

4. Offeror staff shall engage in care coordination, treatment team meetings, and include the client and family members and system partners such as the client’s primary SMHS provider, criminal justice system, housing organizations, primary care providers, teachers and other partners to ensure care coordination and appropriate service delivery, as applicable.

5. Offeror shall work collaboratively with community navigators, community providers, and other mental health agencies, substance use treatment service providers, physical health providers, educational systems, child welfare systems, juvenile justice systems, and other groups that provide supportive services.

6. Offeror shall utilize a variety of behavioral approaches to resolve identified behavioral health problems in a manner that considers the client and family’s individual needs.

7. Provide the program’s interventions to address targeted behaviors and maintain clients at home, with foster parents, or other living situations to increase stability. Interventions may also be utilized to support during a transition to a lower level of residential care.

8. Collaborate with primary SMHS provider to ensure coordination of service delivery and alignment of treatment goals.

9. Services shall be provided collaboratively to help clients achieve agreed upon outcomes, achieve a sense of mastery, and ability to positively influence their own lives.

10. Offeror shall provide services based on the client’s TBS Treatment Plan and Problem List. Services include the following:

a. Provide 1:1 TBS-ID behavioral interventions;

b. Evaluation and assessment of client utilizing functional behavioral analysis;

c. Case management

11. Offeror shall coordinate with the primary SMHS provider when medication management services are needed.

12. Offeror shall provide treatment to children/youth with co-occurring disorders and serious mental health symptoms as part of the service continuum.

13. Offeror shall provide a Client Status Report (CSR) monthly upon request of the Probation Department, if providing services to youth and young adults in the Juvenile Justice System. The CSR shall contain relevant information regarding the client’s progress, compliance with program requirements, and any significant developments pertinent to the client’s case.

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14. 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.

15. CFT Meetings

a. CFT Meetings are central to the California Integrated Core Practice Model (ICPM). It is strongly recommended that all Offerors have training to support the integration of ICPM. Children who are involved in the child welfare or juvenile justice system will have CFT’s facilitated by an identified provider and will typically include the client, client’s support system, social worker or probation officer, behavioral health provider, and other supports the client/family identify. When invited, the Offeror shall attend and participate in CFT meetings.

b. The Offeror should obtain a Release of Information (ROI) from the client to be able to share the information with parties in attendance of the CFT that are not covered by the Department Health Care Services’ (DHCS) Information Notice. Additional guidance can be found in All County Letter (ACL) 18-09 (http://www.cdss.ca.gov/Portals/9/ACL/2018/18-09.pdf?ver=2018-01-26- 162122-640) and ACL 18-85 (http://www.cdss.ca.gov/Portals/9/ACL/2018/18-85.pdf?ver=2018-07-09- 134620-230).

16. Transformation Care Planning (TCP)

The Offeror shall implement TCP as the model for service delivery and care planning. All direct service staff shall be trained in TCP and shall practice to TCP standards and philosophy. Staff shall develop a collaborative case formulation and TCP care plan as delineated in the BHSD TCP curriculum. Prior authorization and care plans are required for youth receiving ICC, IHBS, and TBS-ID services.

17. Offeror shall possess the capability to identify risk factors associated with vulnerable child and youth populations, encompassing but not limited to the following: commercial sexual exploitation of children and adolescence, juvenile justice involvement, child abuse and neglect, and clients with developmental needs. Furthermore, Offeror shall be equipped to provide necessary resources and training to staff members aimed at effectively addressing the needs of these populations.

18. Offeror shall prioritize cultural competence and the ability to engage in action or create conditions that maximize the optimal development of the client and client systems. Service array shall reflect the BHSD’s values pertaining to client and family empowerment, best practices, health and wellness, and cultural responsiveness, including the following:

a. Offeror shall provide cultural, ethnic and language specific services to meet the individual and family needs (e.g., culture, preferred language(s) and http://www.cdss.ca.gov/Portals/9/ACL/2018/18-85.pdf?ver=2018-07-09-134620-230 http://www.cdss.ca.gov/Portals/9/ACL/2018/18-85.pdf?ver=2018-07-09-134620-230

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19. Staff shall utilize behavioral interventions from EBPs, PPs, cultural and trauma-informed practices whenever clinically indicated and based on client’s social-emotional and behavioral health needs. EBPs and PPs recommended for the program may include but not limited to the following: Affirming Counseling, Behavior Therapy, Brief Psychodynamic Therapy, Child-Parent Psychotherapy (CPP), Motivational Interviewing (MI), Stages of Change, Seeking Safety, Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), Family Therapy, Interpersonal Therapy, Solution-Focused Brief Therapy (SFBT), trauma-informed approaches including Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), integrated co-occurring disorder practices including CBT for Substance Use Disorders (SUD) and peer supports.

20. Offeror shall utilize a family focused EBP or PP behavioral interventions when clinically indicated.

21. Offeror shall provide services based on the client’s TBS-ID Treatment Plan and Problem List.

22. Offeror shall coordinate with the primary service provider when medication management services are needed.

B. Staffing Requirements

1. Offeror shall ensure that the clinical staff required by the program are in place prior to the start of the Program and shall remain available to provide services to the clients on an ongoing basis.

2. Offeror shall maintain appropriate staffing for the program, including the following:

a. Waivered or Licensed Practitioner of the Healing Arts (LPHA)

b. TBS Coaches

i. Must meet the minimum criteria regarding their scope of practice, training, and experience according to State regulations (TBS Documentation Manual), California Mental Health Services Authority (CalMHSA) Clinical Documentation Guide, Behavioral Health Provider Services Department Provider Manual, and BHSD Clinical Practices Guideline Manual.

c. Quality assurance staff.

3. Offeror’s staff shall meet all BHSD training and licensing requirements, including but not limited to:

a. Offeror shall provide adequate supervision of staff following the BHSD clinical

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(https://www.sccgov.org/sites/bhd/partners/QI/PQIC/Documents/Clinical%2 0Supervision%20%28CS%29%20Workgroup/SCCMHD%20Clinical%20Supervi sion%20Recommendations%20-%20docx%20-%2091614.pdf).;

b. Offeror shall provide consistent, scheduled, and structured 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 2-day training on Reflective Practice provided by the BHSD. This requirement also applies to paraprofessional or other practitioners who are not on a licensure or certification track;

c. Staff shall participate in reflective supervision and shall have completed the 1-day training on reflective practice facilitation provided by the BHSD;

d. Training and supervision to ensure staff competency, knowledge, skills and sensitivity to effectively engage and treat the population they are serving.

This includes understanding and addressing diverse needs including by not limited to age-specific, cultural, developmental, and system involved considerations;

e. County policy (staff which meet specific discipline requirements;

appropriately trained Licensed Practitioner of the Healing Arts [LPHA]); and

f. State and Federal (Title 9, Title 19, and Title 22 of Medi-Cal Regulations) policy.

4. Offeror’s staff shall meet the BHSD Co-Occurring Standards. The BHSD Co- Occurring standards expect all paraprofessional and professional practitioners to have the minimal core skills and be trained according to the following three-core skill levels:

a. Co-Occurring Informed: This level of practice identifies the core skills needed to support treatment. The identified domains for this level are screening, engagement, readiness and retention, education, advocacy, and collaboration;

b. Co-Occurring Capable: This level of practice identifies the core skills needed to provide an integrated assessment and provide treatment to clients and families facing mild to moderate co-occurring disorders. The identified domains for this level are screening, assessment, diagnosis, and co-occurring capable treatment; and

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c. Co-Occurring Enhanced: This level of practice identifies the expertise needed to provide fully integrated treatment to clients and families challenged with moderate to severe co-occurring disorders. The identified domains are assessment, diagnosis, and integrated treatment.

5. Offeror shall maintain practices related to recruiting, hiring, and promoting multilingual staff and/or a culturally or ethnically diverse workforce. Offeror shall have training requirements related to diversity, equity, and/or inclusion (e.g., Lesbian, Gay, Bisexual, Transgender, Queer, Questioning + [LGBTQ+], cultural and linguistic capacity, racial equity). Offeror’s staff shall also participate in the Sexual Orientation and Gender Identity and Expression (SOGIE) 101 Training.

6. Offeror shall ensure that appropriate staff shall attend all system wide required BHSD trainings and shall participate in all required trainings specific to the needs of the program and in accordance with the BHSD Provider Manual.

C. 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 leadership that models 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. 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.

3. The program shall be composed of staff who are proficient in the seven (7) Santa Clara County threshold languages (Spanish, Vietnamese, Mandarin, Cantonese, Tagalog, Farsi, and Russian). Offeror’s organization shall have a plan to address barriers when they do not have staff available to meet the County threshold languages and a plan for actions and changes to ensure diversity and inclusion in service delivery.

4. Cultural Diversity and Inclusion Services must be provided in a culturally responsible manner to the entire target population, demonstrating fair and equitable practices for participants of diverse identities including gender, age, culture, religion, race, spiritual beliefs, ethnicity, sexual orientation, gender identity, maturational level, educational functioning level, physical health, and disability.

5. Offeror shall maintain and promote an organization that provides the highest quality of services to clients regardless of actual or perceived sexual orientation, gender identity, or gender expression. Lesbian, Gay, Bisexual, Transgender, RFSQ-BHSD-FY25-0066: Children, Youth, and Family System of Care Services Page 12 of 16 ATTACHMENT A15: Therapeutic Behavioral Services for Youth with Intellectual Disabilities or Developmental Delay Scope of Work CATEGORY 5: Behavioral Health Placement Support Services

Queer, and Intersex (LGBTQI+) clients shall receive fair and equitable treatment, without fear of negative bias or discrimination and in a professional and confidential manner based on principles of sound professional practice.

D. Referrals and Admissions

1. Offeror shall accept referrals from the BHSD Utilization Management (UM) team with an approval to being TBS services, per BHSD policy and procedure UMR-001 (P&P UMR-001) and as outlined in BHSD Authorization Process Guides – Authorization Request Form Directions.

2. Offeror shall be aware that based on client need and system capacity, the BHSD UM may refer non-English-speaking clients to clinics having availability regardless of language and cultural specialization.

3. The Offeror shall have a centralized intake procedure for receiving referrals.

E. The Offeror agrees to implement and maintain a feedback loop process that ensures timely notification to primary SMHS provider regarding the status of the referral. This process includes providing relevant sections of the assessment and informing of the outcomes and/or next steps

F. Care Coordination

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

a. To facilitate care coordination, Offeror shall request Health Insurance Portability and Accountability Act (HIPAA) and California law-compliant client authorization to share client information with all other providers involved in the client’s care, in satisfaction of state, and federal privacy laws and regulations;

b. Offeror shall engage in care coordination activities beginning at client intake and throughout the treatment and discharge planning processes;

c. Offeror shall use a treatment team process that includes consulting with the TBS team and primary SMHS provider team, when determining client needs and goals;

d. Clients who are open to receiving program services shall, as part of their acceptance into this program, sign appropriate Authorization for Release of Information so that program staff have authorization to share client information with their primary mental health providers;

e. Offeror shall have the willingness, experience, and ability to collaborate with multiple County systems and services;

f. Offeror shall integrate co-occurring disorder behavioral practices that are inclusive of the client and family;

g. Review each client’s status and progress towards planned goals at regular https://bhdp.santaclaracounty.gov/get-bhsd-forms

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h. Coordinate with primary SMHS service provider to link clients to community-based resources, educational services, developmental services, as well as primary care services based on client and family needs, as applicable; and

i. 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.

G. Program Hours of Operations

1. Offeror shall provide services on a year-round basis. Every effort should be made to meet with clients and their families at times that are convenient for them.

2. 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. Offeror shall provide regular business hours that take into account expected client and parent work schedules; and twenty-four (24) hours, seven (7) days a week risk coverage of clients.

H. Evaluations, Transitional Planning, and Discharge

1. Offeror shall comply with all audits performed by the County including regularly scheduled audits and evaluation of Offeror for compliance and quality assurance.

These include monitoring and review activities such as chart audits, administrative review of Offeror’s organization, policies, personnel, and fiscal reviews. The annual audit as performed by the County may lead to a Corrective Action Plan. The Offeror shall follow timelines and follow-up as outlined in the Provider Manual as well as in the Notice of Correction that is issued by the County.

2. FBA assessments may be provided by any qualifying LPHA, as stated in the BHSD Clinical Practices Guideline Manual.

3. Offeror shall collaborate with the primary SMHS provider regarding required and additional assessments when needs are identified.

4. TCP: Offeror shall review the referring primary SMHS program’s Child and Adolescent Needs and Strengths (CANS) and Pediatric Symptom Checklist (PSC-

35) assessment tools, problem list, and care plan to help inform TBS treatment goals and problem list.

5. Offeror shall discharge clients when they meet at least one (1) of the following criteria:

a. Upon mutual agreement by the client and provider that the client completed

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b. Upon a good faith determination by Offeror that the program cannot effectively serve the client;

c. Upon client or guardian's unilateral decision to terminate treatment (against medical advice);

d. Upon transfer to another County mental health or substance use program, in which Offeror shall 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;

e. When the client is incarcerated for over thirty (30) days;

f. When the client no longer needs the program and/or medically necessary specialty mental health services; and/or

g. When the client is not engaged and responsive after thirty (30) days of persistent efforts to locate them and following all County policies and procedures.

6. Offeror shall establish written discharge policies and procedures, either independently or by adopting the County's policies. These procedures should cover:

a. Written criteria for discharge types, including successful completion, administrative, involuntary, transfers and referrals; and

b. A discharge summary that includes reason for discharged, description of treatment episodes; description of services completed; current alcohol and/or drug use; and other relevant information.

IX. Public Health Emergency or Other Emergency Disaster Plan

A. Offeror shall have policies and procedures to address disaster preparedness during a Public Health Emergency or other emergency disaster. Offeror shall complete Appendix B, Evaluation Criteria and Qualifications and submit the following supplemental information:

1. Emergency and disaster plan to deliver services during a Public Health

Emergency or other emergency disaster that includes, at a minimum, evacuation procedures, training for workforce members, and quarterly emergency drills; and

2. Emergency and disaster plan to deliver services during a pandemic such as the COVID-19 pandemic.

B. Offeror shall comply with all County requirements in effect relating to COVID-19 for persons who routinely perform services for County onsite and share airspace with or proximity to other people at a County facility as part of their services for County as set forth in a County Health Order (or similar directives).