Bernalillo County: Services to Prevent and Address Adverse Childhood Experiences (ACEs)
Bernalillo County is seeking pilot programs aimed at preventing the incidence of Adverse Childhood Experiences, reducing future Adverse Childhood Experiences in children who have already experienced them, and preventing long-term adverse physical and behavioral health conditions that have been proven to result from exposure to Adverse Childhood Experiences.
Adverse Childhood Experiences (ACEs) are broadly defined as “childhood experiences judged to be stressful for the developing child.” ACEs are broadly categorized into the following groups:
- Abuse: Categories include emotional, physical, and sexual abuse
- Neglect: Categories include emotional and physical neglect
- Household challenges: Categories include domestic violence, household substance abuse, household mental illness, divorce or separation, or household incarceration
The key characteristics of service delivery are detailed below. An award is not incumbent on the inclusion of all of these desired service components, however respondents will be assessed and scored on their ability to respond to the following considerations and the strength of those responses.
Client centered and culturally competent care: Program participation is expected to be voluntary, at the discretion of the participant and with special attention given to a client-focused method of care. Special consideration will be given to programs and service providers that can demonstrate deep connections to the communities they serve, knowledge of languages spoken by clients, staff comprised of community members with close connections to the community, and interventions that support and build upon the strength and resilience of families and communities.
Integration with existing behavioral health care systems: A key goal of Bernalillo County’s Behavioral Health Initiative (BHI) is to identify and fill gaps that currently inhibit the functionality of an integrated and comprehensive behavioral health system. These gaps include but are not limited to:
- Marginalized populations or sub-populations that have difficulty accessing existing behavioral health services due to cost, insurance, cultural, or other barriers
- Missing referral mechanisms that would enable more timely and seamless matching of populations in need to available services
- Discharge processes that place at-risk individuals in inadequate behavioral health care or without access to care
- Inadequate or non-existing processes to assess behavioral health needs and to identify populations at risk of experiencing negative physical and mental health outcomes
With respect to programs aimed at preventing and reducing ACEs, the County believes there are specific gaps in the array of services currently provided. These gaps include, but are not limited to:
- Screening mechanisms to indicate risk factors in children
- In-depth assessment mechanisms for at-risk children
- Serving hard-to-serve populations in greatest need
- Evaluations of program effectiveness
Supplementing and leveraging existing funding sources for behavioral health interventions: Another goal of the BHI is to maximize funds by integrating programs with other forms of funding and by utilizing funds where no other funding is available and where (but for this funding) those services could not otherwise be provided. Proposals must describe the extent to which county funding will be integrated with other municipal, state, federal, and private funding sources. Furthermore, proposals will be asked to describe existing challenges to funding their proposed interventions and provide a description as to why proposed services cannot partially or wholly funded by existing resources.
Leveraging existing institutions for client referral: Respondents must describe their referral mechanisms in depth, and provide assurance that the referral system enables the service provider to target clients with high levels of acuity and high-risks for future negative health outcomes. Further, respondents must describe the extent to which referral mechanisms are related to the identification and measurement of tangible client outcomes, integrated into existing programs or services administered in Bernalillo County and conducive for rigorous program evaluation. Respondents may propose client referral from existing government or health care services including but not limited to the Metropolitan Detention Center (MDC), the juvenile justice system, orders of protection, managed care organizations, local hospitals, and other institutions.
Offerors are encouraged to propose services supported by a strong national and local evidence base. Examples of service delivery models that address ACEs and are supported with a strong evidence base are detailed below. These are not intended to serve as the only examples of what services the County wishes to fund, but rather as examples of services that are backed by strong bodies of research and evidence.
- Home-visiting models that provide voluntary, family-focused services in the family’s primary residence and can provide services that address health, social service, or educational needs
- School-based models that utilize existing connections between schools and other community services such as child care, early education, and pediatric services to extend mental health services and raise awareness for the effects of trauma
- Other approaches, including enhanced primary care, behavioral parent training programs, parent-child interaction therapy, and therapeutic treatment services
Offerors should be able to demonstrate expertise providing prevention and intervention services for youth: 1) Ages zero through five; and/or 2) School-aged youth (five to eighteen).
Where appropriate, services may also be provided to the families and caregivers of children identified to be in need of services. Service providers are to engage with major front doors in the community including (but not limited to) managed care organizations, hospitals, Albuquerque Public Schools, community schools, charter schools, the courts, and law enforcement in order to receive referrals.
Amount: Bernalillo County may fund several interventions in pilot program formats at a total cost not to exceed $3,000,000 per year. The county anticipates to fund one or more interventions for two-year pilot contracts with the expectation that some of those pilots will be scaled-up and/or funded for subsequent years. Offerors will be expected to explain the feasibility of their services being delivered in a pilot format, and whether total yearly expenditures can equal $500,000 or less. Offerors will also be expected to describe how each cost component and the cost of the entire intervention increases as services are scaled, and at what intervals costs and service expansion are increased.
Eligibility: An “Offeror” is defined as any person, corporation, or partnership who chooses to submit a proposal. Offerors should be able to demonstrate that they have the ability to adhere to the service required.
Note: A non-mandatory pre-proposal meeting will be held on November 9, 2016.
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