Attachment A2.docx

ATTACHMENT A2

CATEGORY 1: PREVENTION AND EARLY INTERVENTION SERVICES

NEW REFUGEE PREVENTION AND EARLY INTERVENTION SERVICES

Scope of Work

Purpose The County of Santa Clara (County) Behavioral Health Services Department (BHSD) is seeking statements of qualifications from qualified Offerors to operate a New Refugee Prevention and Early Intervention (PEI) Services (hereafter referred to as “the program”).

The program shall provide mental health prevention, outreach, and intervention services to new refugees and asylum seekers, newly resettled in Santa Clara County within the past seven (7) years, and their families resettling in the County. Services shall be continually informed by and adapted to suit refugees’ and asylum seekers’ cultural strengths and norms and clients’ specific needs and desires.

Mental health prevention and outreach activities shall target the large new refugee population and shall be grounded on the cultural understanding of each ethnic group, the group’s assets, its protective factors, and its natural wellness and healing practices.

Newly resettled refugees and asylum seekers with behavioral health needs shall be provided brief intervention services (maximum duration of one [1] year) in order to quickly alleviate symptoms. Refugees and asylum seekers who are identified as needing further services shall be referred to appropriate service providers.

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

B. Offeror shall strategically operate a Medi-Cal and Medicare-certified service delivery site within the catchment areas of the County. The site shall be considered the primary operating facility for Offeror’s staff. In addition to established sites, services shall optionally be offered in the community or at the clients’ school, home, homeless shelter, etc.), as appropriate.

II. Background Information A. According to the Office of Refugee Health (ORH) data completed in 2018 on the United Nations High Commissioner for Refugees (UNHCR), the UN Refugee Agency, (https://www.unhcr.org/en-us/figures-at-a-glance.html), California admitted five thousand and three-hundred and thirty-three (5,337) refugees and Asylum seekers, and one hundred and nineteen (119) of them were admitted to the County. The age of new refugee and asylum seekers at the time of arrival range from 18 through 100 years of age, and the gender distribution was 49% female and 51% male. The largest group of arrivals (23%) were ages 6 through 18 years old, arriving from countries such as: Afghanistan (63.8%), Ukraine, (6.8%), China (3.9%), El Salvador (3.5%), Iraq (1.7%) and other (1.4%). Currently, the BHSD has a new refugee outpatient program that has served ninety-six (96) clients and outreached to eight-hundred and thirty-three (833) clients using different types of outreach process from July 1, 2019 to June 30, 2020.

B. Research has shown that half of newly resettled refugees exhibit symptoms of anxiety and depression associated with adjusting to their new surroundings and to American society. They also are at a higher risk of trauma related to the experience of fleeing their country of origin because of experience from war, torture, violence, or persecution.

C. Although all refugees have Medi-Cal for eight (8) months (more if they have minors), their coverage only guarantees them access to primary care services. Refugees who have a severe and persistent mental illness can access the County’s system of care. For the remaining new refugee population, there is little to no mental health assistance available. Left unassisted, any mild-to-moderate problems hinder their ability to become self-sufficient and may lead to more severe mental health problems.

D. The new refugee population is also often unfamiliar with the concept and nature of mental illness and the role of clinical treatment. Stigma related to mental illness is deeply entrenched in many cultures and contributes to a higher level of reluctance to acknowledge mental health symptoms and to accept and engage in mental health services.

E. The program is funded under the PEI component of the Mental Health Services Act (MHSA) and shall be in accordance with the California Welfare and Institution Code (WIC) Division 5, Community Mental Health Services 5000-5912.

III. Target Population A. The program shall serve adults, older adults, new refugees, and asylum seekers who are:

1. Classified as “Refugee” under the United States Citizenship and Immigration Services (USCIS) regulations;

2. Covered under refugee social service programs up to seven (7) years from date of entry into the United States; and

3. Asylees who have been granted “Qualified Alien Status.”

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:

Reducing stigma against identifying mental health issues and provide access for these services;

Reducing disparities in access to mental health PEI services in the target population;

Reducing trauma, specifically intensity and/or frequency of symptoms and decreasing any negative impact on client’s functioning in daily living activities; and Increasing suicide prevention awareness among members of the target group, by helping to inform the target population of the factors and symptoms of mental health issues, which can contribute to suicidality.

2. Objectives shall be achieved by offering services designed to empower clients to acculturate and guide them towards self-sufficiency by:

a. Using responsive and trauma-informed interventions to improve engagement in services;

b. Counseling to provide clients with the opportunity to process their experiences, learn coping strategies and skills, and increase their sense of self-efficacy and resilience;

c. Connecting clients with local organizations through referral networks to provide additional supportive services such as language support, housing assistance, job training programs, and legal help;

d. Ensuring that clients have access to appropriate resources in order to meet their needs deemed appropriate by Case Management;

e. Providing education on common mental health issues among refugee populations (e.g., depression, anxiety, Post-Traumatic Stress Disorder), healthy coping strategies, understanding cultural differences in communication styles or behaviors related to stress and trauma; and

f. Providing preventative interventions (e.g., mindfulness practices and tools) for new arrivals to manage stressors associated with acculturation into a new country.

IV. Reporting and Data Collection Requirements A. Offeror shall submit report(s) as requested by the BHSD Program Monitor with the following:

1. The source of all referrals received;

2. The number and disposition of assessments;

3. The number and disposition of clients and/or families receiving intervention services;

4. The duration and frequency of intervention services per client/family;

5. The effectiveness of intervention services; and

6. The number of clients who were referred to specialty mental health services and whether they subsequently received specialty mental health services.

B. Offer shall submit a Quarterly PEI report to the BHSD Program Monitor which shall include demographic information, mental health prevention activities, the number of clients served, and the number and source of referrals.

C. Offeror shall submit semi-annual project implementation and status reports containing the most prevalent presenting client mental health conditions to the BHSD Program Monitor.

D. Offeror shall be responsible for collecting data, including the following as appropriate for the program:

1. Netsmart/myAVATAR data;

2. Results of all pre- and post-test results of refugee population normed with the use of tools such as the Current Adaptive Functioning Index-Cross-Cultural Version (CAFI-XC);

3. Pre- and post-service surveys at psychoeducation engagement events; and

4. Administer assessment tool(s) as part of the program requirement(s) and report assessment tool data collected.

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

1. PCE with 837 billing;

2. 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 need for the particular program/contract.

V. Outcomes and Measurements A. The following outcomes shall be reported to the MHSA Oversight and Accountability Commission (OAC) for the purpose of evaluating the program:

1. Prevention and Outreach Outcomes:

a. Provide Prevention and Outreach services to clients of the target population residing in the County.

2. Early Intervention Outcomes:

a. Create a robust referral network to the program as demonstrated by a variety of referral paths to access the program’s activities.

b. Ensure a positive experience of service as demonstrated by the number of refugees who self-refer or seek services through the recommendation of the Community Partners with at least one (1) prior contact with the program in the past.

c. Provide materials in appropriate languages for the current demographics of new clients, as defined per State refugee arrival data in the County.

B. Offeror shall implement the following outcome measurement methods:

1. Utilize evidence-based surveys and assessments including, but not limited to:

a. The Refugee Health Screener-15 (RHS-15): This survey is designed to assess the mental and physical health needs of newly arrived refugees in primary care settings. It is administered via an online questionnaire or face-to-face interview and provides a baseline assessment of physical and mental health status, prior trauma, and resettlement experiences, as well as knowledge of access to services available in the local community.

b. The Harvard Trauma Questionnaire (HTQ): This survey has been developed specifically for use with refugee populations and evaluates symptoms related to traumatic events experienced before resettlement, as well as currently experienced stressors. It is composed of a series of self-report questions regarding exposure to traumatic events, current levels of functioning, post-traumatic stress symptoms, social support, and other areas relevant to overall mental health welfare.

c. Global Assessment Scale (GAS): This scale is used to evaluate a client’s level of functioning across multiple domains, including physical health, psychological well-being, social relationships, occupational performance, leisure activities, and spiritual life. It assesses both current functioning as well as changes to functioning over time.

2. Offeror’s chosen measurement methods shall succeed in providing important data for understanding the success of a behavioral health program for new refugees by measuring changes in symptom severity or overall functioning across multiple domains at various intervals throughout treatment.

3. Offeror shall implement a minimum of two (2) measurement tools.

4. Offeror shall utilize at least one (1) evidence-based outcome measurement or choose from the tools listed above.

5. In addition to these survey tools, Offeror shall also optionally collect qualitative feedback from clients regarding their treatment experiences in order to gain further insight into their perception of the quality of services received or the level of support given by their provider(s). Ultimately this information is used to inform decisions about whether interventions are working effectively or need further exploration or refinement.

VI. Program Description A. Service Description

1. Offeror shall provide services to clients who have been displaced from their homeland and need mental health support.

2. Services shall be provided in a variety of settings, including outpatient clinics, the County Refugee Clinic, at the client’s home, or in other appropriate community settings considered clinically appropriate and confidential. The program is designed to help clients build resilience, manage their stressors, and integrate into their new surroundings.

3. Offeror shall provide culturally competent care that is respectful of each person’s unique experience and create a safe environment free from stereotyping or judgment, so clients feel comfortable talking about their experiences in a nonjudgmental setting. Offeror shall provide services to guide clients toward meaningful goals related to personal growth and development within the context of their culture.

4. Offeror shall have expertise in providing behavioral health—ethnic- and culture- specific, and other resources to refugees and asylum seekers in community resources, as needed. Offerors shall respect healing practices that may not necessarily be a part of the unserved and underserved communities and provide culturally capable care that is responsive to the diverse needs of the population being served.

5. Outreach and Prevention services shall include the following:

a. Outreach events including, but not limited to, tabling events, community fairs, faith-based/cultural community events, Annual Refugee Day, and orientation and psychoeducation groups.

b. Group services whose primary aim is to orient newly arrived refugees on the various resources and provide services to recognize signs and symptoms of mental health issues. In addition to any clinic-based programming, services shall also be readily available to the community where refugees normally congregate.

c. Promote access to PEI mental health services by providing mental health awareness and literacy training to resettlement agency staff, service providers that support resettlement agencies, and the network of providers and volunteers of the Immigrant and Refugee Forum of Santa Clara County.

d. Translation and promotion of mental health literacy and outreach material.

e. Provide education to refugee communities through a variety of activities, including, but not limited to public presentations, utilization of specialized media designed to decrease the stigma of mental health and promote cultural protective factors, facilitating discussion groups, participating in existing refugee orientation sessions, and participating in current trainings and meetings.

f. Participate in community gatherings including, but not limited to, cultural celebrations, holiday events, faith-based gatherings, and various events in which information shall be provided on the services available for refugees and their families.

g. Conduct prevention and education outreach activities throughout the County to the target population’s communities, community organizations, schools, churches, social groups, professional organizations, and social service providers. Presentations and materials shall be in English and in the target population’s languages.

B. Early Intervention

1. Offeror shall provide mental health treatment services for mild to moderate behavioral health needs and issues for the target population who are willing to accept therapeutic services. Early intervention services include the following activities:

a. Group/family and/or individual mental health rehabilitation services;

b. Case management services;

c. Psychoeducation;

d. Group/Family and/or individual therapy;

e. Medication management services; and

f. Crisis intervention.

2. Utilize assessment tools/approaches and provide treatment that is culturally relevant, is strength-based, and incorporates the cultural framework of Client(s) being treated, with a goal of improving outcomes across multiple life domains.

3. Clinical staff shall conduct a clinical evaluation using a culturally adapted approach using strength-based assessment tools. Depending on the client’s presenting mental health issues, the refugee may be referred to other appropriate services, including the BHSD specialty mental health/behavioral health system.

4. Staff shall be understanding of the difficulty of transitioning after displacement and shall help clients feel safe and secure in their new home.

5. The program shall support clients’ ability to thrive in their new environment by developing self-care strategies, increasing their confidence and self-esteem, connecting them with resources in the community, and providing a space for healing from past traumas that may have occurred during displacement or resettlement.

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

7. 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[footnoteRef:1]; [1: Clients require both mental health and substance use treatment services.]

d. Standardized screening and transition tools;

e. Behavioral Health CPT coding transition; and

f. Payment reform.

C. Staffing Requirements

1. Offeror shall provide an updated agency plan for administrative coverage or program-related changes to the BHSD Division Director at the beginning of each new fiscal year, and whenever any changes to this plan occur. The BHSD Division Director and/or their designee must approve the plan and any changes prior to implementation.

2. Offeror shall describe the existing staff who shall be providing the services and program components described in this Request for Statement of Qualifications (RFSQ). Offeror shall include a staffing table and credentials for staff providing and supporting these services which indicate position title, linguistic and cultural skills, education, experience, licensure, and certifications, including administrative, supervisory, and direct service.

3. Offeror shall describe their plan to recruit and maintain appropriate staffing to meet the diverse population of Santa Clara County. Offeror shall provide a personnel retention plan, which includes a current list of staff at the organization, their credentials, bilingual language capacity, and the length of time the employee has worked with the organization.

4. Offeror shall provide the approximate percentage turnover of the direct service staff over the past three (3) years. Offeror shall also describe how the organization shall provide continuity of care for families during staff turnover.

5. Offeror’s staff shall attend regularly scheduled meetings, training sessions, seminars and/or other meetings as scheduled by the BHSD Director and/or their designee. Meetings shall include but are not limited to: Adult/Older Adult System of Care meetings, and Quality Improvement (QI) meetings.

6. Mental health prevention services (outreach, promotion, and engagement) shall be provided by skilled community engagement specialists with lived experience who meet linguistic needs of the target populations and/or who have knowledge of cultural experiences of the target populations.

7. Training

a. Offeror shall send all appropriate staff to attend all mandated, systemwide BHSD trainings.

b. Offeror shall ensure that staff understand the principles of wellness and recovery services and other Evidence Based-Practices (EBPs) as determined by the BHSD.

c. Mandatory staff trainings shall be required and approved by the BHSD Program monitor.

d. Clinical licensed and waivered staff shall expect to be trained and competent in Cognitive Behavioral Therapy (CBT) and Trauma Focused CBT (TF-CBT). Offeror shall ensure that the program staff understand Trauma Informed services to best accommodate their clients’ needs.

e. Offeror shall plan and implement continuous staff training and quality improvement related to cultural and linguistic responsiveness.

8. In addition, Offeror shall train and ensure that their staff is trained and proficient in the following background and skills as appropriate to their role:

a. Knowledge and skills in the principles of psychosocial rehabilitation and recovery processes;

b. Confidentiality;

c. Crisis assessment and intervention;

d. Understanding of psychopathology and physical health problems within the context of client age and culture;

e. Effective addressing of clients’ culture and language needs;

f. Knowledge of the local community resources available to the client population, including self-help centers and ethnic community resources; and

g. Understanding of the presiding mental health system of care.

9. Administrative Participation: Offeror shall ensure a staff representative attends regularly scheduled meetings, training sessions, seminars or other meetings as scheduled by the Director of Behavioral Health or their designee. This includes Adult & Older Adult System of Care Meetings.

10. Offeror’s organization shall maintain practices related to recruiting, hiring, and promoting multi-lingual staff and/or a culturally or ethnically diverse workforce. Offeror’s organization shall have training requirements related to diversity, equity, and/or inclusion (e.g., Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, Plus [LGBTQ+], cultural and linguistic capacity, racial equity).

D. Cultural Competency

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

2. 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. Offeror’s organization shall have a plan to address barriers when they do not have staff available to meet the six (6) Santa Clara County threshold languages (Spanish, Vietnamese, Mandarin, Cantonese, Tagalog, and Farsi) and a plan for actions and changes to ensure diversity and inclusion in service delivery.

4. Offeror’s organization shall provide outreach activities focused on reaching underserved, underrepresented, and/or multicultural populations.

a. Offeror shall have interpretative services that meet the needs of clients.

b. Offeror shall provide services in accordance with Offeror’s Cultural Competency Plan. This plan must be submitted to the BHSD Director and shall be in accordance with the BHSD standards.

c. Offeror shall meet the needs of clients who identify with the LGBTQ+ community.

E. Referrals and Admissions

1. Offeror shall accept referrals from the BHSD call center.

2. Offeror shall accept referrals from the County Refugee Clinic, the Refugee Resettlement agencies, and from the community directly.

3. Clients who self-refer or are referred for assessment by various sources such as family members, community workers, primary care physicians and case workers, independent of time of resettlement, may receive intervention services.

4. Offeror shall provide behavioral health services within ten (10) working days of receiving client referral. Services must be accessible within the greater of fifteen (15) miles or thirty (30) minute drive from the client’s primary residence.

F. Care Coordination

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

a. Offeror shall coordinate care with the client’s Primary Care Provider (PCP) by providing a behavioral health diagnosis and treatment plan, name and contact details, and clarify medications that the person is actively taking medication both for physical and mental health conditions. Offeror shall proactively initiate collaboration with the PCP routinely.

b. Offeror shall provide a warm hand-off and referral services to specialty mental health, substance use treatment providers, and other social services and community resources.

c. Offeror shall collaborate and coordinate with local providers of health and human services to provide adjunctive services to clients.

d. Offeror shall collaborate with the BHSD and refugee service organizations to ensure that services are coordinated, and resources are utilized to enhance and expand services to the target population.

e. Medi-Cal Enrollees: Offeror shall service clients who are currently enrolled beneficiaries in Medi-Cal and clients who need assistance in maintaining Medi-Cal enrollment. Offeror shall service clients in a timely manner and help clients to accurately prepare and submit their Medi-Cal re-enrollments and/or re-certification.

G. Program Hours of Operations

1. Offeror shall be open for services during regular office hours Monday through Friday, 8:30 a.m. - 5:30 p.m. Regular office hours shall be at a minimum of forty (40) hours per week. Following contract negotiations, changes to office hours shall be approved by the BHSD in writing.

2. Offeror shall develop a plan to include after-hours crisis care, provide medication support to crises in a timely manner, and indicate plans to respond in person when clinically appropriate.

3. Referral to crisis outpatient services shall be available twenty-four (24) hours a day, seven (7) days a week to address the emergency needs of clients under the program. Offeror shall be required to maintain coverage that shall include Welfare and Institutions Code (WIC) 5150 evaluations for clients as needed.

H. Evaluations, Transitional Planning, and Discharge

1. Mental health intervention services shall not be provided to anyone, whether an individual or a family, in excess of any twelve (12) consecutive months. Clients who are identified as needing further services shall be referred to appropriate providers or to the BHSD’s Call Center.

2. When clients need a higher or lower level of care, the program’s staff shall follow the BHSD transition procedures to refer clients to appropriate services.

3. Offeror shall initiate transfers and referrals consistent with client choice and need. Consideration shall be given to the client’s area of residence, age, language, and culture.

VII. 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 B2 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 relating to COVID-19.

1. If applicable, Offeror shall complete the Attachment E, Contractor Certification of Compliance with COVID-19 Vaccine Requirements (“Certification”) upon successful contract negotiations. For staff who routinely perform services for the County onsite and share airspace with or proximity to other people at a County facility as part of their services for the County, including but not limited to vaccination, as applicable and periodically updated, and available at https://procurement.sccgov.org/doing-business-county/contractor-vaccinations and incorporated herein by this reference.

RFSQ-BHS-FY23-0210: Adult and Older Adult System of Care Services Page 1 of 3 ATTACHMENT A2: New Refugee Prevention and Early Intervention Services Scope of Work CATEGORY 1: Prevention and Early Intervention Services