Attachment A6.pdf

APPENDIX A6

CATEGORY 3: OUTPATIENT SERVICES

RFSQ-BHS-FY25-0066: Children, Youth, and Family System of Care Services Page 1 of 4 APPENDIX A6: Outpatient Continuum Scope of Work CATEGORY 3: Outpatient Services

OUTPATIENT CONTINUUM

SCOPE OF WORK

In addition to Attachment B – Standardized Scope of Work Language, the following applies:

I. Purpose A. Outpatient Continuum (CYF OPC) Program (hereafter referred to as “the program”) has been designed to provide culturally and age-appropriate specialty mental health services to children, youth ages 6-20 and their families (hereafter referred to as “client”) within Santa Clara County.

B. The program shall provide a range of services levels that includes Intensive, Outpatient and Wellness services that shall meet the needs of clients and address impacts to life domains including education, employment, living situation, personal wellbeing, interpersonal relationships, substance use, and community functioning.

II. Background A. The Outpatient Continuum (OPC) was designed to meet a need for targeted support to the unserved and underserved population in Santa Clara County. Services incorporate culturally and age-appropriate practices to meet the needs of youth and their family throughout Santa Clara County. In fiscal year (FY) 2023-2024, 4,546 clients were served with 42% of clients identified as male and 58% of clients were female.

The majority of clients served in OPC were identified as Latinx (66%). 67% were between the ages of 6-15 and 32% between the ages of 16-20. The most common diagnoses at admission include Depressive Disorders (31%) and Anxiety Disorder (27%).

III. Target Population A. Medi-Cal beneficiaries who are residents of Santa Clara County, between the ages of

6-20, with an emphasis on serving youth involved in public systems such as the Superior Court, and Regional Center or transitioning out of child-service programs (e.g. child welfare, juvenile justice) who need medically necessary Specialty Mental Health Services (SMHS) and may have a co-occurring substance use need.

B. A typical client in the OPC program may require support for 6-12 months at a varying frequency of one or more times a week and have, but not limited to some of the below characteristics:

1. Functional Impairment: clients experience significant difficulties in family interactions, peer interactions, and school/employment functioning. They demonstrate moderate to severe emotional regulations needs that require external supports;

2. Common Diagnoses and Presenting Behaviors (not limited to): Typical diagnoses include moderate to severe anxiety disorders, major depressive disorder, trauma-related disorders, and adjustment disorders with co-occurring moderate substance use disorders. These conditions result in marked impairment in daily

RFSQ-BHS-FY25-0066: Children, Youth, and Family System of Care Services Page 2 of 4 functioning. Internalizing or externalizing behavioral issues contribute to moderate to severe disruptions in relationships and overall functioning;

3. Support System: Clients have access to some social and environmental support, there is a critical need for substantial strengthening and buffering of these supports to adequately meet their complex needs. Involvement with the child welfare system may also be present;

4. Care coordination: may range from simple and occasional communication with other providers, focusing on transitions and continuity of care to requiring multi- Disciplinary Teams (MDTs) and Child Family Team Meetings CFTs), dependent on service level provision.

IV. 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:

a. Increase access to integrated mental health and substance use services.

2. Objectives shall be achieved by:

a. Effectively engage and educate clients and their families by providing client and family centered trauma informed practices, that are culturally, linguistically and developmentally appropriate to ensure voice and choice in services;

b. Maintaining effective and efficient organizational and program processes, including adequate staffing and supervision structure.

V. Reporting and Data Collection Requirements

A. Offeror shall track the clients served in the Outpatient Continuum program and the level of service that is being provided (Intensive, Outpatient, or Wellness) and have the ability to provide this information to the BHSD upon request.

B. Quarterly program outcome reporting that includes EBPs utilized, staff training and credentials.

VI. Outcomes and Measurements

A. Offeror shall achieve the following outcomes:

1. Increase knowledge and support from family and/or natural support systems.

VII. Program Description

A. Service Description

1. Offeror shall provide a range of non-stigmatizing services from Intensive, Outpatient to Wellness level of service to children, youth and their family who need medically necessary specialty mental health services and who may have a co-occurring substance use need.

a. Intensive services shall be provided to clients who demonstrate higher

RFSQ-BHS-FY25-0066: Children, Youth, and Family System of Care Services Page 3 of 4 acuity of needs and may require higher frequency of support to address symptoms, conditions, and/or risk factors that are impacting their ability to maintain themselves in community settings. Services shall include crisis response services, as needed.

b. Outpatient services shall be provided to clients who may need support to address behavioral health challenges that impact life domains including employment, education, living situation, personal wellbeing, interpersonal relationships, and community functioning.

c. Wellness services shall be provided to clients who may need medication management and light case management short term support to sustain their wellness and recovery as the program is actively working on linking to longer term medication support with Primary Care Physician (PCP), Managed Care Plan (MCP), or other long-term provider to ensure a warm handoff.

2. Offeror shall provide primarily community-based services, which may occur in the client’s residence, and/or other locations in the community as appropriate to meet the needs of the individual served.

3. Offeror shall ensure that all clients who are identified as needing psychiatry, medication management, or other adjunct SMH service will be provided and/or linked to services within the required network adequacy timeline determined by the Department of Health Care Services (DHCS).

B. All clients referred to the program shall be screened for the benefit of Intensive Care Coordination (ICC) services to support wellness, recovery, and improvement in functioning for children who are involved with multiple child serving systems. ICC services are delivered within the context of the Child and Family Team (CFT) which centers on the voice and choice of the family and supports the child and family moving through phases of treatment to improve wellbeing and guided by the Integrated Core Practice Model (ICPM) ICPM Guide and ACIN 1-21-18.

C. Care Coordination

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

a. Ensure feedback loop, as listed in Attachment J, is provided to all relevant parties to support client care. This may include but not limited to, medical home (Primary Care Physician), Juvenile Probation, Child Welfare, school placement.

i. Feedback loop shall be inclusive of but not limited to, outcome of referral, changes to treatment, and other needed information for client care.

b. Offeror shall use a treatment team process that includes consulting with the treatment team members including but not limited to therapist, case https://www.cdss.ca.gov/Portals/9/ACIN/2018/I-21_18.pdf

RFSQ-BHS-FY25-0066: Children, Youth, and Family System of Care Services Page 4 of 4 manager, psychiatrist and PCP, as needed, when determining client needs, diagnosis, and best program type.

D. Program Hours of Operations

1. Offeror shall provide hours of operations that ensure accessibility for Youth and their family receiving services. Services shall be available between 8:00am to 8:00pm at minimum four (4) days a week. After hours, including weekend, supports shall be established to support families for urgent needs, as appropriate.

VIII. Staffing Requirements

A. Offeror shall provide a multidisciplinary team inclusive of a diverse group of professionals and paraprofessionals with comprehensive knowledge of and capability to deliver high quality comprehensive services to the target population. Team members include, but not limited to:

Team Member Description

Clinician Co-occurring Enhanced Licensed Practitioner of the Healing Arts (LPHA), including waivered staff, that provides therapeutic interventions utilizing evidence-based practices to support the wellness and recovery of children in the program.

Family Specialist Bachelor level staff who provide a range of assistance with predictable behavioral routines/interventions, caregiver education, accessing community resources, and referrals and linkages to additional service needs.

(MHRS/paraprofessionals)

Psychiatrists/ Other Licensed prescribing practitioners

Prescribing, administering, dispensing, and monitoring of psychiatric medications, and medication education evaluation of clinical effectiveness and side effects of psychotropic medication; obtaining informed consent;

instruction in the use, risks, and benefits of, and alternatives for, medication.