ADDENDUM NO. ONE Page 1
REQUEST FOR PROPOSAL NUMBER 952-4675
February 24, 2009
COUNTY OF FRESNOONEADDENDUM NUMBER: ONE
952-4675 / RFP NUMBER: 952-4675
EMERGENCY ROOM RESPONSE TEAM (ERRT)
February 24, 2009
EMERGENCY ROOM RESPONSE TEAM (ERRT) / PURCHASING USE
cf / G:\PUBLIC\RFP\952-4675 ADD 1.DOC
IMPORTANT: SUBMIT PROPOSAL IN SEALED PACKAGE WITH PROPOSAL NUMBER, CLOSING DATE AND BUYER’S NAME MARKED CLEARLY ON THE OUTSIDE TO:
COUNTY OF FRESNO, Purchasing
4525 EAST HAMILTON AVENUE
FRESNO, CA 93702-4599
Closing date of proposal will be at 2:00 p.m., on MARCH 6, 2009MARCH 6, 2009.
PROPOSALS WILL BE CONSIDERED LATE WHEN THE OFFICIAL PURCHASING TIME CLOCK READS 2:00 P.M.
Proposals will be opened and publicly read at that time. All proposal information will be available for review after contract award.
Clarification of specifications are to be directed to: Gary W. ParkinsonGary W. Parkinson, phone (559) 456-7110, FAX (559) 456-7831.
NOTE THE FOLLOWING AND ATTACHED ADDITIONS, DELETIONS AND/OR CHANGES TO THE REQUIREMENTS OF REQUEST FOR PROPOSAL NUMBER: 952-4675 AND INCLUDE THEM IN YOUR RESPONSE. PLEASE SIGN AND RETURN THIS ADDENDUM WITH YOUR PROPOSAL.
Ø Please see next page for Addendum contents.
Ø Addendum One Attachments: 952-4675 Addendum 1 attachments A-G.pdf
G:\PUBLIC\RFP\952-4675 ADD 1.DOC / (12/02)
ADDENDUM NO. ONE Page 6
REQUEST FOR PROPOSAL NUMBER: 952-4675
February 24, 2009
ACKNOWLEDGMENT OF ADDENDUM NUMBER ONE TO RFP 952-4675COMPANY NAME:
(PRINT)
SIGNATURE:
NAME & TITLE:
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1. The following handouts (attached) were provided to define the perspective to the RFP and statistical information pertaining to the provision of requested services:
a. Fresno County Department of Behavioral Health Strategic Plan Summary 2007 2010 (ATTACHMENT A)
b. Fresno County Department of Behavioral Health Goals of Psychiatric Re-Design System (ATTACHMENT B)
c. Fresno County Current Crisis Intervention services Flow Chart (ATTACHMENT C).
d. Fresno County Crisis Intervention Services Utilization data and Services Output (ATTACHMENT D)
e. Fresno County Board of Supervisors Agenda Item (March 27, 2007) regarding the designation of Lanterman-Petris-Short Act Psychiatric Evaluation and Treatment Facilities and Training and Certification of Professional Staff to initiate involuntary holds under Welfare and Institutions (W&I) Code 5150 (ATTACHMENT E)
f. Fresno County Department of Behavioral Health – Directory of Services (ATTACHMENT F)
g. Fresno County Behavioral Health System Quality Improvement Plan CY2009 (QI Plan) (ATTACHMENT G)
2. Department of Behavioral Health (DBH) shared the importance of outcomes as per the QI Plan handout.
3. The County Department of Behavioral Health is also seeking the partnership with community programs to help with additional services being sought through RFPS for:
· A second Psychiatric Health Facility, an inpatient program for Fresno County consumers
· Co-Occurring Detoxification and Assessment Center (CODAC)
4. County staff will operate crisis services on Monday through Friday from 7: 00 AM through 3:30 PM. Contract providers will be responsible for managing crisis services Monday through Friday from 3:00 PM to 7:30 AM each day. There will be shift change report between County staff and contract provider staff each day when the County and Contract Provider interface. The shift change reports will provide essential information to ensure continuity of care/services and discharge planning for consumers in the local emergency departments at the time of the shift change.
Services for this RFP will start July 1, 2009 and will be as follows:
Mondays: from 3:00 pm to 7:30 am
Tuesdays: from 3:00 pm to 7:30 am
Wednesdays: from 3:00 pm to 7:30 am
Thursdays: from 3:00 pm to 7:30 am
Fridays: from 3:00 pm through Monday mornings at 7:30 am
Contractor(s) shall also provide services on 24/7 basis on 11 County observed holidays in each calendar year as follows:
New Year Holiday
Martin Luther King, Jr. Holiday
President’s Day
Cesar Chavez
Memorial Day
Independence Day
Labor Day
Veterans Day
Thanksgiving
After Thanksgiving Day
Christmas
Beginning July 2009, the remaining following Holidays are observed Holidays for Fresno County:
Friday, July 3, 2009
Monday, September 7, 2009
Wednesday, November 11, 2009
Thursday, November 26, 2009
Friday, November 27, 2009
Friday, December 25, 2009
5. Current Crisis Intervention Services program flow chart discussed and a handout provided (attached). Another handout containing the number of consumers served in the 12-month period for FY 2007-08 in the form of a flowchart identifying number of consumers served at each service delivery point (attached).
6. Provided a copy of the QI Plan (attached) and emphasized outcome measures to include tracking the following:
a. Number of consumers seen
b. ERRT Team response time to Fresno Metropolitan and rural County Hospitals
c. Time it took to have consumer discharged from the Hospital ED
d. Frequent and repeat consumers utilizing ED services
e. Reviews of 5150 holds and their discontinuation
f. Clinical outcomes by 5150 placements after its discontinuation
7. Provided the Fresno County Board of Supervisors Agenda Item (attached) regarding the designation of Lanterman-Petris-Short Act Psychiatric Evaluation and Treatment Facilities and Training and Certification of Professional Staff to initiate involuntary holds under Welfare and Institutions (W&I) Code 5150.
8. The following represents statistics on the numbers of 5150 cases taken to local Hospital Emergency Departments (EDs) by Emergency Medical Services for a 12-month period:
· Clovis Community Hospital 20
· Hanford Community Hospital 1
· Fresno Community Regional Medical Center 720
· Selma Hospital 14
· Sierra Kings Hospital 3
· St. Agnes Hospital 81
· Coalinga Hospital none reported
These numbers are not representative of any particular day of work or shift but for a 24-hour period for the 12-month period. These numbers are included in the 4,611 total numbers of consumers served by Fresno County as illustrated in the in Crisis Intervention Flowchart for FY 2007-08.
9. The County will also be opening a same-day service program (Wellness Center) on July 1, 2009 which will serve mental health consumers needing immediate and urgent care, Monday-Saturday, 9:00 a.m. to 6:00 p.m. This will provide a community option for non-emergency mental health services, impacting the number of 5150s coming into the system through EDs.
10. Regarding consumer evaluations who are under the influence and suicidal, the immediate need will be to protect them from endangering themselves, perform 5150 evaluation, obtain medical triage/clearance and recommend/refer the consumer to the appropriate level of care/services such as the Co-Occurring Detoxification and Assessment Center.
11. For clarification, the Board Agenda Item handed out provides information on State of California licensed professionals, who can initiate a 5150 application for detention.
12. Contracted vendor staff must be trained and have staffing ability to discontinue a 5150 application for detention in the ED setting. Only trained Licensed Clinical Social Workers (LCSWs), Licensed Marriage Family Therapists (LMFT) and Psychiatrists may recommend discontinuation of a 5150 application for detention. Follow local Emergency Department’s policy and procedures.
13. The County of Fresno DBH and selected vendor will be meeting with EDs and reaching an understanding as to when contracted vendor staff can leave the patient at the hospital after the patient assessment is completed and the plan for follow-up treatment is discussed with the hospital staff.
14. There is a 5150 Task Force currently meeting with law enforcement, EMS and hospitals which is discussing issues related to services pertaining to crisis design for 5150 consumers. The County is collaborating with the 5150 Task Force members under the leadership of the Hospital Council to discuss issues like data sharing and credentialing to ensure a smooth transition of services on July 1, 2009.
15. For hospitals that already have staff providing crisis intervention assessment and treatment, vendor staff shall still be required to provide consultant services, assessments and intervention and recommendation to ED for follow up linking resources.
16. Currently the Fresno County CIS intake averages at approximately 4 per shift and 12.3 consumers a day of which:
· 32% come during the day shift (7 AM- 3:30 PM)
· 33.7% are admitted on the pm shift (3 PM – 11:30 PM)
· 34.1% are admitted during the NOC shift (11:00 PM- 7:30 AM)
17. Based on past experience there has been no negative feedback from either law enforcement or hospital staff when a 5150 has been discontinued by County DBH staff. Positive outcome has been due to the education provided by DBH to law enforcement and medical staff at EDs.
18. In collaboration with the local National Alliance for Mental Illness and the Mental Health Board, there is momentum for the creation of local Crisis Intervention Training needs and programs with law enforcement and hospital staff. CIT training is being held in Monterey in March 2009 for the further development of the curriculum.
19. County DBH is moving forward with its new information technology vendor to electronic medical records tentatively beginning on July 1, 2009 and will work closely with the selected vendor to meet federal/state mandates and implementation of deadlines.
20. Technically, it is possible to connect to the County’s new mental health system through a wireless laptop. However, the following needs to be noted:
1) This only works where there is a strong wireless connection. If a cell phone won’t work, this won’t work.
2) Many hospital and hospital emergency rooms forbid the use of wireless devises. In such cases, this will not work.
3) If they are in rural locations, there are areas where connection may be weak or non-existent.
4) For optimum results, the laptop must have Windows XP, vpn allowed and have high speed internet connection.
5) It is suggested that for a better connection in hospitals the selected vendor may wish to negotiate with the hospital to allow vendor access to a computer with the internet. DBH can then add VPN software to that which will allow a more consistent connection.
21. The County will provide potential start up funds as stated in the RFP and must be submitted in the vendor’s proposal budget.
22. On page 3 (Overview) first paragraph says that “organizations to provide evening, weekend, and holiday mobile emergency room response services to an estimated 4,000 consumers annually…”
Is the contractor going to serve approximately 4000 consumers, or is the number 4,000 the number of consumers who may use the services 24/7?
The approximate 4,000 consumers is the estimated total number of consumers who accessed crisis services in FY 07/08 on 24/7/365 basis. See Item # 16 above for average intake of census for each shift.
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