Attachment A4.pdf

ATTACHMENT A4

CATEGORY 3: OUTPATIENT SERVICES

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SCHOOL-BASED OUTPATIENT

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 for the School-Based Outpatient (SB OP) program (hereafter referred to as “the program”), previously known as Mental Health Services Act (MHSA) School Linked Services (SLS), under the Early Intervention and School-Based Division.

B. Offeror shall provide behavioral health services to school-aged youth, hereafter refer to as “clients,” primarily in the school setting, although services may also be provided in a variety of settings, such as the clinic, home, community, and community agencies as necessary and as needed by the clients served.

C. Offeror shall partner with identified school district(s) and school site(s), designated to the Offeror by BHSD, to fully integrate the SB OP program within the school’s processes, culture, and align it with the school’s Multi-Tiered System of Supports (MTSS) framework.

1. The MTSS framework is a proactive and preventative framework to provide targeted supports to address students’ behavioral, academic, and social emotional needs through three (3) tiers of support, as follows:

a. Tier 1 – Universal support for all or majority students (e.g., 75%+ student enrollment) providing core instruction and basic interventions;

b. Tier 2 – Supplemental support for some students (e.g., 15% student enrollment)); includes targeted supports with group interventions; and

c. Tier 3 – Intensive support for few students (e.g., less than 10% student enrollment)). Students receive more intensive, individualized support to improve their outcomes.

2. Offeror shall provide Tier 3 services through the SB OP program.

II. Background Information

A. The SB OP program was designed to meet the needs of students by providing a continuum of services and supports, ranging from outpatient to intensive outpatient through culturally and developmentally appropriate practices, and community-defined evidence-based practices. Since 2016, the SB OP program has served school-aged youth throughout Santa Clara County on school campuses in high-risk zip codes.

In fiscal year (FY) 2023-2024, 832 clients were served. Slightly more than half (57%) of clients served were female, 68% were Hispanic or Latino, and 26% of clients preferred Spanish as their language. The majority (85%) of clients served were between the ages

RFSQ-BHSD-FY25-0066: Children, Youth, and Family System of Care Services Page 2 of 8 ATTACHMENT A4: School-Based Outpatient Scope of Work CATEGORY 3: Outpatient Services of six (6) and fifteen (15). The most common diagnoses at admission included anxiety disorders (33%) and depressive disorders (31%).

III. Target Population

A. The program shall serve clients in grades pre-kindergarten through high school, primarily middle and high school, and their families residing within high-risk areas (HRAs) and attending targeted school districts and designated school sites.

1. The program shall serve clients with full-scope Medi-Cal.

2. Targeted school districts and school sites are identified by, but not limited to, three (3) criteria:

a. Designated Title 1 school;

b. School located in an HRA/zip code;

c. School population has greater than 60% of students who qualify for Free & Reduced Lunch.

3. School districts are grouped into four (4) regions in Santa Clara County:

a. Central County (Cambrian, Campbell Union, Campbell Union High, Cupertino Union, Franklin-McKinley, Lakeside Joint, Loma Prieta Joint Union, Los Gatos Union, Los Gatos-Saratoga Joint Union, Luther Burbank, Moreland, Oak Grove Union, San Jose Unified, Santa Clara Unified, Saratoga Union, Santa Clara County Office of Education, Union);

b. East County (Alum Rock Union, Berryessa Union, East Side Union High, Evergreen Elementary, Milpitas Unified, Mount Pleasant Elementary, Orchard);

c. North County (Los Altos, Mountain View-Los Altos, Mountain View-Whisman, Palo Alto Unified, Sunnyvale Elementary, Fremont Union High); and

d. South County (Gilroy Unified, Morgan Hill Unified).

B. A typical client in the SB OP program may have, but is not limited to, some of the characteristics below:

1. Functional Impairment: Some difficulties observed in family interactions, peer, and social interactions. Difficulties in school functioning that impact their school behavior, achievement, and attendance. Moderate emotional and behavioral regulation needs, requiring occasional external support.

2. Common Diagnoses and Presenting Behaviors: Anxiety disorders, depressive disorders, adjustment disorders. Clinically high risk for psychosis. Internalizing or externalizing behavioral issues causing mild to moderate impact on relationships and functioning. Some challenges with attention and concentration.

3. Support System: Access to social and environmental support but may benefit from strengthening and buffering.

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4. Types of Treatment and Timeline: Clients and their families typically require support for six (6) to twelve (12) months, with sessions once per week. Treatment includes individual, family, and group therapy, case management, and medication support.

5. Crisis Intervention: Clients are generally stable and unlikely to need immediate crisis intervention. However, a plan should be in place for potential exacerbation of symptoms.

6. Care Coordination: Simple and occasional communication with other providers, focusing on transitions and continuity of care.

IV. Program Goals and Objectives

A. The program shall be aligned to achieve the following goals and objectives:

1. Short-term goals shall include, but are not limited to:

a. Improve school functioning in areas such as school attendance, school achievement, and school behavior.

2. Long-term program goals shall include, but are not limited to:

a. Increase high school graduation rates;

b. Reduce chronic absenteeism; and

c. Improve overall school climate.

B. Objectives shall be achieved by:

1. Providing MTSS Tier 3 services and support that include, but are not limited to:

a. Individual, group, and family therapy;

b. Case management;

c. Medication support;

d. Crisis intervention;

e. Critical incident clinical support for critical incidents that occur within the designated school or surrounding community of the designated school; and

f. Evidence Based Practices (EBPs), Promising Practices, and Community Defined Evidence Practices (CDEP).

V. Reporting and Data Collection Requirements

A. Data Collection Requirements

1. Data required per funding source and BHSD guidelines include, but are not limited to:

a. Client demographics;

b. Number of clients served;

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c. Number of clients referred to treatment;

d. Number of therapeutic group services provided and group attendance;

e. Detailed outcome data; and

f. Evaluation summary:

i. Successes;

ii. Challenges;

iii. Lessons Learned; and

iv. Implementation barriers, if applicable.

2. Data collection required by the EBP or program:

a. Administered pre and post or admit and discharge; and

b. Data collection and reporting inform clinical practices, service quality, and Continuous Quality Improvement (CQI).

B. Data Reporting Requirements

1. Narrative reporting requirements as required per funding or BHSD guidelines;

2. A cumulative fiscal year report shall be submitted after the fiscal year ends; and

3. Outcome measure, client level, data submission is due to BHSD quarterly in an approved Microsoft Excel template.

a. Data at client level includes, but is not limited to:

i. Outcome measure scores at pre and post or admit and discharge or other timeframes as indicated by BHSD.

VI. Outcomes and Measurements

A. Offeror shall achieve the following outcomes:

1. Demonstrate program and EBP effectiveness;

2. Achieve client and parent satisfaction;

3. Demonstrate behavioral and emotional changes;

4. Demonstrate improvement in school functioning in areas such as attendance, behavior, and achievement.

B. Offeror shall administer standardized, reliable, and valid measurements as identified by the EBP at pre- and post-EBP or identified by BHSD at specified time periods such as admission and discharge. Offeror is responsible for training staff on the use, scoring, and interpretation of the measurements.

1. EBP and other outcome measures include, but are not limited to:

a. Triple P Level 4 and Level 5 clinical tools that allow the monitoring of pre and

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i. Parent Satisfaction Survey, a questionnaire that measures family functioning, behavior, and successes;

ii. Eyberg Child Behavior Inventory (ECBI), a parent/caregiver report to assess the frequency and severity of disruptive behaviors that occur at home;

iii. Sutter-Eyberg Student Behavior Inventory-Revised (SESBI-R), a teacher report to assess the frequency and severity of disruptive behaviors that occur at school.

b. Trauma Focused Cognitive Behavior Therapy (TF-CBT)

i. UCLA PTSD Reaction Index is a self-report questionnaire to screen for exposure to traumatic events and assess PTSD symptoms in school-age children and adolescents. The scale assesses the frequency of occurrence of PTSD symptoms during the past month;

ii. Child Behavior Checklist (CBCL), a parents' reports of children's competencies & problems;

iii. Trauma Symptom Checklist for Children (TSCC), which measures posttraumatic stress and related psychological symptomology in children ages eight (8) to sixteen (16) years who have experienced traumatic events such as a physical or sexual abuse, major loss, or natural disasters, who have been a witness to violence;

iv. Child Sexual Behavior Inventory (CSBI), if applicable, is a measure of sexual behavior in children that is completed by the mother or other primary female caregiver.

VII. Program Description

A. Service Description

1. Services shall be provided to clients who need support to address behavioral health challenges that impact their education, well-being, families, relationships, and other domains of functioning. Services shall also be provided to clients who have specific qualifying risk factors.

2. More intensive levels of service shall be provided to clients who need a higher frequency and/or dosage of support to treat symptoms, conditions, and/or to address challenges related to risk factors.

3. Paraprofessional-level case management and other services shall be provided, when needed according to the client’s specific needs, including when a client’s service needs change and result in a step up or down in service delivery.

4. Offeror shall provide a continuum of services and supports, from an outpatient level of care to an intensive outpatient level of care, which include, but are not

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a. Therapy;

b. Case Management;

c. Crisis Intervention;

d. Critical incident therapeutic support following a critical incident that occurs on or near the designated school site;

e. Rehabilitation Counseling;

f. Psychiatry/Medication Support;

g. EBPs that include, but are not limited to:

i. Positive Parenting Program (Triple P) Level 4, an EBP for parents of children with severe behavioral difficulties;

ii. Triple P Level 5, intensive support for families with complex concerns.

Parents generally complete a Level 4 Standard or Group program before (or in conjunction with) a Level 5 course; however, parents can also be referred by their Primary Care provider.

iii. TF-CBT, an EBP to help children and adolescents and their parents recover after trauma;

iv. Motivational Interviewing, a guiding style of communication designed to empower people to change by drawing out their own meaning, importance, and capacity for change;

v. Solution Focused Therapy, a short-term, goal-focused evidence-based therapeutic approach incorporating positive psychology principles and practices that helps clients change by constructing solutions rather than focusing on problems;

vi. Cognitive Behavioral Therapy, an EBP that teaches clients to challenge negative thought patterns so they can view challenging situations more clearly and respond to them in a more effective way;

vii. Cognitive Behavioral Intervention for Trauma in Schools (CBITS), a skill-based, youth group intervention for youth in grades five (5) through twelve (12), aimed at relieving symptoms of posttraumatic stress disorder, depression, and general anxiety.

h. Re-engagement Support in situations where the client is returning to school from a hospitalization, suspension, etc.

5. Offeror shall participate in meetings such as Coordination of Services Team (COST), Individualized Education Plan (IEP), and other relevant meetings related to their client.

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6. Offeror shall provide therapeutic support to the designated school sites if a critical incident occurs at the designated school site or within the community of the designated school site.

a. Total hours of support will be determined with BHSD based on school district size.

Student Enrollment Range School District Size

Less than 4,000 Small

4,000-9,000 Medium

9,000 or greater Large

7. Offeror shall follow school district and school site processes, safety plans and procedures related to scheduling services during school hours.

B. Staffing Requirements

1. Direct service staff, such as Licensed Practitioners of the Healing Arts (LPHA), including waivered staff, shall be the lead and holder of the case.

a. Paraprofessional staff and services may be added to support the client as determined by the LPHA/waivered staff.

2. Staff-to-school site ratio is one (1) LPHA staff/waivered staff to no more than 2.5 school sites.

3. Offeror shall be responsible for training staff to meet fidelity of the EBP along with providing supervision.

a. Offeror shall be responsible for certification and re-certification of the EBP if required by the EBP.

C. Referrals and Admissions

1. Offeror shall accept referrals for students from identified, designated school sites.

2. Offeror shall accept referrals from the School Linked Services (SLS) Coordinator, School-based Wellness Center, and school site designee.

3. Offeror shall accept referrals from BHSD Call Center, if appropriate.

4. Offeror shall participate in and be integrated within school’s existing referral system, process, and pathway.

a. If the school site does not have a referral process, Offeror shall collaborate with school site to establish a referral process to receive and triage referrals to appropriate level of care.

5. Offeror shall receive referrals and admit clients into the program throughout the

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D. Care Coordination

1. Offeror shall be knowledgeable about existing supports and services within the school site and community to coordinate care.

a. Step down to existing school services at the Wellness Center or school district resources;

b. Primary Care Provider referral;

c. Managed Care Plan; and

d. Coordinate to higher level of care.

2. Offeror shall coordinate services and collaborate with school staff, partnering agencies, and other organizations to connect families and children to key services outside the scope of SB OP program, when services are appropriate and available. Interagency collaborative efforts with other community partners and agencies are essential to reduce duplication of services, close service gaps, increase accessibility of services to the targeted population, continuity of services during the summer break, and establish family engagement services.

3. Offeror shall efficiently and effectively link clients and their families’, including siblings ages birth through (five) 5, to appropriate services within the County’s CYF System of Care.

a. Offeror shall partner with SLS Coordinator or school site providers such as Wellness Center staff and academic counselor, to provide linkage to resources at school and services and supports that complement the MTSS Tier 3 services provided by the SB OP program.

b. This service shall include connecting families to appropriate services if their needs for behavioral health services are beyond the scope of the SB OP program.

c. Offeror shall coordinate services with the SLS Coordinator.

E. Program Hours of Operations

1. Offeror shall provide services on a year-round basis, including during school breaks such as winter, spring, and summer breaks.

2. Offeror shall provide services, Monday through Friday, before, during, and after school hours as well as times requested by the family and student.

a. Services shall not impede the client’s academic time and their right to an education.

3. The Offeror shall provide services on designated school sites, according to a schedule determined in collaboration with the school districts.