Attachment A17.pdf

ATTACHMENT A17

CATEGORY 6: RESIDENTIAL

RFSQ-BHS-FY25-0066: Children, Youth, and Family System of Care Services Page 1 of 12 ATTACHMENT A17: Youth Crisis Residential Scope of Work CATEGORY 6: Residential

YOUTH CRISIS RESIDENTIAL

SCOPE OF WORK

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

I. Purpose

A. The County of Santa Clara (County) Behavioral Health Services Department (BHSD) is seeking statements of qualifications from qualified Offerors interested in establishing and operating a Youth Crisis Residential Treatment Program with Medication Support (hereafter referred to as “the program”) The program’s facility shall provide a safe and supportive environment for youth who are experiencing crisis situations and acute mental health challenges and require short term 24/7 care and supervision for stabilization prior to transition to a less restrictive, home-based environment. The program shall treat youth who are stepping down from the following acute settings:

psychiatric hospitalization, Crisis Stabilization Unit (CSU), and Emergency Psychiatric Services (EPS). The program shall also treat youth who require a more intensive level of service to prevent hospitalization at a CSU, EPS, or other locked hospital setting.

Offeror shall deliver high-quality services and support the healing and growth of youth in crisis.

B. Facility and Licensing Requirements

1. The facility must meet the criteria established by the State Department of

Mental Health Certification Standards (www.dmh.ca.gov) and the State Department of Social Services Licensing Standards (www.cdss.ca.gov).

2. Offerors must ensure that their facility is licensed by the California Department of Social Services (CDSS) Community Care Licensing Division. This includes obtaining the appropriate license type, such as a Residential Care Facility for Children (RCFC) or a Crisis Residential Treatment (CRT) license.

3. Offerors will certify that they have a facility located in Santa Clara County or within a 90-mile radius. Additionally, Offerors must certify that their facility is licensed for Crisis Residential Services or will be licensed before contract implementation.

4. Note: If Offeror cannot meet these facility and licensing requirements by the start of the Contract, they should not proceed with submitting a proposal.

II. Background Information

A. The primary purpose of as the program is to offer a safe and supportive environment for youth experiencing a mental health crisis who may need a step-down level from an acute psychiatric hospital, EPS, and CSU and no longer meet criteria to be on a 5150 hold but continue to require short term stabilization. The goal is to provide

RFSQ-BHS-FY25-0066: Children, Youth, and Family System of Care Services Page 2 of 12 ATTACHMENT A17: Youth Crisis Residential Scope of Work CATEGORY 6: Residential immediate crisis intervention, counseling, co-occurring treatment, medication support and individualized treatment planning to help youth stabilize their acute mental health needs to return to their prior functioning and safely transition from an intensive care setting to a less restrictive, home-based environment. Currently in Santa Clara County, there are limited therapeutic resources offering 24-hour supervision to meet this need and help to better stabilize youth from needing to cycle in and out of psychiatric hospital settings. The program shall provide a bridge to stabilize youth experiencing crisis and high psychiatric needs to ensure readiness to return into their home environments and avoid further hospitalization.

B. The program shall follow the System of Care principles outlined in the Integrated Core Practice Model (ICPM) guide (ICPM Guide and ACIN 1-21-18 ) and strive to meet the prioritized needs identified by the child/youth and their and family/caregivers, to increase and strengthen the family’s natural supports, improve the client’s level of self-efficacy within their family system, and integrate the work of system partners and service providers.

III. Target Population

A. The program shall serve children and youth (hereafter referred to as “clients”) ages twelve (12) through eighteen (18) who are residents of the County of Santa Clara and have full-scope Medi-Cal benefits.

1. Clients served through the program must be diagnosed with a mental illness and/or co-occurring diagnosis and have either 1) experienced a recent acute psychiatric episode; 2) a recent history of hospitalization; 3) be transitioning from a locked psychiatric treatment facility such as EPS, or CSU services; or 4) be at immediate risk for hospitalization and require support beyond the resources available in the home. Admission is voluntary.

2. Clients served must meet medical necessity criteria in accordance with all laws and regulations governing Medi-Cal programs mandated by federal, state, and local statues, in addition to CCR Title 9.

3. Clients younger than 12 or turning 18 during the course of treatment may be considered for admission with County and Licensing/Accreditation Body’s approval.

4. Clients served may exhibit the following risk factors in multiple domains, including functional impairment, diagnostic complexity and acute symptomology, and insufficient social supports as follows:

a. Functional Impairment: Recent history of presenting with danger to self, danger to others, or grave disability;

b. Common Diagnosis and Presenting Behaviors: May include, but not limited to major depressive disorder, bipolar disorder, complex trauma, anxiety, and psychotic disorders. Behaviors that necessitate crisis intervention due to acute symptoms or exacerbations. Behaviors may include suicidal ideation, https://www.cdss.ca.gov/Portals/9/ACIN/2018/I-21_18.pdf

RFSQ-BHS-FY25-0066: Children, Youth, and Family System of Care Services Page 3 of 12 ATTACHMENT A17: Youth Crisis Residential Scope of Work CATEGORY 6: Residential self-harm, psychosis, severe agitation, high impulsivity, aggressive behavior, co-occurring substance use needs, and/or frequent running away;

c. Support system: There may be an inability to utilize a support system, or support systems may be minimal, underscoring the critical role of available and effective support networks—comprising of family, friends, caregivers, and community resources—to provide immediate and ongoing assistance.

Clients may be involved with the child welfare or juvenile justice systems;

d. Treatment and Timeline: Typically involves immediate intervention and treatment for 30 days. Following crisis stabilization, coordination of ongoing treatment support is essential for sustained recovery and well-being;

e. Crisis Intervention: On-site assessment and interventions, offering immediate support in the person's environment to de-escalate crises and facilitate connections to appropriate resources. In severe cases, a 5150 psychiatric hold may be required to ensure the client’s safety, along with coordinated transport to a designated LPS (Lanterman-Petris-Short) facility for comprehensive evaluation and care; and

f. Care Coordination: Critical need for intensive care coordination, often requiring Multi-Disciplinary Teams (MDTs) and Child Family Team Meetings (CFTs). Coordination among medical providers, mental health professionals, educators, and law enforcement may be critical.

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 access for clients who need immediate crisis intervention and stabilization. The program does not serve clients that meet the criteria for EPS, CSU, acute psychiatric hospitals, or intensive outpatient programs;

b. Enhance the resilience and skill-building capacity of clients in crisis and ensure clients are provided coordinated service delivery to stabilize symptoms and prepare them for success to transition back to a home or community living environment;

c. Increase family engagement and support to maintain stabilization and improve levels of functioning; and/or

d. Increase clients’ ability to develop and implement safety plan to reduce crisis, prevent suicide risk and potential readmittance to psychiatric hospital settings.

2. Objectives shall be achieved by:

a. Provide a structured and supportive crisis residential setting that promotes the stabilization of mental health symptoms, enhances coping skills, RFSQ-BHS-FY25-0066: Children, Youth, and Family System of Care Services Page 4 of 12 ATTACHMENT A17: Youth Crisis Residential Scope of Work CATEGORY 6: Residential improves client functioning and prepares clients for successful transitions to less restrictive, home-based settings;

b. Demonstrate the practice and principles of the Integrated Core Practice Model (ICPM) to provide culturally appropriate and trauma informed services;

c. Deliver individualized treatment plans that address each youth's specific needs and goals;

d. Promote cohesive, coordinated transition plans, linkage to services and appropriate levels of care to support the ongoing needs of clients;

e. Engage and involve the client’s family, natural supports, and other providers in the treatment process; and

f. Engage underserved clients who have not benefited from traditional outpatient and crisis mental health services due to complex risk factors, including: substance use, community violence, sexual exploitation, interpersonal family violence, general neglect, and exposure to trauma.

V. Reporting and Data Collection Requirements

A. Offeror is to report any incidents or critical events within the facility promptly. This includes incidents such as physical altercations, self-harm, medical emergencies, or any other significant incidents that may impact the safety and well-being of the youth.

B. Offeror shall maintain and provide comprehensive staffing and training records to be reviewed quarterly in a format approved by BHSD. These records demonstrate compliance with contractual requirements. Training records shall include training names, training dates, and any certifications obtained as a result. Staffing records shall include the employee's name, date of hire, job title, language capacity, qualifications, and certifications. Vacancies shall also be noted on the staffing records.

C. Offeror shall create a process for notifying the BHSD Program Monitor when clients meet criteria to stay longer than thirty (30) days at their facility.

D. Measure and report the program’s clinical outcomes, including (but not limited to) data on admission and discharges, demographic information, changes in symptomology, improvements in functioning and coping skills. Utilize validated assessment tools and surveys to gather this data and track progress over time by use of functional assessment tool(s), such as the Crisis Assessment Tool (CAT).

VI. Outcomes and Measurements

A. Key Outcomes:

1. Timely access to services within 24-48 hours of receipt of referral.

2. Restore client and family to prior level of stabilization and functioning.

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3. Decrease mental health symptomology and risk-taking behaviors.

4. Successful transition to home-based/community setting, including coordination to appropriate step-down levels of care.

5. Decrease incidents of re-hospitalization.

B. Offeror shall achieve the following data submission requirements:

1. Offeror shall develop a process to systematically monitor and analyze the performance of each targeted outcome to be achieved, including, but not limited to, the following outcome measurement methods:

a. Crisis and Assessment Tool (CAT)

i. For programs with 30-90 average length of stay (LOS), the CAT shall be administered to clients. This supports decision-making, treatment planning, quality improvement, and service outcome monitoring. Offeror shall abide by the CAT Operational Guideline developed by BHSD.

ii. Offeror is responsible for training, certifying and annually re-certifying their staff to implement the CAT.

iii. Offeror shall establish and/or maintain an online account with Praed Foundation to access online CAT training and certification.

b. If Offeror provides services to youth and young adults in the Juvenile Justice System, Offeror shall provide a Client Status Report (CSR) monthly upon request by the Probation Department. 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.

VII. Program Description

A. Offeror shall obtain appropriate licensing and certifications to operate a Crisis Residential Facility.

1. Ensure the facility is licensed by the California Department of Social Services (CDSS) Community Care Licensing Division. This includes obtaining the appropriate license type for your facility, such as a Residential Care Facility for Children (RCFC) or a Crisis Residential Treatment (CRT) license.

2. Maintain a valid license in good standing with the California Department of Social Services.

2. Maintain appropriate staff-to-youth ratios as mandated by CDSS. This includes having qualified and trained staff available 24/7 to supervise, support, and care for the clients at the facility.

3. Ensure all staff members meet the required qualifications and receive training.

This may include cardiopulmonary resuscitation (CPR) and first aid certification, RFSQ-BHS-FY25-0066: Children, Youth, and Family System of Care Services Page 6 of 12 ATTACHMENT A17: Youth Crisis Residential Scope of Work CATEGORY 6: Residential crisis intervention training, and training on trauma-informed care.

4. Implement safety protocols to protect the well-being of the clients in the program’s care. This may include maintaining secure premises, conducting regular safety drills, and having policies in place for emergencies.

5. In addition to the licensing requirements, the facility should consider how the environment creates a warm, inviting, and engaging space for youth that feels supportive and promotes healing and growth. The facility should promote inclusivity and celebrate diversity. Things to consider include bedrooms that designed to feel cozy and personalized and having spaces for personal belongings while maintaining a sense of safety and security. Common areas shall be designed to encourage social interaction and relaxation and may include games, books, art supplies, comfortable seating, soft lighting, etc. Therapy rooms shall be designed to be calming and private.

B. Service Description

1. Offeror shall provide comprehensive, integrated behavioral health assessment for emotional, behavioral, functional, and social. Offeror shall utilize a variety of treatment approaches to resolve identified behavioral health problems in a manner that considers the client's and family’s individual needs. Services shall be strength-based, individualized, and shall consider each client’s age, developmental level, culture, family values and structure, educational functioning, and physical health.

2. Offeror shall provide treatment and services to aid in the stabilization of client’s experiencing crisis, which may include:

a. Immediate care and intervention for youth facing crises, including crisis intervention services.

b. Individualized Treatment Planning that addresses each client’s unique needs and circumstances.

c. Focus on the underlying causes of the crisis while promoting the development of healthy coping mechanisms and life skills.

d. Treatment methods including individual, group, collateral and family therapy, and trauma-informed care.

e. Rehabilitation and Collateral Services.

f. Intensive Care Coordination (ICC) that shall include the facilitation of CFTM and MDT meetings.

g. Coordination and linkage with other providers and institutions (including other mental health and primary care providers), to foster strong engagement and collaborative relationships to enhance service integration and continuity of care across diverse service settings.

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h. Comprehensive medical and psychiatric evaluations to assess client’s physical and mental health needs.

i. Medication Management Services, including medication assessments to determine the need for pharmacological intervention, medication administration, monitoring, education, and support to clients’ and their families.

3. Offeror shall prioritize efforts to enhance access and engagement for clients from unserved and/or underserved communities. Offeror shall implement targeted strategies aimed at reducing barriers to access and fostering meaningful engagement with the specified populations.

4. The Program shall ensure that all clients have access to meet their educational needs while participating in treatment.

5. It is highly recommended that programs consider utilization of promising practices that focus on somatic movement and sensory experiences. Examples of practices include, but are not limited to somatic experiencing, art therapy, movement therapy, mindfulness-based approaches, expressive arts therapy, sensory integration, trauma-informed yoga and ecopsychology.

6. CFT Meetings

a. CFT Meetings are central to the California Integrated Core Practice Model (ICPM). Offeror shall attend and participate in CFT Meetings held by other providers supporting the client; and

b. The program shall be equipped to facilitate CFT Meetings for clients while in the program, if they do not have another provider concurrently open to do so.

7. Average LOS shall be thirty (30) days or as determined by medical necessity criteria, to improve level of functioning and ensure client is ready to successfully transition back to home/community-based care.

8. Offeror shall provide presentations, outreach and education to community and stakeholders on the Crisis Residential facility’s role within BHSD CYF System of Care.

C. Staffing Requirements

1. In addition to the staffing requirements listed in the “CYF Scope of Work”, staff requirements include, but are not limited to:

a. Capacity to work effectively as part of a multidisciplinary team;

b. Use of Family Specialists/Partners/Peer Support workers is highly encouraged;

c. Knowledge of crisis management and have a defined practice model (e.g.

Therapeutic Crisis Intervention (TCI), Collaborative Problem Solving, etc.)

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d. Understanding and commitment to the principles, values and phases of the

ICPM;

e. Capacity to deliver ICC to coordinate, develop and facilitate the CFT;

f. Capacity to deliver Intensive Home-Based Services (IHBS), as described by the Medical Manual for ICC, IHBS, and TFC.

g. Capacity to provide individual, family and group treatment by a credentialed licensed/waivered clinician;

h. Staffing to support the direct care and supervision of clients as required by Community Care Licensing (CCL) regulations;

i. Knowledge of the child welfare and juvenile justice systems, including basic knowledge of mandated reporting, court procedures, rights of children and families; and

j. Knowledge of the developmental stages of children and the impact of trauma, abuse and neglect on their emotional wellbeing.

2. The ICC:

a. A highly skilled facilitator, with a strong clinical background, who coordinates and develops the CFT, and serves as the single point of accountability for the care plan for the youth. Provides ICC services as described in Section G.

b. Able to navigate complex team and family dynamics to ensure equity, psychological and physical safety of all participants, and full participation, by lifting the voices of the child and family to center the work, setting clear expectations, and using advanced skills in team facilitation to help reach consensus on next steps and mitigate barriers to support the client.

c. Serves in a distinct capacity separate from individual treating clinician or service provider delivering IHBS.

d. Staff should have knowledge of the child welfare and juvenile justice systems, including basic knowledge of related mandated reporting, court procedures, and rights of children and families; an understanding of the developmental stages of children, the impact of trauma, abuse, and neglect on their emotional well-being.

3. The IHBS:

a. Provides medically necessary, skill-based interventions known as IHBS for the remediation of behaviors or improvement of symptoms, including, but not limited to, the implementation of a positive behavioral plan, and/or modeling interventions for the child’s/youth’s family and/or significant others, as

RFSQ-BHS-FY25-0066: Children, Youth, and Family System of Care Services Page 9 of 12 ATTACHMENT A17: Youth Crisis Residential Scope of Work CATEGORY 6: Residential described in Section 7 (A).

b. IHBS services may be provided by credentialed paraprofessional staff, Mental Health Rehab Specialists, Clinicians, and other mental health professionals.

c. Serves in a distinct capacity from the ICC Coordinator.

4. Clinicians:

a. Licensed Practitioner of the Healing Arts (LPHA), including waivered staff;

i. Licensed or Associate Marriage and Family Therapist (LMFT/AMFT)

ii. Licensed or Associate Clinical Social Worker (LCSW/ACSW)

iii. Licensed or Associate Professional Clinical Counselors (LPCC/APCC)

b. Clinicians to provide primary therapeutic interventions (in addition to services described by ICC and IHBS) may be assigned a separate clinician to provide this service. Individual, family, and group therapy may be provided among other treatment modalities.

c. This is a separate staff/ role than the ICC coordinator and would be embedded as part of the CFT.

5. Psychiatrists/ Other Licensed prescribing practitioners:

a. Service activities may include but are not limited to 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

b. Services may include assessment, collateral, and plan development related to the delivery of service and/or psychiatric assessment for the client;

prescribing, administering, dispensing, and monitoring of psychiatric medications, and medication education.

6. Parent/ Family Partners:

a. As determined by the CFT, a parent/family partner may be assigned as part of the team to provide direct services, advocacy, and support, to the youth and/or their caregiver.

i. Parent/family partners are key individuals who work with children, youth, and families within the public child welfare, juvenile probation, or behavioral health systems.

ii. Parent/family partners have lived experience and can convey

RFSQ-BHS-FY25-0066: Children, Youth, and Family System of Care Services Page 10 of 12 ATTACHMENT A17: Youth Crisis Residential Scope of Work CATEGORY 6: Residential information on how systems and programs can instill the family-centered and family-driven philosophy and principles necessary to engage children, youth and families. The parent/family partner shall be part of the CFT.

D. Referrals and Admissions

1. Offeror shall service clients as determined by County BHSD policies, procedures, directives, and guidelines and that are within Offeror’s resources. Referrals shall come from various sources, including, but not limited to, behavioral health providers, hospitals, crisis stabilization programs, emergency psychiatric services, schools, child welfare, juvenile probation and juvenile hall and Ranch settings, and community organizations. Referrals shall be made and accepted based on criteria developed with BHSD.

2. Offeror agrees to make admission decisions within 24 hours from the time a completed referral and all required documentation are received. Offeror also agrees to expedite admission processes for hospital discharges, ideally making admission decisions with 3-4 hours of receipt of a referral.

3. If Offeror declines admission, the Program shall provide written notification to the referring party, include the reason for the decision and include the BHSD Program Monitor on the communication. Declined admissions shall be reviewed during regularly scheduled program meetings with BHSD to identify common reasons for declined admissions and attempt to work through barriers to ultimately have a “no reject” practice.

4. The program shall develop a pre-admission screening process to gather additional information about the client’s needs. This shall also include coordination with other stakeholders associated with the client and process to obtain necessary consents and authorizations to provide treatment.

5. Offeror shall comply with a feedback loop process to ensure that referral sources are notified of the status of the referral, care coordination, and informed of outcomes and/or next steps.

6. Offeror shall coordinate admission process with youth, legal guardians and other collateral supports prior and during admission. Admission process shall include coordination around transportation to program, a comprehensive intake assessment to inform the development of an individualized treatment plan, and continued collaboration and coordination with the referring source and other stakeholders supporting the client.

E. Care Coordination

1. Care coordination is a crucial component of the program given the high acuity needs of the client and average 30-day LOS. Coordination with other team members and providers needs to occur as soon as possible. This is further

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2. Offeror shall coordinate and communicate with other providers (e.g. psychiatric hospitals, crisis programs, social workers, probation officers, school staff, medical professionals, psychiatry, etc.) and participate/facilitate in CFT meetings and/or Multidisciplinary Team Meetings (MDT) beginning at client intake and throughout the treatment and discharge planning process.

3. Offeror shall immediately (within twenty-four [24] hours) report any changes in client’s medical or mental health condition requiring a higher level of care, including medical or psychiatric hospitalization, behavioral incidents, and elopement from the facility to the designated BHSD staff.

4. A central component of ICC services is ensuring that the holistic needs of the youth, including physical health care needs, are addressed. Care coordination involves communicating with the Primary Care Physician or other health professionals to support development of a more holistic care plan and help reduce fragmented care. If the client is receiving Enhanced Care Management (ECM) from the Managed Care Plan, the ICC Coordinator coordinates planning with the ECM provider to avoid duplication and address any gaps in services.

5. Offeror shall describe their organization’s willingness, experience, and ability to collaborate with multiple County systems and services.

6. Offeror shall describe the process for consistent review of each client’s status and progress towards planned goals to determine possible discharge planning and/or step down to a less intensive type of service.

7. Offeror shall discuss in their proposal evaluation criteria for clients needing additional mental health services and other resources, including how they would assist in transitioning the client upon discharge.

8. Upon discharge, program shall coordinate a warm hand off with the new provider and engage in communication with client, family and other system partners to ensure minimal disruptions in care.

F. Program Hours of Operations

1. The program shall operate twenty (24) hours, seven (7) days a week. The program services shall be offered daily (7) days per week. Staff shall be available twenty-four (24) hours daily to provider supervision and structured therapeutic milieu, including the care, supervision and emergency needs of the client.

2. Besides onsite staff, Offeror shall designate a 24-hour on-call professional and psychiatric staff, as Offeror must be available 24 hours a day to address the needs of crisis residential individuals.

3. Offeror shall accept referrals seven (7) days per week.

G. Evaluations, Transitional Planning, and Discharge

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1. The program’s staff shall monitor client’s needs, progress and goals using the

CFT.

2. Offeror shall demonstrate knowledge of the different levels of care within BHSD system to determine appropriate transition planning with the client.

3. Offeror shall partner and collaborate with other providers to transfer clients who have stabilized and completed the program to lower levels of care, based on the client's level of care need as determined by relevant screening tool.

4. Offeror shall facilitate transitions and warm handoffs to other agencies for additional or more specialized support for clients requiring higher levels of care.

5. Offeror shall provide client, family and/or other appropriate team members with a written transition/discharge plan for continuity of care.