Attachment A8.pdf

APPENDIX A8

CATEGORY 3: OUTPATIENT SERVICES

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EARLY CHILDHOOD MENTAL HEALTH OUTPATIENT CONTINUUM

SCOPE OF WORK

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

I. Purpose A. ECMH Outpatient Continuum (hereafter referred to as “The Program”) has been designed to provide specialty mental health services that are culturally and age appropriate for children ages birth through five (5). Services are delivered in the context of the parent-child relationship to improve the family and child’s opportunity for optimal health and development to meet their needs for safety, nurturing, and support. Offeror shall provide services utilizing the Infant-Family and Early Childhood Mental Health (IFECMH) approach which “emphasizes the importance of parent-infant relationships on brain development, attachment, and regulation of emotions and behavior” (California Training Guidelines and Personnel Competencies for Infant- Family and Early Childhood Mental Health, https://cacenter-ecmh.org/wp-content/uploads/2016/09/compendium-ifecmh-fall-2016.pdf.

II. Background A. Early childhood mental health services, formerly known as KidConnections, which was established in 2006 through a partnership with FIRST 5 Santa Clara County, to ensure the youngest population in Santa Clara County have access to mental health services that are developmentally and relationally driven to support the caregiver and child’s needs to address their overall wellbeing. Early Childhood Mental Health services focus on the family and child who may need necessary behavioral and developmental health services in the community which may include their place of residence, community or other settings as appropriate to meet their needs for safety, nurturing, and support. In fiscal year 2023-2024 1,304 children and families were served with 62% male and 38% female. Majority of children and families served identified as Hispanic or Latino (73%). The most common diagnoses at admission are anxiety disorders (35%) and trauma/stress related disorders (29%).

III. Target Population A. Medi-Cal beneficiary from birth through age 5 and their parents/caregivers, with emphasis on serving vulnerable children including those involved in public systems such as the Superior Court, Child Welfare, Children of Youth involved with Juvenile Probation, Early Education (Head Start, Early Start, Early Learning Program), Regional Centers, Women Infants and Children Program, and Substance Use Treatment Services (SUTS) including Dependency Wellness Court (DWC).

B. Children/families of unserved and underserved communities including but not limited to Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ+), ethnic communities, etc.

C. Children/families living throughout Santa Clara County where there are concerns about the child’s health, safety, and overall development. This includes, but is not limited to the following concerns:

1. Difficulties with daily functioning in early care and education settings.

https://cacenter-ecmh.org/wp-content/uploads/2016/09/compendium-ifecmh-fall-2016.pdf#:%7E:text=The%20purpose%20of%20the%202016%20California%20Compendium%20of https://cacenter-ecmh.org/wp-content/uploads/2016/09/compendium-ifecmh-fall-2016.pdf#:%7E:text=The%20purpose%20of%20the%202016%20California%20Compendium%20of

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2. Behavioral and developmental concerns with children who have been exposed to the negative impacts of parental substance use

3. Exposure to domestic and community violence and/or other traumatic events

4. Behavioral concerns (including social functioning), that may be exacerbated by parental mental health needs, including maternal depression

5. Moderate to serious behavioral concerns and suspected developmental delays

D. A typical client in the program may require support for 6-12 months 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/childcare 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 developmental delays such as, but not limited to expressive and/or receptive language disorder, global developmental delay disorder, autism spectrum disorder, etc. These conditions result in marked impairment in daily 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;

IV. Program Goals and Objectives A. The Program shall be aligned to achieve the following goals and objectives:

1. Goals include, but are not limited to:

a. Increase in the number of children who are healthy and experience optimal health and development.

b. Increase in the number of families providing a safe, stable, loving, and stimulating home.

c. Increase in the number of children who enter school fully prepared to succeed academically, emotionally, and socially.

d. Increase self-help and child/family involvement.

2. Objectives

a. Provide ECMH services within an ecological context, considering the child’s family, culture, language, and community; and the child’s individual developmental, behavioral and relationship age-appropriate needs.

b. Provide ECMH services in the home, school, and community, as appropriate to the treatment needs and service goals of the child and family in the least restrictive and least intrusive manner.

c. Provide ongoing early screening and childhood mental health clinical assessment to understand child’s level of global functioning inclusive of developmental and social-emotional functioning and establishing continued

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d. Support and enhance parenting skills, parent-child attachment, and child development.

e. Develop or maintain natural and community network of supports for the child and their family/caregivers.

V. Reporting and Data Collection Requirements A. Offeror shall maintain and provide comprehensive staffing and trainings records to be reviewed quarterly in a format approved by BHSD. These records demonstrate the compliance with contractual requirements. Training records should include, names of trainings, dates of trainings, and any certifications obtained as a result. Staffing records should include, employee’s name, date of hire, job title, language capacity, qualifications, and certifications. Vacancies should also be noted on the staffing records.

B. Offeror shall track the level of service that is being provided (Family Specialist and/or Therapeutic Services) and provide this information to the BHSD upon request.

C. Data submission

1. The offeror shall collect and report data according to the timeline identified, for the following:

a. Ages and Stages Social Emotional Questionaire-2nd edition (ASQ:SE-2) –

Initial and follow-up (as appropriate);

b. Child and Adolescent Needs and Strengths – Early Childhood (CANS-EC) –

Initial, Follow-up, and Discharge;

c. Keys to Interactive Parenting (KIPS) – Initial, Follow-up, and Discharge;

d. Positive Parenting Program (Triple P) Assessment/ Outcomes Tools –

Pre/Post; and

e. Other assessment tools and outcomes tools required related to the provision of evidenced based practices.

2. Quarterly reports on referrals and teaming approach.

a. Number of children/families who declined ECMH services;

b. Number of children/families served in each level of care (TS/FS);

c. Number of families provided Triple P service inclusive of Level, completion or withdraw;

d. Other data, as identified by BHSD, to determine program outcomes.

VI. Outcomes and Measurements A. Outcomes:

1. Increase engagement, attachment, and attunement between caregiver-child relationship.

2. Increase and develop predictable routines, and stimulating environment that promotes optimal growth and development.

3. Increase caregiver/parental knowledge of their child’s social-emotional and developmental needs to support parenting skills, and readiness for school/early learning.

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4. Increase knowledge, access, and the utilization of natural/ community networks of supports and resources.

5. Decrease multiple transition of care and maintain stable placement.

6. Mitigate effect of complex/chronic stressors and trauma.

7. Reduce stigma in seeking and utilizing early childhood services.

B. Offeror will comply with the County established outcome measurement methods for the outcomes to be achieved. Methods may include the following data reporting collection of:

1. QUALO Data (or other BHSD EHR) which will include Child and Adolescent Needs and Strengths – Early Childhood (CANS-EC), Child Behavior Checklist (CBCL 1.5-5), Keys to Interactive Parenting Scale (KIPS), Pediatric Symptoms Checklist-35 (PSC- 35), and ASQ-3 and ASQ:SE-2 scores.

2. Eyberg Child Behavior Inventory (ECBI)

3. Parenting Scale (PS) and/or Parent Problem Checklist (PPC), Depression Anxiety

Stress Scale (DASS), scores. PPC shall be utilized only for families in which there are co-parenting opportunities.

4. Other tools as needed based on family and child’s needs.

VII. Program Description:

A. The Offeror shall utilize an Infant-Family and Early Childhood Mental Health (IFECMH) approach that includes but not limited to:

1. A range of service levels that include family partner services, family specialist supports and therapeutic services to provide promotion of wellness, prevention of behavioral health disturbances, and treatment of behavioral health problems that interfere with the child’s optimal development, including critical social-emotional milestones and healthy relationships.

a. Family Partner (FP) provides advocacy and support to the family through assisting with navigating and linking to natural and community resources as appropriate based on needs of the family and treatment team, to mitigate family stressors.

b. Family Specialist (FS) provide a range of educational parent-child engagement activities, training and education to families about children’s personal health, typical and non-typical development, environmental health, quality caregiving, maternal/paternal parenting, and other supportive services to the child and their family in their natural environment.

c. Therapeutic Services (TS) shall focus on the caregiver-child relationship and utilize developmentally appropriate evidence-based practices (EBPs).

Treatment shall be provided to the child and their family and/or natural supports through dyadic, individual, family and/or group therapy to address behavioral health and developmental concerns. Services shall be delivered within the context of the child’s natural ecologies.

2. Services shall include a range of age-appropriate parental/caregiver education and parent/caregiver-child evidence-based practices, within a home visiting framework for service delivery, that support the growth and development of

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a. Child- Parent Psychotherapy (CPP)

b. Circle of Security

c. Developmental, Individual Differences, Relationship (DIR/Floortime)

d. Family Acceptance Project

e. Parent Child Interaction Therapy (PCIT)

f. Positive Parenting Program (Triple P)

g. Celebrating Families 0-5!

h. Watch, Wait, and Wonder (WWW)

i. Ages and Stages Activities

3. Services shall consider all the child’s natural environment and be provided in the environment that is most appropriate, such as home, school, and childcare or community setting, to support and foster best outcomes.

4. Offeror shall provide services that are individualized and tailored to the needs of the child and family based upon age, developmental functioning, history of trauma, cultural values, family environment, and physical health.

5. Offeror shall implement a multidisciplinary team approach consisting of a licensed or licensed waivered Behavioral Health Clinician, Family Specialist, Family Partner and Psychiatrist. In addition, Offeror shall work in collaboration with parents/caregivers and other natural supports and professionals, such as, but not limited to, family members, primary care physicians, court appointed special advocates, and/or early care and education providers.

B. All clients referred to the program shall be screened and offered, as eligible, Intensive Care Coordination (ICC) services to support wellness, recovery, and improvement in functioning. 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.

1. ICC Services may include:

a. Assessing the client and family’s needs and strengths;

b. Identifying interventions and/or course of action targets at the client/family’s assessed needs;

c. Assessing the adequacy and availability of formal and informal resources and working with the child and family team to increase natural resources and supports;

d. Reviewing information from family and other sources;

e. Ensuring that plans from any of the system partners are integrated to comprehensively address identified goals and objectives;

f. Evaluating the effectiveness of previous interventions and activities;

g. Monitoring and adapting the plan in partnership with the CFT;

h. Preparing the youth for transition in partnership with the CFT;

i. Facilitation of CFT meetings as clinically appropriate, and at least every 90 days, and sharing notes with the team with action plans.

https://www.cdss.ca.gov/Portals/9/ACIN/2018/I-21_18.pdf

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2. Clients receiving ICC may also be eligible for Intensive Home-Based Services (IHBS). IHBS services must be discussed with members of the client’s CFT and confirmed prior to requesting authorization by the County Utilization Management (UM) Division.

3. IHBS are intensive, individualized, and strength-based interventions to assist the client and their significant support person(s) to develop skills to achieve the goals and objectives of the client’s treatment plan and predominantly be delivered outside of an office setting (e.g., in the home, school, or community), and incorporate the principles of the ICPM.

4. IHBS services may include:

a. Implementation of a positive behavioral plan and/or modeling interventions for the clients’ significant support person(s) and assisting them to implement strategies;

b. Educating the client and/or the client’s significant support person(s) on how to effectively manage the client’s mental health disorder to improve functioning;

c. Teaching skills or replacement behaviors that allow the client to fully participate in meaningful activities.

5. ICC and IHBS shall be provided in accordance with the Medi-Cal Manual for ICC, IHBS, and Therapeutic Foster Care (TFC) Medi-Cal Manual Third Edition ADA.

6. ICC and IHBS services shall be primarily community-based, and may occur at the client’s residence, clinic or agency, school, and other locations in the community, as necessary and as needed by the clients served.

C. Parent/Caregiver Workshops: The Offeror shall utilize the recommended practice of The Positive Parenting Program (Triple P) or other approved curriculums. Workshops shall be provided in a group or individual format to fidelity of the model.

1. Topics including but not limited to:

a. Typical and atypical child development;

b. Effective parenting strategies and strengthening family involvement;

c. Establishing and maintaining a nurturing and supportive home environment;

d. Identifying obstacles to school readiness and preparing clients to succeed in school;

e. Strategies for working effectively with the client’s education system;

f. Children with special needs

2. The program must address all workshop potential barriers such as:

a. Location, ease of access

b. Hours of services

c. Quality and approach of learning environment inclusive of visual, audio, linguistic and comprehension for children and adults D. Care Coordination

1. Adhere to feedback loop procedure, as listed in Attachment I, and notify referring party, especially primary care providers, upon initiating services and any ongoing treatment changes.

https://www.dhcs.ca.gov/Documents/ChildrensMHContentFlaggedForRemoval/Manuals/Medi-Cal_Manual_Third_Edition.pdf

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2. Promote coordination and collaboration in care planning efforts with other child-serving agencies and institutions involved in delivering services to the child and family, to ensure comprehensive and consistent care, including Primary Care Providers, Medical Homes, etc.

3. Provide coordinated care to the child and their family that supports the parent-child relationship and linkage to additional resources that may benefit the child and family such as: access to other early childhood services and/or other Medi- Cal beneficiary services.

VIII. Staffing Requirements A. Offeror shall provide a multidisciplinary team inclusive of a diverse group of professionals and paraprofessionals with comprehensive knowledge of the IFECMH framework and capable of delivering 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 development of predictable behavioral routines/ interventions, caregiver education, modeling and coaching focused on parent/caregiver-child relationship.

(MHRS/paraprofessionals)

Family Partner Supports advocacy, access, linkage, and utilization of natural and community resources to reduce family and/or community stressors. (Peer Support Specialist)

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.

Other Staffing according to EBP, best practices or promising practices:

Intensive Care Coordinator (ICC facilitator):

A highly skilled facilitator, with a strong background in navigating complex team and family dynamic to ensure equity, psychological and physical safety of all participants, and full participation, by lifting the voices of the child and family to center the work. Develops the Child and Family Team and serves as the single point of accountability for the care plan for the child and their

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Intensive Home Based (IHBS) provider:

IHBS Provides medically necessary, skill-based interventions known as IHBS for the remediation of behaviors or improvement of symptoms, including, but not limited to, the implementation of a positive behavioral plan, and/or modeling interventions for the child’s/youth’s family and/or significant others. Family Specialist may support in this identified provider role, as appropriate.

B. In addition to licensing requirements, the following experience, training, and skills will be required of team members:

1. Knowledge of core principals of Brazelton’s Touchpoints Model.

2. Knowledge of trauma informed practices.

3. Knowledge of relationship based and parent/child psychotherapy practices/models.

4. Knowledge of child abuse, substance abuse, domestic violence, typical and atypical child development.

5. Knowledge of local community resources available to the target population.

6. Capability for addressing the diverse levels of client acculturation and those with bi-cultural backgrounds.

7. Knowledge and training in working with children and families with special needs.

8. Understanding and ability to engage with dually diagnosed individuals to support the needs of their child.

9. Knowledge and familiarity with IFECMH knowledge domains required for endorsement, including:

a. Parenting, Caregiving, Family Functioning, and Parent-Child Relationships;

b. Infant, Toddler, and Preschool Development;

c. Biological and Psychosocial Factors Impacting Outcomes;

d. Risk and Resiliency;

e. Observation, Screening, and Assessment;

f. Diagnosis and Intervention;

g. Interdisciplinary / Multidisciplinary Collaboration; and

h. Ethics.

IX. Additional Program Requirements:

A. Professional Development

1. Offeror shall participate in the following training to support and develop their skills in working with this specialized population:

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Title/Topic Target Audience

Overview of Assessment for Intervention Process and Tools Supervisors

Brazelton’s Touchpoints new staff, training in this model is required within the first six (6) months of employment

Providers and Supervisors

Basic Skills of Reflective Practice Providers

Reflective Practice Facilitation Supervisors

Triple P Providers

KIPS Providers and Supervisors

CANS: EC Providers and Supervisors

DC 0-5 Providers and Supervisors

ASQ/ASQ:SE Providers and Supervisors