Agenda Item AGENDA STAFF REPORT ASR Control 24-000513
MEETING DATE:	04/08/25
legal entity taking action:	Board of Supervisors
board of supervisors district(s):	All Districts
SUBMITTING Agency/Department:	Health Care Agency (Approved)
Department contact person(s):	Veronica Kelley (714) 834-7024
	Ian Kemmer (714) 834-2160

Subject: Contract for Suicide and Self-Harm Reduction Services and 988 Hotline Services

ceo CONCUR

County Counsel Review

Clerk of the Board

Concur

Approved Agreement to Form

Discussion

3 Votes Board Majority

Budgeted: N/A

Current Year Cost: N/A

Annual Cost: FY 2025-26 $2,200,000

Staffing Impact:

# of Positions:

Sole Source: Yes

Current Fiscal Year Revenue: N/A

Funding Source: State: 100% (Mental Health Services Act /Prop 63)	County Audit in last 3 years: No
Levine Act Review Completed: Yes

Prior Board Action: N/A

RECOMMENDED ACTION(S):

Approve the Contract with Orange County Asian and Pacific Islander Community Alliance, Inc. for the provision of Suicide and Self-Harm Reduction Services, for the term July 1, 2025, through June 30, 2026, in an amount not to exceed $1,650,000, renewable for two additional two-year terms.

Approve the Contract with Didi Hirsch Psychiatric Service dba Didi Hirsch Mental Health Services for provision of 988 Crisis Hotline Services, for the term July 1, 2025, through June 30, 2026, in an amount not to exceed $550,000, renewable for two additional two-year terms.

Authorize the County Procurement Officer or Deputized designee to execute the Contract with Orange County Asian and Pacific Islander Community Alliance, Inc. and Didi Hirsch Psychiatric Service dba Didi Hirsch Mental Health Services, as referenced in the Recommended Actions above.

SUMMARY:

Approval of the Contracts with Didi Hirsch Psychiatric Service dba Didi Hirsch Mental Health Services and Orange County Asian and Pacific Islander Community Alliance, Inc. will ensure that individuals in an acute or persistent state of risk for suicide and who are needing specialized intervention will have access to services in support of suicide and self-harm reduction.

BACKGROUND INFORMATION:

The Health Care Agency (HCA) identified a need for evidence-based intervention and resources that effectively meet the needs of Orange County residents experiencing elevated risk of suicide or self-harm and those who have been significantly impacted by a loss due to suicide. In order to ensure that these specialized services are available for Orange County residents, and that these services align with the existing crisis network of care, HCA is looking to establish contracts for suicide and self-harm reduction services and 988 Hotline services.

The 988 Hotline portion of services is a Sole Source contract with Didi Hirsch Psychiatric Service dba Didi Hirsch Mental Health Services (Didi Hirsch). Didi Hirsch is the only state accredited service provider in the Southern California region and is one of 12 regional centers approved to operate 988 call centers in the State of California. The regional model for 988 is a standardized response model that incorporates a general response to callers, regardless of call location and is not incorporated into the specialized County crisis networks established within the different Counties covered. This Contract establishes an Orange County specific Call Center and will provide cultural and County specific resources and support that incorporates the local Orange County crisis response network of support.

To ensure the distinct and specialized care would be offered by a qualified provider, the Suicide and Self-Harm Reduction Services were solicited utilizing the Request for Proposal process. The scope of services was adjusted to align with the new mandates and service requirements established within the Behavioral Health Services Act (BHSA). This includes establishing a billing component to the clinical support and services offered under the Contract.

Request for Proposal

On October 31, 2024, HCA released a Request for Proposal (RFP) in the County’s online bidding system to solicit proposals from qualified providers for the provision of Suicide and Self-Harm Reduction Services. The RFP included the County’s intent to award one contract to the qualified provider whose proposal was determined to be the most responsive to the requirements of the RFP. There were four responses received by the due date of November 25, 2024. HCA received proposals from Didi Hirsch, Norooz Clinic Foundation, Orange County Asian and Pacific Islander Community Alliance, Inc. (OCAPICA), and Phoenix House Orange County, Inc. The Orange County Preference Policy is not applicable to this Contract Award.

Proposal Evaluation Process

A standard evaluation panel of five members comprised of three members of the public and two County individuals with subject matter expertise, was recruited to evaluate the proposals. The evaluation panel evaluated the proposals and recommended contract award to OCAPICA. There was one protest of award received; the protest was denied by HCA.

Respondent	Average Score
Orange County Asian and Pacific Islander Community Alliance, Inc.	901
Didi Hirsch Psychiatric Service dba Didi Hirsch Mental Health Services	852
Phoenix House Orange County, Inc.	849
Norooz Clinic Foundation	612

Scope of Services

Suicide and Self-Harm Reduction Services include several intervention tools and strategies for individuals who have experienced or are experiencing thoughts of self-harm or suicide, including those who have survived a suicide attempt, as well as family members or loved ones who have experienced a loss due to suicide. Services will be available for all Orange County residents, particularly those community members who are known to be at elevated risk of suicide or self-harm (i.e. youth, men in their middle years, older adults, etc.). Primary interventions and services will include crisis assessments and support, individual and group therapy, emergency interventions, loss response and bereavement support. The services will be provided by clinicians and peers who have specialized training in suicide prevention, many of whom have lived experience with suicide.

The services will incorporate a step-down component for individuals who are discharged from hospitals and other higher levels of care and will include partnerships with Orange County hospitals and acute treatment programs to facilitate expedited access to care at a time of elevated risk and vulnerability. This intervention model will support effective transitions into community-based care and decreased rates of readmission for these high-risk individuals post discharge. Services will include one-on-one therapy sessions for individuals, as well as couple and family sessions, to reduce the risk of a suicide attempt and will be provided by clinicians who have specialized training in evidence-based interventions specific to those presenting with risk of suicide and self-harm. At time of enrollment, OCAPICA will also identify any available insurance coverage for billing purposes and establishing a fee-for-service billing model. OCAPICA will document billable services provided for Medi-Cal recipients, while the billing will be managed by HCA. The funds collected through the billing model will offset the use of BHSA funds for services provided.

The final component of these services will be loss support for family members and loved ones who have experienced a loss due to suicide. The impact of a suicide loss can be severe for those left behind, and while the experience of grief is significant, this group typically tends to avoid seeking help. Loss support has been shown to facilitate access to care and recovery, helping loss survivors engage in treatment when it is most needed. Without this type of support, loss survivors tend to wait years before seeking help. The loss support services provided as part of this Contract will incorporate volunteers with lived experience who will reach out to the bereaved and help guide them through the process of accessing support and moving through their grief. They will facilitate access to individual counseling services as well as support groups to help build a connection and ensure these individuals are not left alone with their grief.

Suicide and Self-Harm Reduction Performance Measures

Table 1

Service Category	Goals
Screenings/Assessments	350
Unduplicated individuals served	250
Support groups conducted	60
Support group sessions conducted	180
Unduplicated participants receiving group services	100
Individual or family sessions provided	1,200
Unduplicated participants receiving individual or family services	150
Loss support volunteers recruited and trained	10
Loss support activities conducted	50
Unduplicated loss support services recipients served	30
Stakeholder and community engagement activities	50

As indicated in Table 1, OCAPICA plans to engage no less than 250 unduplicated individuals in Suicide and Self-Harm Reduction Services over the next fiscal year (FY), with targeted goals relating to both group and individual interventions. As the services will support those who are actively experiencing risk of suicide as well as those who have lost someone to suicide, the established performance outcome measures will focus on the needs of both participant presentations. The established outcomes include:

•	A minimum of 80 percent of enrolled participants presenting with suicidal ideation will demonstrate improvement in their ability to manage and cope with suicidal thoughts.
•	A minimum of 80 percent of participants presenting with suicidal ideation will be able to maintain community-based treatment, not requiring psychiatric hospitalization.
•	A minimum of 80 percent of enrolled participants experiencing symptoms of depression will demonstrate a decrease in depressive symptoms.
•	A minimum of 80 percent of enrolled participants coping with grief and loss will demonstrate an improvement in their ability to manage symptoms of grief.
•	A minimum of 50 percent of individuals engaged by the Loss teams will request follow-up support.

988 Hotline Services

Talk/text/chat support will be available to any Orange County resident experiencing a suicidal crisis and seeking services for themselves or someone they know through a toll-free, 24/7 confidential and culturally appropriate Suicide and Crisis Prevention Lifeline/Hotline (Hotline). This service will establish a dedicated cultural and regional-specific resource for Orange County residents, accessed through the designated 988 national system of response. This resource will enhance the critical safety net for Orange County residents who are identified to be at their most vulnerable point.

The goal of the Hotline is to reduce the incidence of suicide attempts through effective and appropriate intervention at the point of crisis via support to callers. The interventions are designed to de-escalate and stabilize the callers, alleviate imminent risk of self-harm or suicide, provide support in accessing appropriate resources, and coordinate care with other service providers. Hotline services shall be provided by trained staff who have lived experience with suicide, and include immediate assessment, support, triage and referrals for follow-up care when necessary. The support shall be provided in multiple languages that represent the Threshold Languages in Orange County. Didi Hirsch shall regularly update and expand existing Orange County specific resources for the database to ensure appropriate and timely referrals are provided.

988 Hotline Services Performance Measures

Table 2

Service Category	FY 2024-25 Goals	FY 2024-25 Goals Achieved (Jul-Dec)	Proposed FY 2025-26 Goals
Hotline calls	11,000	9,744	15,000
Unduplicated callers	8,500	5,768	10,000
Percentage of follow-up attempts	100%	100%	100%
Indicators		FY 2024-25 Achieved Outcomes (July-Dec)
A minimum of 60% of callers rating themselves at high or imminent risk will show a decrease in their self-rated intent by the end of the call		66%
A minimum of 65% of callers rating themselves at medium risk will show a decrease in their self-rated intent by the end of the call.		73%

As indicated in Table 2, the proposed 988 Hotline Services are expected to serve at least 10,000 unduplicated callers, with an anticipated total of 15,000 calls from Orange County residents who have dialed 988 for support during a suicidal crisis. These service goals represent an increase from 8,500 unduplicated callers and 11,000 calls under the previous contract. An increase in calls is an indication that there is an increase in the public’s awareness of the 988 services and more callers are feeling comfortable in accessing the Hotline to address their suicidal thoughts.

The primary goal of the Hotline services will be to de-escalate callers presenting in crisis and to reduce suicidal intent for those who are at high or moderate risk of suicide attempt. Hotline staff will also follow-up with 100 percent of callers in support of continued stabilization and linkage to Orange County resources.

As noted in Table 2, Didi Hirsch has also met their performance goals relating to self-reported intent over the past two contract years. The proposed FY 2025-26 goals will be increased to reflect the following expectations:

-	A minimum of 80 percent of callers rating themselves at high or imminent risk will demonstrate stabilization or improvement in their self-rated intent by the end of the call.
-	A minimum of 80 percent of callers rating themselves at medium risk will demonstrate stabilization or improvement in their self-rated intent by the end of the call.

HCA has verified there are no concerns that must be addressed with respect to Contractors’ ownership/names, litigation status or conflicts with County interests.

HCA staff have conducted due diligence on OCAPICA and reference checks were satisfactory and completed with California Department of Social Services, City of Irvine, and Sierra Health Foundation. HCA staff have conducted due diligence on Didi Hirsch.

The proposed Contracts do not have any subcontractors or pass through to other providers. See Attachment C for Contract Summary Forms.

HCA requests that the Board approve the Contracts with OCAPICA and Didi Hirsch as referenced in the Recommended Actions.

FINANCIAL IMPACT:

Appropriations for this Contract will be included in Budget Control 042 FY 2025-26 Budget.

The Contract includes provisions allowing HCA to terminate the Contract, reduce the level of services, and/or negotiate the levels of services provided, as necessary. This includes a notice that allows HCA adequate time to transition or terminate services to clients, if necessary.

STAFFING IMPACT:

N/A

ATTACHMENT(S):

Attachment A – Contact MA-042-25010461 for Suicide and Self-Harm Reduction Services with OCAPICA
Attachment B – Contract MA-042-25011085 for 988 Crisis Hotline Services with Didi Hirsch
Attachment C – Contract Summary Form
Attachment D – Individual Score Sheets