Rapid Response Stabilization Services for Children and Youth

RFP #0617-005

ATTACHMENT A

FORMS

Partners Behavioral Health Management

RFP# 0617-005 Rapid Response Stabilization Services for Children and Youth

  1. Title Page (counts as 1 page)

Please complete the following information:

Name of Organization: / Click here to enter text. /
Organization Type: / ☐ Hospital
☐ Private Organization: ☐ not for profit ☐ for profit
☐ Governmental/Public
Facility License Number (If Applicable): / Click here to enter text. /
Accreditation Type and Source: / Click here to enter text. /
Primary Client Population: / ☐ Adults ☐ Adolescents ☐ Children ☐ All ages
Mailing Address: / Street, City and Zip Code Click here to enter text.
Facility Location Address: / Street, City and Zip Code Click here to enter text.
Name of Contact Person: / Click here to enter text. /
Contact Person Phone # & Email: / Click here to enter text. /
Please list other MCOs, with whom you have contracts: / Click here to enter text. /
Please list other MCOs, with whom you are credentialed: / Click here to enter text. /
Please indicate in which counties services would be provided: / ☐ Burke ☐ Catawba ☐ Cleveland ☐ Gaston
☐ Iredell ☐ Lincoln ☐ Surry ☐ Yadkin
  1. Provider Experience

Please briefly describe the organization’s history of experience as a Mental Health/Intellectual Developmental Disability/Substance Use Disorder provider. Do not include pre-printed promotional materials. (Limited to 3 pages or less) Include the following:

  1. organization’s qualifications for providing the services (Therapeutic Foster Care Homes) as listed in this RFP;
  2. evidenced based practices used in the organization;
  3. number of years operating as a behavioral health provider;
  4. how cultural competence is managed;
  5. experience working with special populations;
  6. capacity for expansion of services;
  7. organizational and supervisory structure;
  8. methods for crisis management; and
  9. how consumer safety is ensured.
  1. Provider Qualifications for Service

Please list all staff, title, credentials, special certifications and length of experience for those participating in the delivery of this service. If you need to hire staff, please include your plan for hiring and training. (Limited to 2 pages)

  1. Provider Implementation Model

Please describe your plan for implementation/expansion for this service. (Limited to 6 pages or less)

In your description please address how the following activities and components will be provided:

  1. Individualized and intensive supervision and structure of daily living designed to minimize the occurrence of disruptive behaviors related to family and psychosocial stressors and to help restore at a minimum to the previous level of functioning.
  2. Psychoeducation to impart information about the beneficiary’s diagnosis, condition, and treatment to the beneficiary, family, caregivers, or other individuals involved with the beneficiary’s care.
  3. Specific and individualized interventions including identifying triggers that lead to crises, including, interventions to assist in anger management, relearning relevant social skills, family and/or caregiver communication skills, stress management, relationship support, and intensive crisis or crisis prevention and management including de-escalation interventions exclusive of physical restraints.
  4. Ensure linkage to community services and resources, including connecting with schools, vocational programs, and other service and physical health providers.
  5. Direct and active intervention in assisting children and youth to remain involved in naturally occurring community support systems and supporting the development of personal resources (assets, protective factors, etc.). This includes licensed clinical staff work with the family and/or natural supports.
  6. 24/7 availability of provider agency staff and therapeutic parents for immediate response and placement.
  7. 24/7 emergency/crisis support from provider QP staff for Rapid Response therapeutic parents to avoid burn out of families serving high needs youth.
  8. 24/7 availability of licensed clinical staff for clinical assessment and consultation.
  9. The Rapid Response Provider is the First Responder while the youth are in a Rapid Response home.
  10. Program design/structure for staffing and supervisory experience available, if you do not currently provide services as described in this RFP, please include plans for how you will develop and train the required staff.
  11. Modalities or evidenced based practices to be used, if applicable or plan for how training will be implemented.
  12. Plan for how service will be implemented (include actual service start date).
  13. Plan and timeline for how the services will be accessed and adherence to response timelines will be met.
  14. Understanding that this Medicaid service definition must be used for all Medicaid recipients meeting the criteria for the service, documented and billed in accordance with all relevant rules and regulations.
  1. Expected ProviderOutcomes (limited to 4 pages or less)

Rapid Response Stabilization Services for children and adolescents are designed to be treatment focused and intended to support family stability, prevent abuse and neglect, be of short term duration, return children to the home and prevent or minimize the need for out-of-home placements.

It is expected that youth served will return to their natural family setting, with a goal of increasing the percent of youth returning home over time. If alternate placement is needed, then the least restrictive most appropriate level will be chosen. CFT’s should plan around crisis, transition or residential placement. Barriers to returning to original setting shall be documented and an action plan shall be created to address the barriers.

Placement Outcomes:

  • At least 75% of youth served shall be diverted from out of home placement after receiving the service.
  • If a return home is not the CFT recommendation, 100% of youth will be connected with the identified appropriate level of care.

Hospital Admissions Outcomes:

Monitor the % of youth who are diverted from crisis or inpatient services due to entering the Rapid Response beds, with a goal of increasing the percent over time (FY 16 will serve as baseline).

Response to placement requests will be handled in a prompt manner:

  • 100% of requests for the service by local crisis or inpatient services are answered within one (1) hour of request;
  • 90% of requests for the service by other entities (Care Coordination, other providers) are answered within one (1) hour;
  • 80% of youth meeting criteria for service are placed in Rapid Response home within 12 hours of the initial request.

Data Collection and Reporting:

Providers will need to submit monthly data reports which will include the following information:

  • Source of referrals
  • Location to which child/youth is discharged
  • Service to which child/youth is discharged
  • Date of referral to the service to which they are discharged
  • Date the assessment was completed
  • Date of referral to Care Coordination
  • Response time to requests for service
  • Time between request for service and placement in Rapid Response Home

For this section, please explain your plan for ensuring all data is collected, tracked and evaluated for adjustments, including process of reporting monthly to MCO. Include the format you will use for monthly reporting of the data required.

Please include an example of data from the past 12 months of a current service including lengths of stay, recidivism-rate of return to services or higher level of services and consumer satisfaction with services. Attach any tools (not included in page count) used to previously measure outcomes.

Rapid Response Stabilization Services for Children and Youth

RFP #0617-005

Attestation

The below signed attests the following:

  1. the information contained in this RFP and service definition has been read;
  2. understanding and agreement that an organizational representative in attendance at the Bidder’s Conference is mandatory for application;
  3. understanding and agreement of all exclusionary criteria as listed on page 6 of RFP #0617-005;
  4. affirms that information submitted in the response is true and accurate to the best of their knowledge; and
  5. confirms the organization’s authorization to submit this information.

Signature:

Title: Click here to enter text.

Organization: Click here to enter text.

Date: Click here to enter a date.

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RFP# 0617-005 Rapid Response Stabilization Services