Attachment A1a.pdf

ATTACHMENT A1a

CATEGORY 1: CRISIS

RFSQ-BHS-FY25-0066: Children, Youth, and Family System of Care Services Page 1 of 7 ATTACHMENT A1a: Mobile Response and Stabilization Services Scope of Work CATEGORY 1: Crisis

MOBILE RESPONSE AND STABILIZATION SERVICES

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 operating Children, Youth, and Family System of Care (CYF) Mobile Response and Stabilization Services (MRSS) program (hereafter referred to as “the program”).

B. Offeror shall provide MRSS services to children, youth, and young adults (ages 4-20).

C. Up to two (2) Offerors shall be utilized to operate various MRSS teams in assigned regions across Santa Clara County (SCC). The regions to be served shall include, but not be limited to, the following cities and their respective unincorporated areas:

1. Central County: Campbell, Cupertino, Los Gatos, San Jose, Alviso, Santa Clara, and

Saratoga.

2. East County: Milpitas.

3. North County: Los Altos, Mountain View, Palo Alto, and Sunnyvale.

4. South County: Gilroy, Morgan Hill, and San Martin.

D. The program shall consist of the following service teams:

1. The MRSS Geographic Teams shall be responsible for responding to calls in their assigned region to provide mobile response in the community, along with up to thirty (30) days of stabilization management and linkage to ongoing services;

and

2. The After-Hours MRSS Team shall provide mobile response services and linkage to ongoing services across the entire SCC, without providing stabilization management.

E. This model of time-limited therapeutic mobile response and stabilization intervention services shall be delivered with the underlying principles of cultural humility and inclusion and equity for children, youth, and young adults in need of services. The services shall include assessment, de-escalation/resolution of crisis, peer support, coordination with medical and behavioral health services, safety planning, resources, and Welfare and Institutions Code (WIC) 5585 evaluation for a minor under age eighteen (18) or a WIC 5150 evaluation for a young adult age eighteen through twenty (18-20).

F. Services shall be child-, youth-, and young adult-centered, strength-based, family-focused, and family-friendly. Rapidly responding to non-life-threatening emotional symptoms/behaviors that are disrupting a child/youth/young adult’s functioning shall help prevent the escalation of the crisis and reduce the need for a more restrictive setting, such as admission to an inpatient psychiatric hospitalization.

G. Offeror shall collaborate closely with the Post Crisis Stabilization Services (PCSS) program and provide linkage and referrals for ongoing crisis support. Offeror shall run both programs to support continuity of care within the crisis continuum of services.

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II. Background Information

A. The County is committed to addressing the needs of the community and has been providing MRSS services for children, youth, and young adults for more than twenty (20) years. Table 1 below provides projected service targets for this RFSQ.

Table 1. Projected Service Targets for Fiscal Year 2025

MOBILE RESPONSE AND STABILIZATION SERVICES

LOCATION HOURS LEVEL OF CARE PROJECTED

CLIENTS PER

YEAR

South County 8am-8pm, 7 days

Mobile Response and Stabilization, up to eight (8) hours in thirty (30) days for all children, youth, and young adults

Central/East County

8am-8pm, 7 days

Mobile Response and Stabilization, up to eight (8) hours in thirty (30) days, for all children, youth, and young adults

North County 8am-8pm, 7 days

Mobile Response and Stabilization, up to eight (8) hours in thirty (30) days for all children, youth, and young adults

Countywide (After Hours)

8pm-8am, 7 days

Mobile Response and Stabilization, up to eight (8) hours in thirty (30) days for all children, youth, and young adults

Total Number of Projected Clients to be Served: 1,200

III. Target Population

A. Clients to be served shall include children, youth, and young adults (ages 4-20) who are located within the SCC and have been referred by the BHSD Call Center (Triage Team).

Additionally, clients may exhibit one (1) or more of the following behaviors:

1. Self-harm;

2. Serious conflict with one (1) or more members of their household, including parents or caregivers;

3. High impulsivity, aggressiveness, assault on others, and property destruction;

4. School truancy problems;

5. Frequent running away; and

6. History of fire setting.

B. The target population may also include:

1. Children, youth, and young adults who are not permanent residents of SCC but are located within SCC and experiencing a crisis that requires immediate intervention;

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2. Children, youth, and young adults temporarily residing in SCC through out-of-home placements, who do not normally reside in SCC but require interventions to stabilize their behavior;

3. Children, youth, and young adults released from detention facilities who may be on probation and need of interventions to stabilize their behavior;

4. Children, youth, and young adults in and out of home placements in need of interventions to stabilize their behavior;

5. Children, youth, and young adults with dual diagnoses, including developmental disabilities; and

6. Children, youth, and young adults struggling to maintain emotional regulation, which may escalate behaviors leading to a crisis and necessitate a WIC 5585 evaluation for a minors under age eighteen (18) or a WIC 5150 for a young adult aged 18-20.

IV. Program Goals and Objectives

A. Offerors shall align their program to achieve the following goals:

1. Reduce the number of completed suicides amongst the target population;

2. Increase the number of clients receiving urgent/non-crisis services;

3. Increase the clients’ diversion rate of hospitalization;

4. Diffuse crisis and restore family stability;

5. Improve client and family functioning;

6. Improve emotional well-being and safety within the home, school, and community, and reduce prolonged suffering;

7. Improve care coordination to ensure the transition of care;

8. Reduce out-of-home facility placements (e.g., residential treatment centers, shelters) while supporting stability of foster care placements when necessary; and

9. Reduce rates of incarceration/juvenile justice involvement.

B. Offerors shall achieve the following objectives:

1. Increase the number of non-crisis mobile responses by 50%, which aims to improve overall functioning for children, youth, and young adults and their families;

2. Diversion of clients from hospitalization by a rate of 80%; and

3. Provide a mobile response within sixty (60) minutes or less from the time of deployment for 80% of the calls for which it is determined a mobile response is needed. This standard is in alignment with best practice guidelines by Substance Abuse and Mental Health Services Administration (SAMHSA).

V. Reporting and Data Collection Requirement

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

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(EHR) system upon request. Before the start of contracting, Offeror and BHSD shall meet to collaboratively discuss data elements that can be collected to support program evaluation and service delivery.

B. Offeror shall 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 shall 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 evidence-based practice (EBPs) utilized within their service. Staffing records shall include, the 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 to be achieved:

1. Restore the clients and family to a pre-mobile response level of stabilization;

2. Improve access to services for clients in need of ongoing services to assist in managing their behavioral health needs;

3. Increase self-help activities and promote health and well-being within a safe environment by providing meaningful stabilization services;

4. Assist clients with behavioral health needs to remain in the community, attend school, and prevent hospitalization and involvement with the justice system; and/or

5. Increase awareness of the need for early intervention for children, youth, and young adult behavioral health.

B. Outcome Measurement Methods and Data Submission

1. Offeror shall utilize the Salesforce platform which allows access to technology and data using the platform designed by Provisio. Offeror shall coordinate with County about the number of licenses necessary to support business based on actual usage.

VII. Program Description

A. Program Operations and Performance Standards

1. Program Operations

a. Offeror shall provide a spectrum of services to the target population to support stabilization from behavioral disruption or mental health crisis.

b. Offeror shall operate community-based services at the location the services are needed.

c. Offeror shall provide linkage, referral, and care coordination within seventy-two

(72) hours of date of first contact.

d. Offeror shall have the ability to dispatch more than one (1) team in the case of multiple calls during the regular working day.

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e. At minimum, Offeror shall ensure staff are trained in crisis theory, risk assessment, and trauma-informed interventions for the developmental levels being served consistent with the best practices for responding to youth in crisis.

f. MRSS Geographic Teams for Central, East, North, and South County shall be available for services Monday-Sunday (seven [7] days a week) from 8am-8pm.

g. After Hours Team shall be available for services Monday-Sunday (seven [7] days a week) throughout SCC from 8pm- 8am.

B. Service Description

1. MRSS services shall be accessible through the Triage Team and consist of two (2) functions: mobile response and stabilization. If the Triage Team’s licensed behavioral health clinician is unable to defuse the crisis via phone, an MRSS Team shall be deployed to the location at which the services are needed. Triage Team clinicians shall make a direct connection for the caller to the agency nearest to them and have the capacity to respond immediately. Triage Team clinicians shall provide authorization for Medi-Cal visits as appropriate. Essential information, including any current mental health provider information, shall be provided during phone contact with MRSS staff and can include a 3-way call to include the caller.

2. Mobile Response - MRSS Teams shall respond within sixty (60) minutes from the time of deployment to provide community-based, rapid response, face-to-face support. Mobile intervention services shall include, but not be limited to:

a. Assessment of the client for clinical risk;

b. Emergency crisis diversion and stabilization for clients with immediate, overwhelming behavioral problems that severely impair their ability to function in the community;

c. Using the CAT tool at pre- and post-admission;

d. Community-based emergency intervention for other behavioral health emergencies;

e. Providing resource support and care coordination within seventy-two (72) hours of first contact;

f. Collaborating with caregivers, natural supports, and system partners as indicated to help ensure client success and engagement with crisis intervention services and evaluation of WIC 5585 and 5150;

g. MRSS field responses shall be deployed in two (2) person teams, comprised of one (1) clinician and/or one peer specialist, or two (2) clinicians;

h. Using peer support for transitional age youth (14-20) when possible, to support and inform the MRSS response;

i. Coordinating with emergency medical or law enforcement responders to work together at the site of the crisis to resolve the situation;

j. Assessing for needed post-stabilization services and development of a plan for services and transition out of stabilization management;

k. Connecting with the caregivers within seventy-two (72) hours of MRSS

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l. Providing WIC 5585 and 5150 evaluations if needed and writing a hold when necessary;

m. Developing a safety plan with child/youth/young adult and family to aid in preserving the stabilization; and

n. If MRSS team is unable to respond in a timely manner, MRSS shall provide a warm hand-off to the Mobile Crisis Response Team (MCRT).

C. Staffing Requirements

1. Organizational Staffing Requirements

a. Offeror shall maintain staffing capacity to provide services seven (7) days a week, three hundred sixty-five (365) days a year, 24/7 for the provision of face-to-face mobile intervention services designed to deescalate the emergent situation and prevent placement disruption and inpatient hospitalization.

b. Staff shall possess and maintain appropriate licenses and certificates in accordance with applicable statutes and regulations. Background checks, criminal record reviews, and Department of Justice (DOJ) clearances shall be obtained and maintained in accordance with County rules and regulations.

c. Offeror shall have sufficient staff to respond to multiple calls at a time during the regular working day.

d. Offeror shall have a licensed clinical staff or licensed clinical supervisor available for consultation to the mobile response staff.

e. Offeror shall have a case manager with a bachelor’s degree and at least one (1) year of experience in providing care coordination and case management.

2. Deployment Team Staffing Requirements - Teams may be composed of two (2) clinicians, or one (1) clinician and one (1) parent/peer partner.

a. A minimum of one (1) Spanish speaking staff shall be available on each deployed team whenever possible. In situations when it is not possible staff shall access language services.

b. Teams shall include a licensed clinician with at least two (2) years of experience;

or is a licensed waivered, which is defined as someone with a post master’s degree and registered with the Board of Behavioral Sciences or another California Professional Board.

c. Teams can include a Peer Partner who is at least eighteen (18) years of age, with a minimum of a high school diploma or GED, and at least one (1) year of experience in building rapport with families.

D. Referrals

1. MRSS Geographical Teams and After-Hour MRSS Teams shall receive referrals from the Triage Team.

2. County will develop a process for MRSS Teams to respond to crises with law enforcement as needed and appropriate.

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E. Care Coordination and Transition Planning

1. The MRSS Geographic Teams shall provide stabilization services (up to a total of eight (8) hours within thirty (30) days from admission) for any client contact to develop linkage to appropriate behavioral health services providers, including commercial insurance provider or Medi-Cal provider for SMHS. When a provider is not already involved, the PCSS Program typically shall be one of the key linkages, thus there should be a strong partnership between MRSS and PCSS.

2. Offeror shall provide care coordination for the client and family to ensure comprehensive and consistent care, good communication with system partners and other child, youth, and adult serving agencies or institutions involved in the client’s service delivery.

F. Transitional Planning and Discharges

1. Typically, client interactions are a one-time occurrence. With that in mind, Offeror shall consider the following as it relates to transitional planning:

a. MRSS team shall assess the need for post-stabilization services and develop a plan to support stabilization management;

b. Provide appropriate linkage to system of care for longer term treatment as clinically indicated;

c. Offeror shall connect with the caregivers within seventy-two (72) hours of MRSS intervention to ensure post-stabilization services are in place and client/caregiver have an opportunity to clarify the plan and discuss any newly identified needs;

d. Offeror shall provide up to thirty (30) days of stabilization management from the date of initial contact.

e. For clients with commercial insurance, the program shall provide one (1) to two

(2) follow-up contacts to help the caregivers identify access for behavioral health services as defined by their health plan.

f. For clients with Medi-Cal insurance, the program shall determine the level of care needed with input from the client and caregiver. The client shall be referred to:

i. Services within the CYF continuum; or

ii. Ninety (90) day PCSS if requiring more intensive services to stabilize and support both the client and their family.