Attachment A5.docx

ATTACHMENT A5

CATEGORY 5: JUSTICE-INVOLVED ADULT AND OLDER ADULT TRANSITIONAL HOUSING CONTINUUM FOR FORENSIC, DIVERSION, AND REINTEGRATION TIME-LIMITED HOUSING STABILIZATION, COMMUNITY REINTEGRATION, AND ESSENTIAL SERVICES FOR JUSTICE-INVOLVED ADULTS AND OLDER ADULTS

SCOPE OF WORK

Purpose A. The County of Santa Clara (County) Behavioral Health Services Department (BHSD) is seeking statements of qualifications from qualified Offerors interested in providing justice-involved adults and older adults transitional housing facilities (the program) in Santa Clara County as part of the Forensic, Diversion, and Reintegration (FDR) Continuum of Care.

B. The program is designed to address the complex needs of justice-involved adults and older adults with severe mental health and co-occurring conditions (mental health and substance use) who are homeless or at risk of being homelessness, and who may be in community or being released from correctional facilities. With a focus on time-limited housing stabilization, community reintegration, and basic needs services, the program underscores a dedication to fostering clients’ self-worth and independence.

C. The program includes the following two (2) types of housing programs:

1. Forensic, Diversion, and Reintegration Transitional Housing Unit (THU) Beds – THUs offer up to six (6) months of housing stabilization and community reintegration to justice-involved adults and older adults with severe mental health and/or co-occurring (mental health and substance use) conditions who are homeless or are at risk of homelessness and may be in community or being released from a Correctional Facility. Eligible clients shall be residents of Santa Clara County and referred to a BHSD Forensic, Diversion, and Reintegration Outpatient Treatment Program; services shall provide a safe living environment designed to promote self-worth and independence, as well as access to basic needs that include but not be limited to access to showers, three (3) daily nutritional meals, clothing, laundry, transportation and lockers, and ongoing collaboration with FDR Outpatient Treatment Providers assigned to clients.

2. Forensic, Diversion, and Reintegration Transitional Referral Beds Program – This program provides dedicated transitional referral beds which provide interim housing for up to a three (3)-month period. This program shall provide housing stabilization and community reintegration for justice-involved adults and older adults with severe mental health and co-occurring (mental health and substance use) conditions who may be releasing from correctional facilities or who may be in-community. Individuals may be homeless or at risk of homelessness and would require that clients be Santa Clara County residents and referred to a BHSD Forensic, Diversion, and Reintegration Outpatient Treatment Program. Support includes interim safe housing that nurtures self-worth and independence, access to daily basic needs that include but are not limited to showers, three (3) daily nutritional meals, clothing, laundry, transportation and lockers, and ongoing collaboration with FDR Outpatient Treatment Providers assigned to clients.

Background Information A. California Welfare and Institution Codes (WIC) 5670-5676.5 delineate the intent of the California Legislature to develop a system of residential programs in every county to provide a range of alternatives to institutional care based on principles of residential and community-based treatment. These regulations further outline the criteria for community residential programs and indicated that the primary focus is the de-escalation of the crisis; stabilization; diagnostic evaluations; assessment of clients’ existing support system; and providing support to clients to design and develop their discharge plan.

B. The County is seeking the provision of interim safe housing for justice-involved adults and/or older adults. Clients shall be referred through FDR Crisis Residential and/or Outpatient programs, the Behavioral Health FDR Collaborative Court, and the BHSD-FDR Reentry Resource Center (RRC) teams.

C. The program shall have a valid lease in place for their facility for the duration of the resulting Agreement.

Target Population A. The program shall specifically target justice-involved adults (ages 18 through 59) and older adults (age 60 and older) residing in Santa Clara County, who face severe mental health and co-occurring (mental health and substance use) disorders and are chronically experiencing homelessness or are at risk of homelessness. Eligible clients shall have full-scope Medi-Cal benefits designated to Santa Clara County (County 43) or may be uninsured.

B. Clients served through the program shall meet the following prerequisites:

1. Be justice-involved residing in community or be releasing from a correctional facility to a community treatment provider.

2. Diagnosed with a serious mental health condition and/or a co-occurring (mental health and substance use) disorder;

3. Received referral from FDR providers, BHSD staff located at the Collaborative Court and BHSD staff located at the Reentry Resource Center; and

4. Referred/enrolled in a BHSD FDR Outpatient Treatment Program.

C. Clients served in the program shall be homeless or at risk of being homeless.

D. Justice-involved clients served may:

1. Be releasing from a correctional facility, emergency psychiatric services, locked psychiatric treatment facility, and/or an institute for mental disease (IMD).

2. Have a history of assaultive behaviors.

3. Have been arrested, charged, and/or convicted of criminal charges, including, but not limited to Penal Code 290 and/or Arson.

E. Clients served shall not require nursing care services and shall be ambulatory and free of communicable diseases.

Program Description A. Service Description

1. Purchase of dedicated beds shall be upon successful contract negotiations and mutual agreement between the BHSD and Offeror.

2. The program shall provide clean, interim safe housing, ongoing coordination and communication with FDR Outpatient Treatment Providers, and case management and other supportive services to the program’s target population. Services are intended to assist a client’s transition to permanent and long-term transitional housing environments. Clients shall be homeless or at-risk of homelessness (e.g., leaving a correctional facility without an identified safe community placement).

3. Upon making a determination that the clients have a history of chronic homelessness, Offerors shall complete the Vulnerability Index – Service Prioritization Decision Assistance Tool (VI-SPDAT) to determine the risk and prioritization assistance to homeless and at risk of homelessness clients in need of BHSD services.

4. Offeror shall provide services that meet clients’ basic human needs, including but not limited to a bed, three (3) nutritious meals per day, showers, toiletries, laundry, transportation, and clothing. There shall also be limited access to computers, telephones, faxes, mail, and the internet.

5. The program shall provide structured daily activities (e.g., support groups and workshops) and individualized services which may be achieved with the ongoing collaboration, communication, and assistance of the assigned FDR Outpatient program through case management services that shall ensure the attainment of: Medi-Cal or any other type of medical insurance that would assist the clients with accessing physical, dental, behavioral health treatment, as appropriate, as well as other income such as General Assistance or Supplemental Security Income.

6. The program shall be staffed twenty-four (24) hours per day, seven (7) days per week (24/7) to address the needs of clients.

B. Staffing Requirements

1. The program shall employ House Managers and other relief positions (e.g., Case Manager), who would be available to residents 24/7.

2. Offeror shall notify the BHSD Program Monitor of any staffing changes within fourteen (14) days of occurrence and provide a year-end staffing report.

3. Staff shall have specialization and experience working with justice-involved adults and older adults.

4. Staff shall attend systemwide BHSD trainings and meetings as required, which include the FDR Governance Meeting, and the FDR Program Monitoring meetings.

5. Offeror shall document and ensure all staff are trained in accordance with program regulations. In addition, staff are expected to be trained and proficient in the following background and skills:

a. Ability to effectively address the target population’s cultural and language needs (e.g., knowledge of the justice involved client population, awareness of cultural and linguistic influences on a client, tailored local community resources, etc.);

b. Ability to collaborate, coordinate, and effectively communicate with other County Health Systems, behavioral health treatment providers, community service providers, and justice partners;

c. Knowledge of core training topics (e.g., confidentiality, crisis intervention, sexual harassment prevention and management); and

d. Principles of Wraparound and other Evidence-based Practices (EBPs) known to be effective with the justice-involved population, and as determined by the BHSD.

6. Offeror’s organization shall maintain practices related to recruiting, hiring, and promoting bilingual or 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 + [LGBTQ+], cultural and linguistic capacity, racial equity).

7. The program shall require all staff to be trained and demonstrate proficiency in essential areas including confidentiality, crisis intervention, cultural competency, and a general understanding of the operations of the justice system. This encompasses understanding and addressing the cultural and language needs of our diverse client base, familiarity with the justice system, and knowledge of local community resources.

8. Staff shall also excel in collaborating, coordinating, and effectively communicating with both health and human services providers to ensure comprehensive support for our clients.

C. Cultural Competency

1. Offeror shall submit a complete and updated list of staff’s cultural, gender, and language specific competencies, per Appendix G, Cultural Competence Form.

2. 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.

3. Offeror shall monitor and evaluate client satisfaction and culturally responsive services/practices to continually improve service quality. Data shall be used to improve program satisfaction.

4. Offeror’s organization shall have a plan to address barriers when they do not have staff available to meet the seven (7) Santa Clara County threshold languages (Spanish, Vietnamese, Mandarin, Cantonese, Tagalog, Farsi, and Russian) and a plan for actions and changes to ensure diversity and inclusion in service delivery.

5. Offeror’s organization shall provide outreach and engagement activities focused on reaching underserved, underrepresented, and/or multicultural populations, particularly those who are justice involved. This includes providing outreach services to justice-involved clients while in-custody.

D. Referrals and Admissions

1. Referrals shall be accepted seven (7) days per week, 365 days per year and shall admit only those individuals who meet the criteria for this service type.

2. Referrals shall be received from FDR Outpatient Providers for justice-involved individuals open to the FDR programs. This may also include concurrent referrals by the BHSD Treatment Court and the BHSD Re-Entry Resource Center for clients being referred to FDR Outpatient programs. These may include referrals that are a result of:

a. Step-downs from a higher level of care;

b. Step-ups from a lower level of care;

c. Client screenings completed by the BHSD Collaborative Court and/or the BHSD Re-entry Resource Center staff;

d. Referrals from other Counties for clients that have benefits designated with Santa Clara County (County 43); and/or

e. Referrals via the FDR Referral Form from Adult Custody Health, the Probation Department, the Parole Department, the Pretrial Department, and other FDR collaborators/partners as determined appropriate by the BHSD FDR Division, and for which are processed and approved by the BHSD Collaborative Court and/or the Reentry Resource Center Clinicians.

3. Clients may be in custody pending release when referred for services.

4. If a client’s needs cannot be accommodated (e.g., client has medical or other personal care needs that the provider is neither equipped nor trained to provide), the referral source shall be notified within forty-eight (48) hours of receipt of referral that the Offeror is unable to accept the referral. In cases where there is a dispute regarding the eligibility of a referral, the FDR Program Monitor shall make a determination regarding the appropriateness of the referral.

5. In the event that the program needs to be closed to referrals due to mitigating circumstances, a Program Closure Request Form shall be submitted for approval, and immediate notification shall be made to the FDR Program Monitor and FDR Division Director.

E. Discharge, Coordination, and Transition Planning

1. Offeror shall review and update referral, discharge, care coordination, and reporting procedures in conjunction with the County. Offeror shall ensure that the following program tasks occur:

a. Collaborate, coordinate, and ongoing communication with the designated FDR outpatient treatment provider, family members of the client, public guardian, or other support system identified by the client;

b. Document, evaluate, report, and resolve inappropriate behavior that constitutes immediate discharge to the BHSD;

c. Notify and coordinate with the assigned FDR Outpatient Treatment Provider whether the client is discharged to the community or transitioning to a new program;

d. Submit a fully completed discharge summary and a Client Status Report (CSR) to the Court system/supervision officer upon a client’s discharge;

e. Submit incident reports to the BHSD when an event causes or has the capacity to cause physical or psychological injury or has the potential for a claim or litigation.

2. Involuntary discharges may occur based on inappropriate behaviors exhibited by the client which may pose a risk to self and/or other residents. Offeror shall collaborate with the FDR Outpatient provider to transition the client to the appropriate level of care. The program shall notify the client’s designated outpatient treatment provider at least twenty-four (24) hours before discharge unless circumstances preclude this advisement.

3. Clients shall be discharged when they meet at least one (1) of the following criteria:

a. Upon obtaining permanent housing;

b. Upon graduating from probation, pretrial, or parole (and therefore are no longer justice involved); or

c. Upon a good-faith determination by Offeror that the client cannot be effectively served by the program, resulting in linkage to other appropriate services that better meet the needs of the client.

4. Offeror shall work collaboratively with the assigned FDR Treatment Provider(s), conservator(s), family members, and other community providers to help clients transition from the program as soon as feasible.

F. Program Hours of Operations

1. Offeror shall be available 24 hours, 7 days per week to address any client emergency needs.

2. Offeror shall provide an updated agency plan for 24/7 coverage to the BHSD FDR Program Monitor at the beginning of each new fiscal year and when any changes to this plan occur for approval prior to implementation.

G. Evaluations, Transitional Planning, and Discharge

1. Client Evaluations

a. Offer shall complete a client housing and needs assessment, and plan development of all client referrals within twenty-four (24) hours of admission. Based on assessment results, clients shall be supported in building on strengths in partnership with the treatment team, family, and/or other supports.

2. Discharge

b. When appropriate, the program shall not discharge clients without prior consultation and approval from the FDR Outpatient staff, FDR Contract Monitor, or FDR Division Director.

c. The program shall discharge clients who have obtained safe and permanent housing.

d. Clients may be discharged or refused admission into the program when the client:

i. Represents a danger to other clients, residents, staff or property;

ii. Has drugs or alcohol on property;

iii. Destruction of property;

iv. Engages in sexual activity or exhibiting sexually inappropriate behaviors/gestures on the premises;

v. Graduates from the justice system; or

vi. Transfers out of Santa Clara County

e. The program shall immediately inform the assigned BHSD FDR Outpatient case manager and submit a follow-up Client Status Report form within 48 hours of first notifying the FDR Outpatient staff.

f. The program shall make good-faith efforts to coordinate and plan discharges in partnership with outpatient treatment teams, service providers and/or the referral source, in order to prevent clients from becoming homeless. In instances in which the client poses a risk to others, the program shall notify the respective outpatient case manager of the intended discharge at least twenty-four (24) hours before eviction, unless circumstances preclude this advisement. Otherwise, clients shall be given a thirty (30)-day written notice and their assigned outpatient case manager shall be alerted as soon as the notice is given to the client.

g. The program shall take all reasonable steps to avoid unnecessary discharges.

h. All discharges shall be accompanied with a discharge summary that shall be sent to the FDR Outpatient case manager/staff.

3. Client Transition Plan

i. Offeror shall ensure that appropriate follow-ups/warm hand-offs to other service linkages and placements are made.

j. Offeror shall coordinate with new service provider to assure an understanding of clients’ strengths, needs, supports, and goals.

k. Offeror shall provide copies of the care plan, narrative summary, assessment information, psychiatric assessment, and medication orders to the new service provider.

l. Offeror shall arrange a visit to the new program location with the current service provider to meet, tour the facility, and provide a warm hand-off.

Program Goals and Objectives A. The program shall be aligned to achieve the goals and objectives outlined below.

1. Goals shall include, but are not limited to addressing the needs of clients by:

a. Assisting clients served in increasing meaningful engagement in school, work, and other activities;

b. Supporting the development of natural networks of relationships;

c. Promoting self-help and involvement of clients and their families;

d. Reducing the risk of homelessness by facilitating access to safe and permanent housing; and

e. Aiding in decreasing episodes of incarceration and recidivism.

2. Objectives shall be achieved for clients through the following means:

a. Facilitating access to and retention of resources to meet long-term basic needs.

b. Facilitating access to and retention of mainstream benefits;

c. Facilitating access to medical and behavioral health services, as needed;

d. Facilitating access to and maintenance of safe, permanent housing; and

e. Contributing to the prevention or reduction of client re-incarceration.

Housing Policies A. The program shall complete the intake process within forty-eight (48) hours from the referral date. At that time, clients shall be provided with a detailed brochure regarding the program and be given an orientation to the facility, staff, and other residents.

B. The program shall encourage, but not mandate, clients to attend any self-help meetings.

C. The program shall provide three (3) nutritional meals per day in accordance with the County of Santa Clara Nutritional Guidelines and Standards. Individualized meal plans shall be provided for clients with special needs.

D. Clients may maintain employment and work any shift within a twenty-four (24) hour period. The client’s work schedule takes precedence over required house meetings.

E. The program shall maintain sensitivity to cultural differences in residences and provide a living environment that supports cultural diversity. Additionally, it shall address the specific cultural needs of justice-involved clients.

Reporting and Data Collection Requirements A. Offeror shall submit quarterly and annual reports demonstrating performance in the above metrics to the BHSD FDR Program Monitor. The BHSD shall assess performance in the aforementioned metrics as well as discussions of improvement activities related to the targeted performance.

B. Offeror shall provide year-end actual staff reports to the BHSD FDR Program Monitor, FDR Senior Manager, and the FDR Division Director.

C. Offeror shall enter all relevant information into the Homeless Management Information System (HMIS), or other information system relating to client data as directed by the BHSD.

D. When applicable, Offeror shall initiate assessment tools and data collection related to program services. Methods may include, but are not limited to, collection and reporting of the following:

1. Client and Service Information (CSI) data (e.g., bed census data, Self-Sufficiency Matrix, Health Vulnerability Index Survey Information);

2. County Data System data; and

3. Other data reporting and submission requirements as requested by the BHSD (e.g., (e.g., Microsoft Excel).

E. The County may request status updates on clients, which shall be utilized to coordinate care and service linkages between the program and FDR outpatient programs. The program shall designate a primary and/or other alternate management position to coordinate all referrals and discharges.

F. Offeror shall be able to meet requirements outlined in the California Code of Regulations under Title 9. Rehabilitative and Developmental Services, Division 1. Department of Mental Health, Chapter 14. Mental Health Services Act.

G. Offeror shall track extension requests on spreadsheets and provide justifications for those extensions in order to assist in determining areas of service improvements.

H. When applicable, Offeror shall administer assessment tools as part of the County’s program requirements.

I. The following data shall be entered into the County’s electronic health record (EHR) system for outcomes data reporting:

4. Client demographic information; and

5. Other appropriate data as requested by the BHSD.

J. When applicable, Offeror shall initiate other data collection methods, which may include, but shall not be limited to, entering data into a database as specified by the County and electronic submission of data to the County using other formats such as Microsoft Excel.

K. All client demographic information, service, and other appropriate data shall be entered into the County’s EHR system.

L. Offeror shall follow the County’s data reporting requirements. Methods may include the following data reporting collection:

6. Offeror shall provide monthly data that shows the number of clients referred and enrolled, and other data as determined by BHSD.

7. Offeror shall follow the County’s data reporting requirements. Methods may include the following data reporting collection:

a. Track the number of referrals received;

b. Track the number of enrollments;

c. Track the number and type of clients served by region, quarterly;

d. Track number of extensions using spreadsheets.

e. Track the number of readmissions to program within thirty (30) days of discharge from program using spreadsheets; and

f. Track the rate of readmission and cost-saving from non-emergency settings and non-psychiatric hospitalization for clients served.

8. Offeror shall describe available data reporting methods and experience with providing monthly and annual reviews, including but not limited to:

a. County EHR data.

Outcomes and Measurements A. Retention

1. At a minimum, 75% of clients shall remain in the program for at least thirty (30) days; and

2. The program shall maintain a minimum occupancy rate of 90%.

B. Benefits and Income

1. At minimum, 75% of clients shall obtain or have a monthly income (e.g., General Assistance, Supplemental Security Income [SSI], Social Security Disability Insurance [SSDI], and/or current employment) prior to/upon discharge from the program; and

2. At minimum, 75% of clients shall obtain or have health coverage prior to/upon discharge from the program.

C. Housing Stability

1. At minimum, 50% of clients shall enter transitional housing, permanent supportive housing, or other permanent housing upon discharge from the program.

D. Service Connection

1. 100% of clients shall be enrolled in an FDR Outpatient treatment program.

E. Offeror shall achieve the following outcome measurement methods:

1. In collaboration with the BHSD, develop a well-defined referral and coordination procedure and decide which data shall be shared for evaluation purposes; and

2. Offeror shall submit a report demonstrating program performance. The report shall include run charts demonstrating monthly performance and discussion of improvement activities related to the targeted performance category.

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 B, Evaluation Criteria and Qualifications 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 in effect relating to COVID-19 for persons who routinely perform services for County onsite and share airspace with or proximity to other people at a County facility as part of their services for County as set forth in a County Health Order (or similar directives).

RFSQ-BHS-FY23-0225: Behavioral Health Treatment Facility Continuum of Care Page 1 of 13 ATTACHMENT A5: Time-Limited Housing Stabilization, Community Reintegration, and Essential Services for Justice-Involved Adults and Older Adults Scope of Work CATEGORY 5: Justice-Involved Adult and Older Adult Transitional Housing Continuum for Forensic, Diversion, and Reintegration