Attachment A18.pdf

ATTACHMENT A18

CATEGORY 7: SUBSTANCE USE TREATMENT SERVICES

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YOUTH OUTPATIENT SUBSTANCE USE TREATMENT SERVICES PROGRAM

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 statement of qualifications from qualified Offerors interested in providing Substance Use Treatment Services (SUTS) Outpatient (hereafter referred to as “the Program”) based on requirements of the Drug Medi-Cal Organized Delivery System

(DMC-ODS).

B. The Program shall provide comprehensive treatment to youth (hereafter referred to as “clients”) in Santa Clara County to improve clinical and functional outcomes for youth with substance use diagnoses.

C. Services shall be consistent with American Society of Addiction Medicine (ASAM) Criteria, federal Substance Abuse and Mental Health Services Administration (SAMHSA) best practices, and longstanding BHSD program practices.

D. Offeror shall be required to meet the ASAM 1.0 Outpatient Services per Drug Medi-Cal Organized Delivery System (DMC-ODS) requirements.

E. Offeror shall address the relationship between the substance-related and mental health disorders (co-occurring needs) and their effect on the client’s treatment needs and readiness to change.

F. The Program shall adhere to all DMC-ODS waiver and Department of Health Care Services (DHCS) requirements, the Adolescent Substance Use Best Practices Guide and all other relevant policies and procedures of the BHSD. Offerors shall have current DMC-ODS certification and Alcohol and Drug Counselor (AOD) certification by 1/1/25 or become certified to provide Medi-Cal reimbursable services on or before the contract start date.

II. Background Information

A. The County recognizes the complex needs around substance use amongst youth in the community and the importance of access and availability to culturally responsive, trauma-informed substance use treatment and recovery services. The Program shall provide comprehensive services substance use treatment services that are centered on the ASAM criteria and are youth-centered to support clients and their families that are experiencing difficulty functioning in their personal lives, relationships, and environments.

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III. Target Population

A. The Program shall primarily serve clients ages 12 through 21 years old. Peer support services focused on engagement and linkage will be provided regardless of insurance type. Treatment focused support is for clients with full-scope Medi-Cal or Medi-Cal eligible who are residents of Santa Clara County and in need of substance use treatment services.

1. Program may serve referrals from Juvenile Probation regardless of insurance status.

2. Program may also serve uninsured clients who likely qualify for Medi-Cal while connecting them to Medi-Cal benefits.

B. The Program is designed to provide outreach, outpatient, and/or recovery services to clients requiring substance use disorder treatment or co-occurring treatment.

C. Offeror shall demonstrate knowledge of specialized populations for which they are submitting proposals for. Target populations include the following:

1. Clients with substance use disorders or co-occurring disorders involved in the Juvenile Justice and/or Child Welfare Systems (including youth transitioning in and out of detention facilities and out of home placements).

2. Clients who may be experiencing significant difficulties in family interactions, peer interactions, school and/or vocational functioning and using substances as a maladaptive coping strategy.

3. Clients with mental health needs in addition to substance use needs. Mental health needs may include, but are not limited to anxiety disorders, depressive disorders, psychotic disorders, bipolar disorders, trauma related disorders, and adjustment disorders. The co-occurring condition is likely resulting in moderate to marked impairment in daily functioning.

4. Clients dually diagnosed with developmental disabilities.

5. Clients that may have a history of, or exhibit the following risk factors:

a. Self-harm;

b. Serious conflict with one or more members of their household, including parents or caregivers;

c. High impulsivity, aggressive behavior, assault to others, and property destruction;

d. School truancy;

e. Frequent running away;

f. Commercial sexual exploitation; and/or

g. History of child abuse.

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6. Clients may have access to some social and environmental support, but there is likely a need for strengthening and buffering of these supports.

7. Crisis may occur; thus, clients should have a comprehensive plan in place to address potential exacerbations of symptoms.

IV. Program Goals and Objectives

A. Goals shall include but are not limited to:

1. Reduce suffering and functional impairment due to substance use disorders;

2. Increase access to services for underserved clients who are at risk due to complex factors including community violence, interpersonal family violence, and exposure to trauma;

3. Increase client’s engagement and understanding of the importance of treatment compliance and medication adherence (as applicable) through psychoeducation sessions;

4. Strengthen client’s participation in their recovery, self-sufficiency, goals towards self-determination and community engagement; and

5. Improve care coordination to meet the varying needs of clients and transition of care.

B. Objectives shall be achieved by:

1. Provide comprehensive, EBP services to youth with substance use disorders, addressing their physical, emotional, social, and educational needs.

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

3. Utilization of substance use treatment clinicians and peer support staff to implement engagement and psychoeducation to support stages of change, client readiness, and openness to services;

4. As appropriate, participation within the Child and Family Team (CFT) as a strategy to identify needs, implement care coordination, and adapt interventions to fit client needs;

5. Demonstrate adherence to ASAM principles throughout the treatment cycle from assessment to discharge and transfers to other levels of care.

6. Improve clinical and functional outcomes for youth, including reducing substance use, enhancing mental health, and developing healthy coping mechanisms;

7. Address co-occurring mental health disorders through integrated treatment plans.

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8. Support clients in developing and utilizing healthy coping mechanisms to handle stress, peer pressure, and emotional challenges.

9. Improve school attendance, performance and social interactions by addressing the impact of substance use on daily life.

10. Engage families in the treatment process to provide support, improve communication, and strengthen family dynamics.

11. Teach clients skills and strategies to prevent relapse and maintain long-term sobriety.

12. Build confidence and a sense of control over their lives through positive reinforcement and personal achievements.

13. Connect clients and families with community resources, support groups, and continuing care options.

14. Establish a foundation for sustained recovery through ongoing support, follow-up care and aftercare planning.

V. Reporting and Data Collection Requirements

A. Offeror shall collect and share data related to program performance, client outcomes, and service delivery that are not captured in the County’s Electronic Health Record (EHR) system upon request. Before the start of contracting, the Offeror and BHSD will meet to collaboratively discuss data elements that can be collected to support program evaluation and service delivery.

B. Offeror should maintain and provide comprehensive staffing and training records to be reviewed quarterly in a format approved by BHSD. These records demonstrate the compliance with contractual requirements. Training records should include, names of trainings, dates of trainings, and any certifications obtained as a result.

This also includes tracking the practice fidelity and client outcomes of any EBPs utilized within their service. Staffing records should include, employee’s name, date of hire, job title, language capacity, qualification, and certifications. Vacancies should also be noted on the staffing records.

VI. Outcomes and Measurements

A. Key Outcomes:

1. Program will provide EBP substance use treatment that results in the cessation of or the reduction in the use of substances.

2. Program will collaborate with Medication Assisted Treatment (MAT) providers as applicable.

3. Program will develop mechanisms to measure the following:

a. Reduction in substance use (e.g., self-reported substance use surveys, reports from family or school).

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b. Improved mental health status on Patient Health Questionnaire and General Anxiety Disorder (e.g., PHQ-9, GAD-7, self-reported mental health status).

c. Enhanced coping skills (e.g., Coping Skills Inventory, self-reports, clinician observations).

4. Program will develop a data tracking system that supports collection, and analysis of outcome data and report key findings on a regular basis (e.g.

quarterly, annually) to BHSD.

5. Increase of clients understanding and readiness of stages of change.

6. Assist collaterals with psychoeducation around substance use and the recovery model.

7. Increase self-help activities and promote health well-being by providing meaningful, comprehensive treatment services.

B. The Program will implement Peer Support Workers to provide outreach, engagement and psychoeducation strategies to increase client’s awareness of the stages of change and readiness for treatment services. Offeror will track the use of the Peer Support Workers that will work collaboratively on school campuses to gauge the effectiveness of linking clients to services more effectively.

VII. Program Description

A. Operations and Treatment Standards

1. Treatment shall be provided in conformance with DMC-ODS contract provisions, which includes providing same day access capability to clients.

2. Individualized treatment for each client will be developed based on ASAM assessment with short and long-term goals that are clinically appropriate and behaviorally measurable based on the comprehensive assessment.

3. Program will provide strength-based, culturally sensitive, developmentally appropriate, trauma informed services.

4. Offeror shall implement Motivational Interviewing and at least one (1) of the following additional EBPs.

a. Cognitive Behavioral Therapy

b. Relapse Prevention

c. Trauma-Informed Treatment

d. Psychoeducation

5. Program shall provide integrated care for co-occurring mental health conditions treatment staff should be certified at the co-occurring capable level, or working towards certification

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(https://bhdp.santaclaracounty.gov/training/co-occurring-disorders-certification).

6. Offerors shall incorporate Substance Abuse and Mental Health Services Administration (SAMHSA) best practices, and state and national best practices for youth treatment. Treatment provided shall conform with the Adolescent Substance Use Disorder Best Practices Guide.

7. Families shall be involved in treatment as much as possible in the context of the family system unit.

8. A unique component of this program is the use of Peer Support Workers to provide psychoeducation and linkage to services for clients. Peer Support Workers are designated throughout high schools and middle schools in Santa Clara County and will provide these services on campus. Collaboration between the Offeror and assigned school sites is a vital piece of the program operations

9. Services will be provided at a location that is most convenient and appropriate for the client and may occur at the clients residence, school, clinic, agency, or other locations in the community as necessary and needed by the clients served.

10. Typically, treatment services range from 30 – 180 days (length of stay).

B. Service Description

1. Outpatient Services (ASAM Level 1.0) shall be provided to clients when medically necessary. These services may be offered up to six hours a week for clients under the age of 21. Services may exceed the maximum based on individual medical necessity. All outpatient services shall also be Co-Occurring Enhanced.

2. Program shall include the following services as part of Outpatient services:

a. Assessment;

b. Care coordination;

c. Case management and brokerage;

d. Counseling (individual and group);

e. Family Therapy;

f. Linkage to Medication evaluation and support services;

g. Linkage to MAT for Opioid Use Disorder;

h. Patient Education/ Psychoeducation;

i. Recovery services;

https://bhdp.santaclaracounty.gov/training/co-occurring-disorders-certification https://bhdp.santaclaracounty.gov/training/co-occurring-disorders-certification

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j. Peer support; and

k. Crisis intervention services

3. Recovery Services shall be provided to clients within outpatient services.

Recovery services can be utilized when the client is triggered, when the client has relapsed, or simply as a preventive measure to prevent relapse. As part of the assessment and treatment needs of Dimension 6, Recovery Environment of the ASAM Criteria, and during the transfer/transition planning process, the provider shall provide clients with recovery services as medically necessary.

This includes the following services:

a. Counseling services: Individual or group counseling to focus on relapse prevention areas, and then reassess if client needs further care;

b. Recovery Monitoring: Recovery coaching and monitoring via telehealth;

c. Substance abuse assistance: Peer-to-peer services and relapse prevention;

d. Education and job skills: Linkages to life skills, employment services, job training and education services;

e. Family support: Linkages to childcare, parent education, child development support services, family/marriage education;

f. Support groups: Linkages to self-help and support, spiritual and faith-based support; and

g. Ancillary services: Linkages to housing assistance, transportation, case management, individual services coordination.

4. Peer Support Services shall be provided to clients at designated middle schools and high schools across Santa Clara County. Peer Support Workers will receive referrals from students, parents, and school staff to provide simple access to substance use treatment. Peer Support Workers will meet with students for engagement, psychoeducation and linkage to providers for treatment services. Peers may also facilitate educational workshops, provide consultation for school staff, and partner with clinical staff working with students. The Peer Support Services supports building respectful, trust-building relationships with an emphasis on:

a. Person-centered

b. Care coordination

c. Resource linkage

d. Recovery-oriented

e. Collaborative

f. Strength-based

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g. Promotion of client self-advocacy and self-efficacy

C. Staffing Requirements

1. Offeror shall document and ensure that all staff is trained in accordance with DHCS licensing requirements. It is required that all staff providing counseling services in all substance use treatment programs shall be licensed and/or certified by DHCS. In addition to licensing requirements all staff shall meet training requirements set by the BHSD.

2. Offeror shall ensure that the clinical supervisor shall be licensed by the Board of Behavioral Sciences or the Board of Psychology and have two (2) years post license experience. The clinical supervisor will also have sufficient training and experience in the area of co-occurring youth disorders.

3. Licensed Practitioner of the Healing Arts (LPHA) will receive a minimum of five

(5) hours of continuing education related to addiction medicine each year.

4. Program staffing may consist of:

a. LPHA, including waivered staff:

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

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

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

iv. Physicians

v. Nurse Practitioners

vi. Physician Assistants

vii. Registered Nurses

viii. Registered Pharmacists

ix. Licensed Clinical Psychologists

x. Psychiatrist

xi. Licensed-eligible practitioners registered with the Board of Psychology or BBS working under the supervision of a licensed clinician

b. Certified Peer Support Specialist

c. The provider team may include an AOD; however, an LPHA must be part of the team, coordinating treatment and providing direct services at least twice per month. The AOD counselor must be registered or certified by one of the three DHCS approved certifying bodies:

i. California Consortium of Addiction Programs and Professionals

(CCAPP)

ii. California Association for Alcohol/Drug Educators (CAADE)

iii. California Association of DUI Treatment Programs (CADTP)

5. The Offeror shall employ staff that meet clearance processes, including criminal background checks, to be authorized to provide transition-based services at Juvenile Hall and James Ranch Detention Centers.

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D. Referrals and Admissions

1. Program shall receive all referrals from the BHSD Call Center or School Districts.

2. Program shall also accept inter-agency transfers and walk-ins from the community and schools.

3. Program shall take the lead and ensure referrals which do not meet the criteria for SUTS or require a different level of care, will be redirected and linked to appropriate alternative resources or another provider.

4. Offerors shall comply with all access standards required by DMC-ODS contract provisions.

5. Offeror shall provide same day access capability to clients in need to maximize engagement opportunities.

E. Care Coordination

1. The Offeror will obtain appropriate release of information to ensure high-quality care coordination and collaboration with other treatment providers in accordance with Title 42 of the Code of Federal Regulations 42 CFR, minor consent laws, and HIPAA regulations.

2. Offeror shall collaborate with community groups or agencies such as the Juvenile Probation Department, Department of Children and Family Services, educational services/school districts, primary medical care physicians and/or clinics, psychiatric/mental health services and any other youth service agencies/systems when appropriate and as authorized to do so with a release of information.

3. Offeror shall coordinate referrals for MAT with the BHSD Addiction Medicine Division and Primary Care Provider, if applicable.

4. Program staff may need access to meet with clients that are currently in Juvenile Hall or the James Ranch Detention Facility to support transitions in client care from in-custody settings to the community. This may include participation in re-entry care plans, attending Multi-Disciplinary Team meetings, and meeting with the client while in-custody. Offeror shall be knowledgeable of the policy and process to access clearance to visit clients within these facilities.

5. Offeror shall ensure that all care, treatment, and services provided are coordinated among all providers who are serving the youth in care, including mental health and other substance use providers.

6. Offeror shall coordinate closely with school districts and school campuses where they have assigned staff. This includes partnering with the school sites to have Program staff onsite several times per week to meet with students and coordinate with school staff.

F. Billing

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1. Offeror shall submit monthly cost reimbursement claims for Peer Specialist Services within forty-five (45) days after the last day of the month which service was rendered. Each claim shall state all actual allowable cost as defined in the appropriate regulations, and all revenues received by Offeror during the month for which the claim is filed.