Approved JOFOC - John Hopkins.pdf

Acquisition Title:

Service Unit/Clinic: Department:

Acquisition Year:

Author/Title:

2. Description of Action:

Name of Proposed Contractor(s):

Street Address:

City, State, Zip:

3. Description of Supplies or Services:

Basis for Approval (FAR 6.303-1(d)): Individual Basis Class Basis

The estimated value of the proposed action, including all options, is:

As applicable, briefly describe the services or supplies required to meet the agency's needs, including make & model number where appropriate. Include quantities of supplies or period of performance for services. Provide information for any options included. If the action is a modification to an existing contract, distinguish clearly between the work covered by the basic order and the work to be obtained by the proposed modification.

4. Authority and Rationale: Identify the statutory authority, FAR title and FAR citation permitting other than full and open competition. It may be one of the following most commonly used citations by the operating divisions of the Department of Health and Human Services (HHS), but other exceptions may apply per FAR Subpart 6.3.

Actions other than simplified acquisition procedures (select only one and provide an explanation):

Pricing: Firm-Fixed Price Other

FOR OTHER THAN FULL AND OPEN COMPETITION

Template for Justification and Approval for Other Than Full and Open Competition

Completion Instructions: The Department of Health and Human Services (HHS) has established a standard template for the preparation of a J&A for Other Than Full and Open Competition. If this is an 8(a) set-aside, please note this form is not required unless the acquisition is valued (including all options) at greater than $22 million. This template may be used for simplified acquisition procedures ( FAR Subpart 13.5 ) but not for Federal

Supply Schedule orders ( FAR 8.4 ) or task or delivery orders subject to fair opportunity ( FAR 16.505 ).

Tailor all aspects of this template to the individual acquisition. Consult FAR Subpart 6.3 for guidance.

JUSTIFICATION AND APPROVAL

Nature: New Requirement Follow-on Requirement

Provide a citation to the applicable section of FAR 6.3 and a full explanation to justify use of the exception.

FAR 6.302-5: Authorized or Required by Statute, 41 U.S.C. 3304(a)(5)

Provide a citation to the statutory authorization and a brief description of its content, or identify the specified source or other agency.

Other (See FAR Subpart 6.3 for additional authority):

If unusual and compelling urgency is the basis for the justification, explain the chronological events leading up to the requirement and explain why time constraints cannot permit even a limited competition. Establish that the action will cover only the minimum quantity or period of performance necessary; in most cases options are unacceptable when citing urgency. Describe impact of required delivery/performance date. Describe the detrimental effects/serious injury to the mission of the requiring activity or to the government, financial or otherwise, that will result if this justification is not approved and the product or service cannot be provided by the intended sole source contractor. Failure to plan for expiring funds is not a valid reason for citing this exception.

May not exceed one year, including all options, unless the head of the agency determines that exceptional circumstances apply.

FAR 6.302-1: Only one responsible source and no other supplies or services will satisfy agency requirements, 41 U.S.C. 3304(a)(1)

Explain why the intended contractor is the only responsible source who can provide the required supplies or services. Discuss the unique capabilities, expertise, etc. that support the lack of competition/why no other type of supplies or services will satisfy agency requirements. Explain factors/unique qualifications such as proprietary data or exclusive licensing rights, if applicable. If brand name, explain why an adequate purchase description or other information suitable to solicit by full and open competition has not been developed or are not available. If in connection with a follow-on contract for continued development or production of highly specialized equipment, detail the substantial duplication of cost or unacceptable delays.

FAR 6.302-2: Unusual and compelling urgency, 41 U.S.C. 3304(a)(2)

5. Bridge Contracts:

6. Actions to Increase Competition:

7. Market Research: FAR 10

For contract extensions or bridge contracts when a competitive follow-on is in the process of being developed, summarize history of current contract and explain the reasons for any delays in the acquisition. Include discussion of the milestones for the follow-on action; the milestones should be as efficient as possible. Discuss why it would be neither cost effective nor realistic to expect another contractor to perform during the brief interim period; include issues such as start-up costs, phase-in, transfer of GFP, recruitment and staffing, etc. If the action is because of a protest, provide a brief discussion of the protest including the date the protest was filed and the basis of the protest. Explain that the action will provide the minimum quantity or performance period.

Describe efforts made to compete the action, including whether a notice was or will be publicized as required by

FAR Subpart 5.2 or which exception under FAR 5.202 applies. If a notice was publicized, discuss the number of written responses to the synopsis and the results of the assessment of the written responses. List sources, if any, that expressed, in writing, an interest in the acquisition. Provide rationale if interested sources were rejected. If applicable, state that no other sources have expressed interest, but all offers received shall be considered. Describe what actions will be taken to increase competition before subsequent acquisition of the supplies or services is required. You may state that an action is a one-time requirement, but if a similar requirement arises, every effort will be made to compete it to the maximum extent possible. If action is sole source because of proprietary data or licensing rights and there will be a continuing need for the requirement, there must be evidence that advanced planning has been initiated to overcome the barriers to competition, or there should be documentation to support an analysis that replacement costs/licensing purchase costs outweigh the benefits of competition. If the action is a contract extension or bridge, explain actions to compete the follow-on. If action is an urgent new requirement and a competitive follow-on is anticipated, explain that efforts are underway to facilitate a full and open competition.

Describe the extent of the market research conducted to identify all qualified sources and the results thereof.

“Market Research” is defined as those attempts you made to ascertain whether other qualified sources exist, and can include contact with knowledgeable experts regarding similar or duplicate requirements, contact with industry, results of a sources sought synopsis, or draft solicitations. Research of the marketplace may consist of written, electronic (i.e. email) telephonic, or world wide web inquiries. Lack of advanced planning is not an acceptable reason for the lack of market research, but true urgency may necessitate abbreviated market research that is limited to readily available historical and commercial information. If action is a contract extension or bridge contract, describe the market research efforts underway or completed for the follow-on. See

FAR 10.002(b)(2).

8. Additional Information to support the justification:

Signature:

Signature: Date:

Date:

10. Fair and Reasonable Price/Cost Determination: As Contracting Officer, by my signature below, I hereby determine that the anticipated price/cost to the Government for this contract action will be fair and reasonable.

Provide the basis for this determination, e.g., describe techniques to be used to determine fair and reasonable price ( FAR Subpart 15.402 ), such as price analysis, cost analysis, cost realism. Per FAR Subpart 15.403-

4(a)(1) , the threshold for obtaining cost or pricing data is $750,000.

11. Contracting Officer's Approval (Required for proposed contract above $3,500 not to exceed $700,000 (value calculated including all options)): I hereby certify that this justification is accurate and complete to the best of my knowledge.

Name: Phone:

If applicable, explain why technical packages or specifications to facilitate competition were not developed or available; describe actions taken to remedy the situation.

9. Technical / Requirements Certification: By my signature below , I certify that the supporting data included in this J&A is accurate and complete.

Department Supervisor (or one level above Department Supervisor)

Name:

Position Title:

Email address:

Signature: Date:

Name: Phone:

12. Advocate for Competition (Required for proposed contract over $700,000 but not exceeding $13.5 million value calculated including all options)):

I have reviewed this justification and find that it adequately supports other than full and open competition.

13. IHS Head of Contracting Activity (Required for proposed contract over $13.5 million but not exceeding $68 million value calculated including all options)):

Name: Phone:

Signature: Date:

1) Will continue to assist in developing the Chinle IHS Zero Suicide model as suicide prevention is a core component of health care services at our service unit.

2) To assist in developing a competent, confident and caring workforce for effectively assessing, screening and treating those who are at risk for suicide.

3) To continue to train community partners, behavioral health specialists and new providers on evidence based suicide care training and to improve universal screening for suicidality throughout our service unit including within primary care, urgent care, behavioral health, and emergency services.

4) Ensure that patients who present with suicidality at our service unit have shared decision making on their safety planning and care management services.

5) Train behavioral health providers in evidence-based practice specifically targeting suicidality.

6) Establish clinical pathway for care for at risk patients from identification to post-acute care.

7) Establish a clear suicide surveillance system that can be used effectively to collect accurate suicide data.

The first year the initiative included formative work in collaboration with native healers and others to assure a thorough understanding of the cultural perspective on suicide prevention. The second year included the implementation and incorporation of the Navajo cultural qualities to the Zero Suicide Initiative (ZSI) evidence-based training, tools, interventions and post-vention services. The Seven Elements of ZSI that are adapted will be tested with the clinical improvement teams using the CSU model for improvement. The system will rely on a coordinated approach involving primary care, integrated behavioral health, staff native healers, emergency department, inpatient, and counseling services. Collaborative efforts and training with the local law enforcement, schools, and other mental health agencies will establish a cohesive trusting relationship toward one common goal of zero suicide within our communities.

The third year will focus on comprehensive and sustainable suicide prevention and treatment system with evidence based practices and culturally informed interventions. In addition, to complete the validation of the ASQ screening tool for the Navajo population within the CSU by using a Research Assistant and an Evaluator who will assist in improving quality services by identifying gaps in services.

FAR 6.302-1: Only one responsible source and no other supplies or services will satisfy agency requirements, 41 U.S.C. 3304(a)(1). See justification below under FAR 6.302-1.

The following are established initiatives met as stated on the Performance Work Statement (PWS) and are crucial compatible portions that carry into Year Three initiative.

Establishing:

1. The Contractor assisted in establishing and facilitating a Community Advisory Board (CAB) to inform the project planning, implementation and work towards developing the Chinle IHS Zero Suicide model. The CAB included youth with lived experience with suicide attempts, ideation and binge substance use—and representatives from core tribal agencies, elders, healers, teachers, parents and other youth advocates.

2. The Contractor facilitated a series of roundtables and group sessions with Chinle Service Unit (CSU) staff Native healers and additional community Native healers (estimated 8-10 total) to develop some consensus on how best to talk about suicide. The Contractor translated these discussions from Navajo into English so both versions can be used to develop educational material.

3. The Contractor established a process for categorizing the different types of suicidal and non-suicidal self-injury according to a well-studied and accepted Columbia Suicide Severity Rating Scale (C-SSRS) classification system.

4. The Contractor assisted the Service Unit to implement a universal suicide screening policy within the urgent care, emergency room departments and all inpatients.

5. Assisted in selecting, adapting and providing training on an evidence based suicide screening tool, such as the PHQ-9, Columbia Suicide Severity Rating Scale (C-SSRS) or the Suicide Ideation Questionnaire (SIQ) to at least 90% of providers.

6. Assisted Chinle Service Unit to implement a universal suicide screening policy within the urgent care, emergency room departments and all inpatients.

7. The Contractor assisted in selecting and adapting an appropriate form of Cognitive Behavioral Therapy for suicide prevention in the service unit setting.

Training:

1. The Contractor assisted in selecting, adapting and providing training on an evidence based suicide screening tool, such as the PHQ-9, Columbia Suicide Severity Rating Scale (C-SSRS) or the Suicide Ideation Questionnaire (SIQ) to at least 90% of providers.

2. The Contractor assisted in selecting a Safety Plan Intervention, such as the Brown and Stanly model, or the New Hope curriculum. Assist in providing training to at least 90% of appropriate culturally competent behavioral health specialists who will carry out Safety Plan intervention.

3. The Contractor developed and trained on crisis and risk management protocols to ensure client safety for patients with attempted suicide, suicidal crisis and/or serious mental illness.

4. The Contractor trained case managers in how to ask follow-up questions in a rigorous and flexible manner to gather high quality information while ensuring the comfort and safety of the at-risk individual.

5. Trained relevant case management/community mental health and other providers to conduct adapted brief interventions to 1) address imminent risk, create safety plans and connect at-risk individuals to available care (“New Hope” intervention) or 2) promote community-specific protective factors (“Elders curriculum), developed by Hopkins with the WMAT.

Implementation:

1. The Contractor helped set up a referral mechanism for individuals presenting with self-injurious behaviors with the local Emergency Department to the case management and follow-up team.

2. The Contractor created materials and train case managers to conduct “in-services” with agencies and community members to educate about and generate suicide reporting forms for the new surveillance system.

3. The Contractor provided case management services through home visiting, phone contacts, and caring letters/texts for those identified at risk for suicide, discharged from an ED or inpatient unit, and/or miss face-to-face appointments

4. The Contractor created a surveillance system database with the intake, follow-up, and death by suicide forms.

5. Worked with Chinle IHS and community stakeholders to establish a follow-up process, which not only involves talking with the individual on whom the report was made but in some instances gathering information from other sources, and how to connect and engage that person with culturally appropriate care, including continued case management as necessary.

In order to move toward sustainability, the team will develop a business case for ZSI services and will have additional permanent positions to support the services after grant funds are expended. Given the limited housing and the challenges of recruiting and retaining health professional, the team plans to develop Mental Health and Social Work professional positions. In addition, the team will partner with Health Promotions to develop culturally-based community education on suicide prevention and treatment.

In Year 3, JHCAIH will assist the Chinle IHS team on the following activities:

• Transition oversight of case managers to Chinle IHS;

• Transition management of CommCare database to Chinle IHS;

• Train new providers as needed on suicide screening, safety plan intervention and culturally-informed practices; and

• Continue technical assistance on surveillance, case management, data analyses, interpretation and dissemination, as well as CBT and brief interventions to address risk and protective factors.

Button9: