AGENDA STAFF REPORT

Agenda Item AGENDA STAFF REPORT ASR Control 19-001182
MEETING DATE:	03/24/20
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: Agreement for Suicide Prevention and Support 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 2020-21 $1,150,000
FY 2021-22 $1,185,000
FY 2022-23 $1,220,000

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: 04/23/2019 #22, 03/13/2018 #13, 06/16/2015 #21

RECOMMENDED ACTION(S):

Approve the Agreement with Didi Hirsch Psychiatric Service dba Didi Hirsch Mental Health Services for provision of Suicide Prevention and Support Services for the term of July 1, 2020, through June 30, 2023, for an amount not to exceed $3,555,000, renewable for two additional one-year terms.

Pursuant to Contract Policy Manual Section 3.4-114, authorize the Health Care Agency Director, or designee to exercise a contingency contract cost increase, not to exceed a total of 10 percent of the agreement amount for the first year of the agreement, for the entire term of the agreement, including renewals, and within the scope of work set forth in the agreement. The use of this contingency contract cost increase is subject to approval requirements established by the County Procurement Officer.

Authorize the Health Care Agency Director, or designee, to execute the Agreement as referenced in the Recommended Actions above.

SUMMARY:

Approval of the Agreement with Didi Hirsch Psychiatric Service dba Didi Hirsch Mental Health Services for provision of Suicide Prevention and Support Services will ensure that individuals who are needing support for a crisis and/or are at their most desperate and contemplating suicide have a safety net of services for themselves and their loved ones.

BACKGROUND INFORMATION:

Didi Hirsch Psychiatric Service dba Didi Hirsch Mental Health Services (Didi Hirsch) currently provides Suicide Prevention and Support Services under two separate Agreements (Crisis Prevention Hotline Services and Survivor Support Services) with the Health Care Agency (HCA). Prior Board actions approved by your Honorable Board of Supervisors (Board) for these services include April 23, 2019, March 13, 2018, and June 16, 2015. HCA recommends that these services be combined under one Agreement to create programmatic and operational efficiencies. These services were sole sourced to Didi Hirsch, as currently no other identified entity can deliver a full array of suicide prevention services in Orange County. Didi Hirsch is a pioneer in the field of suicide prevention services and a recognized national expert, and is also involved in prevention efforts with Be Well OC. By leveraging considerable in-kind operational and infrastructural costs including their state-of the art facilities, Didi Hirsch is able to provide a comprehensive continuum of services to Orange County residents at well below the market rate. Sole Source Request Form was completed and approved for the services with Didi Hirsch. See Attachment C.

HCA staff have conducted due diligence on the vendor. Reference checks were satisfactory and completed with National Suicide Prevention Lifeline and National Alliance on Mental Illness regarding similar projects.

Scope of Services

Suicide Prevention and Support Services will include a continuum of services including a toll-free, confidential 24/7 suicide prevention Hotline Service, suicide prevention support to any Orange County resident seeking outreach, education and training, crisis support or suicide prevention services for themselves or someone they know.

Hotline Services include immediate phone support, referral and follow-up. 24-hour telephone services are available in English and Spanish. 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. The goal of the Hotline Services is to reduce the incidence of suicide attempts through effective intervention at the point of crisis via support to callers and coordination of care with other service providers. Other services include Survivor Support Services to any Orange County resident who may have either experienced the loss of someone to suicide or may have attempted suicide. Services will be provided by trained staff who have lived experience with suicide, and include individual and group support sessions. Finally, community outreach, education and training to increase awareness of suicide risk, promote help-seeking behavior, recognition of signs and symptoms of suicide and learning to intervene will also be provided.

As indicated in the HCA 2014-2018 Suicide Deaths in Orange County Report, in this five-year period, there were 1,648 reported suicide deaths of Orange County residents. This translates to an average annual suicide rate of 10.3 deaths per 100,000 residents, and approximately 330 suicides per year during these five years. These Suicide Prevention and Support Services are key components in the broad spectrum of behavioral health services funded by HCA that are instrumental in preventing suicides and continue to provide a critical safety net to Orange County residents who are identified to be at their most vulnerable point.

Performance Outcomes

Program performance outcomes for the proposed Agreement will be consistent with the current and prior year goals. Performance outcomes for the Hotline Service are measured by a Suicide Risk Assessment tool created by Didi Hirsch, which is recognized as the national standard for assessments. The tool will be administered at the end of a call and measures suicide intent and ideation. Performance outcomes for Suicide Survivor Support Services measure decreases in a participant's depression severity and increases in coping skills.

As noted in Table 1, 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 the provider has been successful in its outreach efforts and more people have been able to overcome the barriers of stigma and access services. In FY 2018-19, a total of 13,536 calls were received at the Hotline, and in FY 2017-18, 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.

Table 1: Program Performance Outcomes

FY 2018-19 Annual Contracted Outcomes	FY 2018-19 Achieved Outcomes
Hotline Services
A minimum of 60 percent of callers rating themselves at high or imminent risk will show a decrease in their self-rated intent by the end of the call.	77%
A minimum of 65 percent of callers rating themselves at medium risk will show a decrease in their self-rated intent by the end of the call.	80%
Survivor Support Services
A minimum of 50 percent of participants will increase their ability to manage their grief.	72.5%
A minimum of 65 percent of participants will show a reduction in depression symptom severity.	70%

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 Agreement includes subcontractors. See Attachment B for information regarding subcontractors and Contract Summary Form.

HCA works collaboratively with each provider to develop a good neighbor policy as required by their agreement. To date, HCA has not received any negative feedback from the respective communities.

Pursuant to Contract Policy Manual Section 3.4-114, authorize the Health Care Agency Director or designee, to exercise a contingency contract cost increase, not to exceed 10 percent of the agreement amount for the first year of the agreement, for the entire term of the agreement, including renewals, and within the scope of work set forth in the agreement. The use of this contingency contract cost increase is subject to approval requirements established by the County Procurement Officer. The contingency provision would be exercised in the event there is an increase in the projected services needed for the clients being served.

HCA requests that the Board approve the Agreement for provision of Suicide Prevention and Support Services with Didi Hirsch, as referenced in the Recommended Actions.

FINANCIAL IMPACT:

Appropriations for this Agreement will be included in Budget Control 042 FY 2020-21 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 Agreement 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.

STAFFING IMPACT:

N/A

ATTACHMENT(S):

Attachment A - Agreement MA-042-20010910 for Suicide Prevention and Support Services
Attachment B - Contract Summary Form
Attachment C - Sole Source Justification Form