Agenda Item   



                                                                                                                        ASR Control  21-000648




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):

Annette Mugrditchian (714) 834-5026 



Jeff Nagel (714) 834-7024



Subject:  Amendment No. 1 for Suicide Prevention and Support Services


      ceo CONCUR

County Counsel Review

Clerk of the Board


Approved Agreement to Form




3 Votes Board Majority




    Budgeted: Yes

Current Year Cost: $1,000,000

Annual Cost: FY 2022-23 $2,000,000




    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



    Prior Board Action: 06/02/2020 #12






Approve Amendment No. 1 to the Contract with Didi Hirsch Psychiatric Service, for provision of Suicide Prevention and Support Services, increasing funds by $3,000,000, for the term of November 17, 2021, through June 30, 2023, for a revised cumulative contract total amount not to exceed $6,555,000.



Authorize the County Procurement Officer or authorized Deputy to execute Amendment No. 1 to the Contract with Didi Hirsch Psychiatric Service, as referenced in the Recommended Action above.







Approval of Amendment No. 1 to the Contract with Didi Hirsch Psychiatric Service for Suicide Prevention and Support Services will expand existing services to ensure that individuals in a crisis who are needing support following a discharge from a healthcare setting will have access to supportive suicide prevention, intervention, postvention services and follow-up care.










On March 12, 2019, your Honorable Board of Supervisors (Board) directed the Health Care Agency (HCA) to allocate  funds to create the Community Suicide Prevention Initiative (CSPI) to address the increasing suicide rates and the mental health-related hospitalizations in Orange County. On June 2, 2020, the Board approved the Agreement with Didi Hirsch Psychiatric Service (Didi Hirsch) for provision of Suicide Prevention and Support Services for the term of July 1, 2020, through June 30, 2023. In an effort to address the needs identified by CSPI, HCA is returning to the Board to increase the contract maximum obligation by $3 million to expand services.


Suicide Prevention and Support Services includes a 24-hour suicide prevention Hotline (Hotline) service as well as suicide prevention and postvention survivor support services to any Orange County resident seeking crisis support for themselves or someone they know.


Scope of Services:

Hotline Services (currently provided):


Suicide Prevention and Support Services includes immediate telephone support, referral and follow-up via a toll-free, confidential 24 hours a day/seven days a week Suicide Prevention Hotline (Hotline) Service.

The goal of the Hotline Service is to reduce the number of suicide attempts through effective intervention at the point of crisis via support to callers and coordination of care with other service providers. The Hotline is offered in English and Spanish 24 hours a day, while Korean services are available eight hours per day during peak evening hours between 4:30 p.m. - 12:30 a.m. Other language coverage is available through volunteers or translation services via the Lifeline Language Line, which has the capacity to translate over 240 languages, including Vietnamese.


Survivor Support Services (currently provided):


Survivor Support Services are intervention and postvention services that include crisis assessment and support, individual and group therapy, emergency interventions and bereavement support to any Orange County resident who may have experienced a suicide attempt, or the loss of someone to suicide. Additionally, community outreach, education and training are provided to increase awareness of suicide risk, promote help-seeking behavior, identify the signs and symptoms of suicide and education on how to intervene are also provided. Services are provided by clinicians and peers who have specialized training in suicide prevention, many of whom have lived experience with suicide.


New Step-Down Expanded Services:


Currently, there are no specific suicide prevention step-down care services in Orange County for individuals who are discharged from hospital settings post treatment. Given the high volume of such patients at Orange County hospitals and with an increasing rate of readmissions for emergency services, especially during the pandemic, these services will be addressing a gap in the continuum of care for high-risk individuals post discharge. Didi Hirsch is a pioneer in the field of suicide prevention services and a recognized national expert. 


The proposed service expansion would include a partnership with Orange County hospitals for linkages and warm handoffs from emergency departments, intensive outpatient programs and inpatient behavioral health units to case managers at Didi Hirsch’s Survivor Support Services. Services will target individuals who were assessed for suicidal ideation, those who may have attempted a suicide or those who were assessed to be at high risk of suicide. Services will include a direct linkage of these individuals, prior to being discharged, to step-down therapeutic intervention, prevention and postvention services. Additionally, upon discharge from Didi Hirsch, two-month follow-up care by a therapist and up to 12 months of extended follow-up care will also be provided. 


Intervention services will include one-on-one therapeutic sessions for individuals, couples and families for an average of 13 weeks per participant to reduce the risk of a suicide attempt and will be provided by clinicians who have specialized training in Cognitive Therapy for Suicide Prevention (CT-SP). Prevention and postvention services for the target population will include coping skills and support groups for individuals and family members, recognizing warning signs, how to obtain help and how to manage their own stress as a support/care provider and bereavement support. Follow-up services will be offered to participants upon completion of therapeutic services from Didi Hirsch and will include monitoring of safety plans, ongoing risk assessments and follow-through on referrals to community resources. The participant’s individual therapist will do a check-in follow-up each month for two months post discharge. Subsequently, the counselors at the Hotline who are specially trained in CT-SP, will be assigned to do extended Follow-Up will make follow-up calls minimally at the three-, six-, nine- and 12-month marks post discharge from the program. Follow-up calls by these Crisis Line Extended Care counselors will also be offered to individuals who were discharged from hospitals but did not attend the Didi Hirsch step-down care program.  


Based on recent Orange County suicide data, Didi Hirsch will also conduct targeted outreach to youth, men in their middle years and older adults. These three groups are identified by the Orange County Community Suicide Prevention Initiative to be at the highest risk. Additionally, Latinx, African American, Korean, Vietnamese, Farsi and Arabic-speaking communities will also receive targeted outreach. Lastly, specialized training and education on suicide risk assessment, prevention and intervention will be provided to staff and professionals who work with these high-risk populations including: primary care physicians, nursing professionals, therapists and social workers at the participating hospitals and other non-participating medical centers. Training will also be offered to non-medical professionals and religious organizations who serve these target populations.


Program Performance Measures:


Table 1: Contracted Goals

Service Category



FY 2021-23

Units of Service (UOS)

Proposed UOS including Step-down Services

FY 2021-22


Proposed UOS including Step-down Services Expansion

FY 2022-23

Number of Calls to Hotline




Number of Unduplicated Callers to Hotline




Percentage of Follow-Up Attempts 




Number of Individual sessions




Number of Closed Support Groups sessions




Total number of CT-SP sessions conducted




Number of Closed Support Groups sessions in foreign/sign language




Number of Open Support Groups sessions




Total number of support groups conducted




Number of Crisis Support Activities conducted




Survivors of Suicide Attempt Groups




Number of Educational Presentations and Trainings





Number of Individuals served through Outreach




Proposed Unduplicated number of participants served through the step-down services


250 individuals



As indicated in Table 1, the proposed step-down services expansion will serve an additional 250 individuals in FY 2021-22 and 500 unduplicated individuals in FY 2022-23. The expansion of Didi Hirsch’s existing suicide prevention, intervention and postvention services will be instrumental in preventing suicides and continue to provide a critical safety net to Orange County residents who are identified to be the most vulnerable.


Program performance outcomes for the proposed step-down services expansion will be consistent with the current and prior year goals for the Survivor Support Services and will also measure decreases in a participant's depression severity and increases in coping skills. Additionally, the step-down services expansion will track the increase in knowledge and ability of enrolled participants to manage their suicidal thoughts.


As noted in Table 2, the Suicide Prevention Services in FY 2020-21 have been effective in all areas measured. The Hotline has been effective in de-escalating suicidal intent for participants who were either at high or medium risk for attempting suicide. The number of calls to the Hotline have steadily been trending up, indicating that Didi Hirsch has been successful in its outreach efforts and more people have been able to overcome the barriers of stigma and access services. In FY 2020-21, a total of 14,092 calls were received at the Hotline, as compared to FY 2017-18 when 11,607 calls were received. Similarly, the performance outcomes for Suicide Support Services indicate that program participants continue to increase their ability to manage grief and reduce the severity of depression symptoms. With the proposed service expansion of the step-down services, Didi Hirsch will also be able to report the improvement in the ability of participants to manage their suicidal ideation.


Table 2: Performance Outcomes


FY 2020-21

Achieved Outcomes

Hotline Services


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.


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.


Survivor Support Services


A minimum of 50% of participants will increase their ability to manage their grief.


A minimum of 65% of participants will show a reduction in depression symptom severity.



The Contractor's performance has been confirmed as satisfactory. HCA has verified there are no concerns that must be addressed with respect to Contractor's ownership/name, litigation status or conflicts with County interests. The Orange County Preference Policy is not applicable to this Contract award.


The proposed Amendment with Didi Hirsch for Suicide Prevention and Support Services includes a subcontractor. See Attachment B for information regarding the subcontractor and Contract Summary Form. Didi Hirsch has provided Suicide Prevention and Support services nationally since 1971. Currently, there is no other provider of these services in Orange County. Didi Hirsch has provided services in Orange County under an Agreement with HCA since 2010. Didi Hirsch was the only respondent during a Solicitation of Interest that was released in 2014. Didi Hirsch is currently the only provider that provides suicide prevention and support services in the entire Southern California region. Didi Hirsch is considered a pioneer of the field of suicidology and first started these services in the nation and is the national expert of suicide prevention services. The curriculum Didi Hirsch offers has been recognized as best practice by the Suicide Prevention Resource Center. Didi Hirsch currently provides a toll-free, confidential 24 hours a day, seven days per week, 365 days a year crisis telephone hotline service also called the Suicide Prevention Lifeline. The Hotline is accredited by the American Association of Suicidology and Contact USA. As there are no other community providers with the ability to provide the full array of services, the County would have to provide the services. To do so, the County would have to establish a Crisis Hotline Center from the ground up, which would be costly and time consuming given all the requirements as described above. Didi Hirsch is utilized state-wide for similar trainings due to their expertise. Sole Source Request Form was completed and approved for the services with Didi Hirsch. See Attachment D.


The Amendment is presented to the Board less than 30 days from the start date of the Contract term due to the additional time needed to negotiate the terms of the Contract for expansion of supportive services.


HCA requests that the Board approve Amendment No. 1 to the Contract for provision of Suicide Prevention and Support Services with Didi Hirsch, as referenced in the Recommended Actions.






Appropriations for this Contract are included in Budget Control 042 FY 2021-22 Budget and will be included in the budgeting process for future years.


Should services need to be reduced or terminated due to lack of funding, the Contract contains language that allows HCA to give a 30-day notice to either terminate or renegotiate the level of services to be provided. The notice will allow HCA adequate time to transition or terminate services to clients, if necessary.












Attachment A - Amendment No. 1 to Contract MA-042-20010910 for Suicide Prevention and Support Services with Didi Hirsch Psychiatric Service
Attachment B - Contract Summary Form
Attachment C - Redline Version to Attachment A
Attachment D – Sole Source Form