ATTACHMENT A5

CATEGORY 3: OUTPATIENT SERVICES

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EARLY PSYCHOSIS INTERVENTION - RAISING EARLY AWARENESS AND CREATING HOPE

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 providing youth and Transitional Aged Youth (TAY) (hereafter referred to as “clients”), ages 12 through 25, with Behavioral Health Services and Supports (BHSS) in accordance with the Early Psychosis Intervention (EPI) program, also known in the County as Raising Early Awareness and Creating Hope (REACH).

B. The REACH program (hereafter referred to as “the program”) is an outpatient continuum initiative. It is designed to provide early intervention to clients who are experiencing early signs and symptoms of clinical high risk for psychosis (CHR-P) or experiencing a first episode of psychosis (FEP).

1. CHR-P refers to individuals who are seeking help and are displaying one or more of the following early warning signs for psychosis:

a. Attenuated Psychotic Symptoms (APS);

b. Brief Limited Intermittent Psychotic Episode (BLIP);

c. Genetic Risk and Deterioration Syndrome (GRD); and

d. Unspecified Prodromal Symptoms (UPS).

2. FEP refers to individuals who are early in the course of psychotic illness and/or treatment.1

II. Background Information

A. The REACH program was designed to meet the needs of clients who are CHR-P and those who have had a first episode of psychosis, through evidence-based practices and a model specific to this population. Since 2012, the REACH program has served youth and young adults throughout Santa Clara County by providing prevention and early intervention services for those who are CHR-P or experiencing a FEP. In fiscal year (FY) 2023-2024, a total of 53 clients were served. 58% of clients served were female, 62% identified their ethnicity as Hispanic or Latino, and 34% of clients preferred language was Spanish with 4% identifying Vietnamese as their preferred language. The majority of clients (89%) were between the ages of 10 through 19. The

1 Breitborde NJ, Srihari VH, Woods SW. Review of the operational definition for first-episode psychosis. Early Interv Psychiatry. 2009 Nov;3(4):259-65. doi: 10.1111/j.1751-7893.2009.00148.x. PMID: 22642728; PMCID:

PMC4451818.

RFSQ-BHSD-FY25-0066: Children, Youth and Family System of Care Services Page 2 of 10 ATTACHMENT A5: Early Psychosis Intervention-Raising Early Awareness and Creating Hope Scope of Work CATEGORY 3: Outpatient Services most common diagnoses at admission include Schizophrenia Spectrum and Psychotic Disorders (77%) and Other (14%).

III. Target Population

A. Offeror will ensure the program will provide services to clients experiencing the onset of serious psychiatric illness, who demonstrate symptoms of CHR-P or FEP, with an emphasis on clients, ages 12 through 25, who are:

1. At risk for developing a psychotic illness and/or are experiencing signs or symptoms that are indicative of high risk for psychotic illness; and

2. Experiencing a first onset of serious psychotic illness such as a first episode of psychosis. These clients are defined as meeting full DSM-5 criteria for a psychotic illness for the first time.

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

1. Functional Impairment: Clients experience significant difficulties in family interactions, peer interactions, and school or vocational functioning. Moderate to severe emotional regulation needs require consistent external support.

2. Common Diagnoses and Presenting Behaviors: Moderate to severe anxiety disorders, major depressive disorder, clinically high risk for psychosis or first episode of psychosis, co-occurring disorders such as bipolar disorder, trauma-related disorders, and adjustment disorders. These conditions result in marked impairment in daily functioning. Internalizing or externalizing behavioral issues cause moderate to severe impact on relationships and overall functioning. May have co-occurring developmental diagnosis/challenges.

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

4. Types of Treatment and Timeline: Initially, clients and their families typically require intensive support for 6-12 months, with sessions scheduled 1-2 times per week. As treatment progresses, session frequency may decrease. Treatment includes individual, family, group therapy, case management, and medication support.

5. Crisis Intervention: Crises may occur occasionally; all clients should have a comprehensive plan in place to address potential exacerbations of symptoms effectively.

6. Care coordination: Clients and families typically have moderate care coordination needs, often requiring Multi-Disciplinary Teams (MDTs) or Coordinated Specialty Care (CSC) model.

II. Program Goals and Objectives

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A. Offeror shall ensure the program is aligned to achieve the CYF goals and objectives;

and ensure the following program specific objectives are met:

1. Reduce the duration of untreated psychosis;

2. Delay or reduce the severity of the onset of psychosis;

3. Reduce psychiatric hospitalization admissions relating to untreated psychosis;

4. Increase the ability of clients to understand signs and symptoms of psychosis to regain productive lives and function;

5. Increase positive family engagement and the experience of care; and

6. Increase education and training in communities throughout Santa Clara County, educational system, and child-service systems that may encounter youth experiencing early warning signs or active symptoms of psychosis.

B. Offeror shall provide services which are defined by the evidence-based CSC model. All services provided in the program shall be guided by the practices and requirements as described by the CSC Model, including but not limited to the following service levels and additional local requirements:

1. Services shall target clients experiencing CHR-P or FEP. The program shall provide early detection, prevention, and intervention services to the target population.

2. Provide behavioral health services including assessments, medication evaluation/support services, crisis intervention, individual, group, and collateral/ family therapy, rehabilitation, and case management/brokerage services.

3. Services shall be individualized and consider each client's age, maturational level, culture, family values and structure, educational functioning level, and physical health.

4. Establish a community-wide system of early detection and intervention for clients at CHR-P or experiencing a FEP.

5. Provide community-based interventions and assist clients experiencing CHR-P or FEP to remain in the community, attend school/work, obtain and maintain long term housing, and prevent homelessness, hospitalizations and involvement in the juvenile justice system.

6. Utilize age specific, comprehensive evidence-based and trauma informed practices to fidelity that address mental health, substance use, physical health and specific to the target population in addressing issues to improve outcomes in all life domains.

7. Develop a robust referral network by creating community partnerships especially with TAY serving institutions such as high schools, youth centers, employment centers, community colleges and universities, child welfare system, the juvenile justice system, and community health clinics to meet the health and human service needs of the clients.

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8. Incorporate peer mentors with lived experience, and family partner service providers in the outreach and treatment components of the program.

9. Services shall be delivered by a team of trained clinical, medical, and social work professionals, and a cohort of trained clients and family partners.

10. Program staff shall work closely with clients’ identified support system(s) to collaborate and participate in shared decision making related to clients’ treatment.

A. Service Parameters

1. Offeror shall provide a continuum of services targeting clients experiencing symptoms of CHR-P through FEP. Services shall provide early detection, prevention, and intervention services with an emphasis on adolescents and TAY, ages 12 through 25.

2. As described in the CSC model, services are provided by clinical teams. After training completion, the team(s) can start conducting outreach, receiving referrals, administering the Mini Structured Interview for Psychosis Risk Syndromes (SIPS), a condensed version of the SIPS, assessments, and admitting clients.

3. After an initial intensive treatment phase, clients shall continue in the program at a lower level of care.

4. In addition to the services described in the CSC model, the following services are required to be provided by Offeror:

a. Substance use counseling is inclusive of the harm reduction model;

b. Peer Support Services utilizing peer mentors and family partners with lived experiences; and

c. Client Financial Support Services related to emergency financial supports based on parameters defined by BHSD.

II. Reporting and Data Collection Requirements

A. Offeror shall measure outcomes for each client served to determine improvements in functioning because of treatment.

B. In addition, the Offeror shall provide data information related to screening, outreach, admission, and discharge activities. the Offeror shall administer, collect, and report on program specific standardized and valid outcome measures that include but are not limited to:

1. Prodromal Questionnaire – Brief Version (PQ-B);

2. Mini-SIPS;

3. Scale Of Prodromal Symptoms (SOPS); and

4. Global Assessment of Functioning (GAF).

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C. Offeror shall be responsible for procuring and purchasing all assessment tools. Offeror shall maintain appropriate certifications for all tools administered.

D. Offeror shall adhere to reporting requirements that include but are not limited to:

1. Reporting requirements as outlined in MHSA reporting requirements. Quarterly Report. Offeror shall deliver a report every three (3) months to BHSD that includes: a list of program staff and service capacity; reports on data collection tools; and Targeted Outreach, Training, and Screening data.

2. MHSA Report. Offeror shall adhere to MHSA Reporting requirements and complete MHSA report template quarterly.

3. Offeror shall provide an annual report to BHSD outlining program achievements, outcomes and measurements, status updates, and recommendations for following fiscal year.

III. Outcomes and Measurements

A. Offeror shall collect treatment and service data for outcomes data reporting. Offeror shall enter direct and outreach services into the BHSD Data System, utilizing standard authorization processes outlined previously.

B. Use of tools shall remain in alignment with policies of BHSD. In collaboration with BHSD, tools shall be reviewed periodically to consider revisions for future contract terms.

C. Data on the tools used shall be submitted quarterly on a data shell provided by BHSD or an approved alternative.

D. BHSD shall receive an inventory of and have access to data pertaining to any additional metrics collected by the Offeror on program clients.

E. Offeror shall utilize forms and capture all data necessary to provide evaluation measures as described in the CSC Model.

F. Offeror shall ensure that following program specific data indicated is entered into the BHSD Data System with frequencies as indicated by the CSC Model and BHSD requirements for the following outcomes measures:

IV. Program Description

Data submitted to BHSD Frequencies

Mini SIPS/ Scale of Prodromal Symptoms (SOPS) Baseline, 6 and 12 months

Social & Role Functioning Scale and Global Assessment of Functioning (GAF)

Baseline, 6 and 12 months

Mini SIPS Baseline, 6 and 12 months

PQ-B Screening (prior to admission)

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A. Offeror shall provide early psychosis intervention services utilizing a CSC team-based intervention model.2

1. Service components include:

a. Individual and/or Group Psychotherapy

i. Evidenced-Based (EB) Psychotherapy modalities at minimum shall include, but are not limited to:

1) Cognitive Behavioral Therapy for Psychosis (CBTp) – Helps individuals become aware of their thoughts and behaviors, with a focus on exploring how this impact their emotions. CBTp is recommended for those experiencing recent onset of psychosis and those at clinical high risk for psychosis.

2) Multi-Family Support Groups (MFG) - Establishes long-term support structures for families and increases their capacity to understand and support their loved ones.

3) Other EBP interventions where clinically indicated (TF-CBT, Integrated Substance abuse Management (SAMM), Family Focused Treatment, Cognitive Remediation, CBT Skills training, etc.).

b. Medication Management

i. Offeror shall maintain close contact with client’s primary care and other medical providers to assure optimal medical treatment for risk factors related to early psychosis.

ii. Offeror shall work with clients and health care providers to provide individualized and tailored psychoeducation and/or medication intervention, where indicated, to address and reduce symptoms of psychosis.

c. Family Education and Support

i. This component teams professional clinical staff, in partnership with peer and family supports, with clients and family members and trains them to recognize, cope, and communicate about the signs and symptoms of clinical high risk for psychosis and first episode psychosis.

d. Service Coordination and Case Management

i. This component assists clients and families in accessing the supportive services they need to achieve and sustain long-term recovery.

2 https://www.nimh.nih.gov/sites/default/files/documents/health/topics/schizophrenia/raise/evidence-based-treatments-for-first-episode-psychosis.pdf https://www.nimh.nih.gov/sites/default/files/documents/health/topics/schizophrenia/raise/evidence-based-treatments-for-first-episode-psychosis.pdf https://www.nimh.nih.gov/sites/default/files/documents/health/topics/schizophrenia/raise/evidence-based-treatments-for-first-episode-psychosis.pdf

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e. Supported Employment and Education

i. This component provides additional and specialized support to enable clients to continue their educational and/or employment activities while maintaining their recovery.

2. Offeror shall meet the needs of clients by providing the following core CSC service functions:

a. Specialized Training in Early Psychosis Care

i. This function is intended to ensure training and competency for all staff involved in providing evidenced-based treatment care for the treatment of youth and TAY clients experiencing symptoms of clinical high risk for psychosis and/or first episode of psychosis.

b. Community Outreach and Education

i. This function is intended to increase the community’s overall awareness of the potential needs of children and young adults experiencing clinical high risk for psychosis and first episode psychosis in order to decrease stigma and discrimination which may be obstacles to seeking treatment.

ii. The efforts shall, also, be directed at professionals in various roles who might encounter young persons in the early stages of decline toward psychosis, including school-based professionals, primary care physicians, child-service systems, mental health clinicians, and other key professionals.

c. Provision of Services to Meet Client Need

i. Community-Based Interventions are provided to clients who have difficulty engaging with clinic-based services, or those who have complex needs requiring intensive support, such as legal issues, homelessness, or obtaining medical care for comorbid physical conditions.

d. Crisis Intervention and Stabilization

i. This function intends to provide supportive services to clients enrolled in the program by providing 24/7 availability for support, with an on-call requirement. This requirement can be met through telephone and/or telehealth intervention.

ii. This function promotes coordinating use of emergency and/or crisis services in instances where remote management is not clinically indicated.

e. Transition of Care

i. This function intends to create successful transitions of care through utilization of a collaborative process between client, support system, and CSC team.

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ii. Transition planning should involve client vision of stability and achievement of goals, success in community function, and personal autonomy. All clients transitioned should receive linkage and service coordination to supportive services, based on client clinical need.

f. Assuring Fidelity to the CSC Model

i. This function involves assurance of program quality through continuous monitoring of treatment fidelity standards.

ii. Fidelity monitoring shall be performed at least bi-annually, utilizing the First Episode Psychosis Services Fidelity Scale 1.0 (FEPS-FS) and/or the Clinical High Risk for Psychosis Services Fidelity Scale 1.0 (CHRP-FS).

B. Staffing Requirements

1. Offeror’s service provider teams shall:

a. Operate under all BHSD applicable policies and procedures.

b. Staff and provide for the delivery of all services identified through the CSC Model and align with the CSC staffing ratio.

c. Have sufficient psychiatry staff that will conduct evaluations and provide medication management.

d. Have final accountability for assuring the delivery of services and responsibility for service outcomes.

e. Consult and collaborate with all interagency staff involved with the client and family (e.g., mental health, child welfare, juvenile/adult justice, education).

f. Any discontinuation of services shall be based on the transition of care practices and requirements as described in the CSC Model. Transfers to behavioral health services will be made based on appropriate level of care required at time of discharge for each client.

2. Other staffing requirements:

a. Offeror shall have the ability to provide treatment to clients with co-occurring disorders as part of the service continuum.

b. Offeror’s staff should have experience in providing mental health treatment/services to the target population.

c. Offeror’s staff should have experience in the development and implementation of outreach, psychoeducation, engagement, and treatment services to the target population.

d. Offeror shall adhere to the staffing requirements as outlined in the CSC model, noted below. Clinical teams shall be assembled and trained at the same time:

i. Team Leader;

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ii. Clinical Therapist;

iii. Supported Education and Employment Specialist (SEE);

iv. Case Manager;

v. Family Advocate and/or Peer Support; and

vi. Psychiatrist and/or Psychiatric Nurse Practitioner.

a. In addition to the specific clinical positions recommended by the CSC Model, the Offeror shall provide staff for creating/maintaining surveys and reports, and data entry into the BHSD data system or designated BHSD Electronic Health Record (EHR).

b. Moreover, specific positions shall be designated for staff with lived experience.

c. Offeror shall adhere to the staffing pattern (e.g., disciplines and FTEs) described in the CSC Model.

d. Offeror shall ensure compliance in the necessary staff trainings and certifications required for CSC Model implementation and sustainability, as outlined in the FEPS-FS and CHRP-FS fidelity rating tools.

C. Referrals and Admissions

1. Offeror shall ensure the program be aligned to achieve the CYF referral and admission guidelines noted previously, and ensure the following program specific criteria are met:

a. Clients identified through the community outreach process or who utilize the REACH hotline, as experiencing CHR-P or FEP shall be referred to the Offeror for assessment and/or treatment.

b. All referred clients will complete the PQ-B, a self-administered tool, to determine initial early psychosis eligibility.

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

3. Offeror shall ensure referred clients who do not meet eligibility criteria for the program shall receive care coordination, in accordance with CYF Care Coordination guidelines, to access services, in the CYF system of care, based on client specific needs.

D. Training

1. Offeror shall maintain fidelity requirements to the CSC Model in all project activities, outreach, assessment, and treatment as indicated by the CSC Model.

2. Any training related to the CSC Model shall only be provided by organizations which are affiliated within the regional early psychosis/early detection network.

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3. Offeror is responsible for any subsequent training needs of staff beyond the initial CSC Model training.

4. Fidelity requirements for maintaining fidelity requirements requires a bi-annual FEPFS/CHRPF S mean score of at least three (3) to indicate fidelity to the CSC model.

a. A reliability rating of at least 75% on the Mini- SIPS;

b. A client and family retention rate of 70%;

c. Family psychoeducation participation rate of 70%;

d. Family psychoeducation and supported employment fidelity;

e. Outreach activities to 60% of middle/high school & colleges in the service area; and

f. Outreach activities to 50% of pediatricians & family physicians in the service area.

5. Offeror shall ensure that staff understands the principles of EBPs and trained to the fidelity of EBPs as determined by BHSD and/or specific to the target population.