Contract Request Template (Contracts; IGAs; Leases)
Date Submitted:8-21-2023
Requesting Agency: Denver Sheriff
Division:
Subject Matter Expert Name: Christina Amparan
Email Address: christina.amparan@denvergov.org <mailto:christina.amparan@denvergov.org>
Phone Number:
Item Title & Description:
(Do not delete the following instructions)
These appear on the Council meeting agenda. Initially, the requesting agency will enter a 2-3 sentence description. Upon bill filling, the City Attorney’s Office should enter the title above the description (the title should be in bold font).
Both the title and description must be entered between the red “title” and “body” below. Do not at any time delete the red “title” or “body” markers from this template.
title
A bill for an ordinance approving a proposed Third Amendatory Agreement between the City and County of Denver and Denver Health and Hospital Authority, to cover additional staffing needs related to the requirements of Senate Bill 19-223, providing interim mental health services for individuals who have been court-ordered for inpatient competency restoration and are awaiting admission to an inpatient bed, citywide.
Amends an intergovernmental agreement with Denver Health and Hospital Authority (DHHA) by adding $310,000 for a new total of $1,147,882.91 and one year for a new end date of 6-30-2024 to cover additional staffing needs related to the requirements of Senate Bill 19-223, providing interim mental health services for individuals who have been court-ordered for inpatient competency restoration and are awaiting admission to an inpatient bed, citywide (SHERF-202368693-03 /SHERF-202056255). The last regularly scheduled Council meeting within the 30-day review period is on 9-25-2023. The Committee approved filing this item at its meeting on 8-23-2023.
body
Affected Council District(s) or citywide?
Citywide
Contract Control Number:
SHERF-202368691
Vendor/Contractor Name (including any “DBA”):
Denver Health and Hospital Authority
Type and Scope of services to be performed:
Target Population. Adults 18 years of age and older that are awaiting an in-custody competency evaluation, awaiting inpatient competency restoration services, are suspected of becoming incompetent to proceed while in jail, or are returning from a CDHS designated inpatient restoration site after receiving restoration services, and who meet any of the following criteria:
a. Have a serious and persistent mental health disorder.
b. Are experiencing acute psychosis or major mood dysregulation.
c. Have substance use issues, especially if suspicion of intoxication is present.
d. Have a low IQ or significant cognitive issues, including dementia, or observable and reported symptoms of mental illness.
e. Have a known previous competency history.
f. Have a Traumatic Brain Injury (TBI).
2.1 Program Referral. The Subcontractor shall refer individuals for competency enhancement services through one of the following ways:
a. When a client has been ordered by the court to be evaluated for competency, found incompetent to proceed (ITP), and/or when inpatient restoration has been ordered.
b. Upon return from a CDHS designated inpatient restoration site.
c. Jail identifies the individual to be in crisis at booking or during the jail stay as defined in section 1.2 Target Population of this statement of work.
d. Priority should be given to individuals who have been found incompetent to proceed and are awaiting admission to the state hospital. Priority should also include individuals who are awaiting a competency evaluation and are highly acute and/or in crisis.
2.2 Court Ordered Treatment Level of Care Type. Taking into consideration the court- ordered competency evaluation, current clinical presentation, any assessment or evaluation, and placement of an individual within the jail, treatment services and contact standards should be based on the following three categories:
a. High Clinical Acuity:
i. Non-compliant with medication, may require the use of forced medications.
ii. Meets 27-65 criteria (i.e., threats or attempts at suicide or seriously bodily harm to self; homicidal or violent acts, attempts, or threats towards others; incapable of making informed decisions or providing for own essential needs without supervision placing themselves at risk for substantial bodily harm, aka gravely disabled).
iii. Placed in a special management unit due to significant medical or behavioral health concerns.
iv. Significant behavioral concerns including verbal and physical threats or need for physical restraint or other involuntary control methods.
1. Unable or unwilling to perform activities of daily living (i.e., catatonic, immobile, consistently not eating/drinking/bathing)
2. Significant risk behavior (unsafe behaviors, such as those listed above, of any type more than 50% of the time)
3. Client has little or no insight into risks
4. Client with significant/severe cognitive or emotional problems that could be barriers to safer behavior
5. Client who has no understanding of or control of behavior
These individuals are in need of immediate coordination of transfer to a CDHS designated inpatient restoration site or consideration for an alternative means of crisis intervention.
They should have daily contact and access to crisis intervention and stabilization services. The Subcontractor will work with the FST Program Coordinator to appropriately triage admission or alternative intervention.
b. Moderate Clinical Acuity:
i. Increased or decreased behaviors from either low acuity or high acuity units and/or monitoring
ii. Generally compliant with psychotropic medication and jail based behavioral health or other resources (under some circumstances may be non-compliant with medications, actively experiencing symptoms of a mental health disorder, but not posing a significant or immediate risk of danger to self or others)
iii. Housing in the general population or transitioning from a special management unit
iv. In general population with psychotropic medication compliance decreasing to less than 80% of the time
v. Temporary medical conditions
vi. Increased ability or willingness to perform activities of daily living from the previous baseline
vii. Moderate risk behavior (unsafe behaviors of any type more than 20-50% of the time)
1. Client has a poor understanding of risks
2. Client has mild/moderate cognitive or emotional problems that could be a barrier to safer behavior
These individuals should have daily contact with the jail medical and/or mental health team. Efforts shall be made to assist in the stabilization of these individuals through clinically indicated regular and frequent contact with mental health clinicians. If clinically appropriate, these individuals should be assessed for and offered treatment services.
These treatment services should include, but are not limited to, groups, individuals, medication management, crisis intervention, and / or MAT.
c. Low Clinical Acuity:
i. Consistently taking psychotropic medication on their own accord (at least 80% of the time)
ii. Ability to and willingness to perform activities of daily living.
iii. Placed in the general population or general supervision cell (this may include individuals with cognitive disorders as opposed to severe mental illness)
iv. Actively engaging in jail based behavioral health or other resources.
v. Occasional risk behavior (client has a fair understanding of risks - unsafe behaviors of any type less than 20% of the time)
These individuals should have daily contact with the medical and/or mental health services team. Efforts shall be made to assist in the stabilization of these individuals through clinically indicated regular and frequent contact with mental health clinicians. If clinically appropriate, these individuals should be assessed for and offered treatment services. These services include, but are not limited to, groups, individuals, medication management, crisis intervention, and / or MAT. Based on clinical acuity, this population may be better suited for outpatient restoration. Competency enhancement program (CEP) should work with and/or refer these individuals to the Forensic Navigator for potential community transition planning. Contractor shall coordinate services with the assigned Forensic Navigator(s)
2.3 Jail Identified Treatment Level of Care Type. At booking, the Subcontractor shall identify individuals that are referenced in section 1.2 “Target Population” and provide treatment services while the individual is awaiting a court hearing. These services include, but are not limited to, groups, individuals, medication management, crisis intervention, and / or MAT. These provisional services are an attempt to intervene and stabilize the identified individual before court-ordered competency is raised.
a. Jail Booking Screening and Referral. The Contractor shall ensure that individuals are screened within 48 hours from booking and referred for additional treatment services based upon the results of the screens. The Contractor shall employ evidence-based curricula, addressing the following areas listed below. All tools are subject to approval by the Behavioral Health Administration (BHA) or Office of Civil and Forensic Mental Health (OCFMH):
i. Substance Use Disorders
ii. Mental Health Disorders
iii. Suicide Risk
b. Jail Referral Process. When there is a positive screen for either substance use, mental health, or suicidal ideation, the Contractor shall ensure that the individual is referred for further assessment with a mental health clinician. Further assessment details shall be shared with the assigned Forensic Navigator(s), informing the Navigators when individuals are placed on or taken off safety protocols.
2.4 Jail Mental Health Evaluation. The Subcontractor shall ensure that a mental health evaluation is performed promptly on all individuals that have been identified as the “Target Population” referenced in section 1.2, either through the court-ordered referral process or through the jail-identified process. A jail mental health evaluation shall identify treatment needs while the individual is awaiting court proceedings or a CDHS designated inpatient restoration site bed. Mental Health Evaluations shall be shared with the assigned Forensic Navigator(s).
2.5 Transition Plan. The Subcontractor and assigned Forensic Navigator(s) shall work to ensure that a transition plan is developed with an individual upon transition to a OFCFMH designated inpatient restoration facility. The transition plan and report shall outline the following:
a. Mental health diagnosis
b. Level of Care type (if applicable)
c. Current mental health presentation:
Symptoms
Medication adherence
Behaviors
Suicidal/homicidal ideations
d. Prescribed psychotropic medications
e. Any identifiable cognitive impairment(s)
f. Treatment services received in jail
g. Copy of the initial plan of care
h. Placement within the jail
i. Information related to community transition plans including emergency contacts and any pending community referrals
j. Any known medical conditions
2.6 Discharge Plan. Upon the individual’s return from an CDHS designated inpatient restoration site, the Subcontractor shall save a copy of the individual’s discharge plan within the same day that individual returns. Once a copy is received, the Subcontractor shall ensure follow-up care is provided, according to that plan, within 24 hours upon return, as well as provide continual treatment services until the person is released from jail. The Subcontractor should make every attempt to continue the individuals on the prescribed course of treatment to include prescribed medications. Medications should not be altered solely based on cost or philosophy. Treatment courses should only be changed if medically or clinically indicated.
2.7 Outpatient Restoration Plan. When the Subcontractor becomes aware that a client’s competency and/or clinical status has improved (due to jail based behavioral health services, sobriety, or medication management), the Subcontractor shall work in collaboration with the Forensic Navigator to identify community supports and/or existing protective factors that would aid in a community transition/re-entry.
2.8 Information Sharing. The Subcontractor is expected to provide regular and frequent updates to the assigned Forensic Navigator(s). These updates should include clinical presentation, housing placement within the jail, medication compliance and adherence, assessment and evaluation information, information related to transition planning, medical condition information, disciplinary/conduct information, and attempted interventions to address unmanaged symptoms.
2.9 Critical Incidents. The Subcontractor shall report any critical incidents to the assigned Forensic Navigator(s) via email or telephone immediately and no more than 24 hours after the event. Critical incidents include but are not limited to: death, suicide attempt, suicide completion, escape, injury to self or others, assault on staff, sexual assault, and significant medical emergency resulting in hospitalization.
2.10 Staff Coverage. The Subcontractor will ensure that appropriate staff coverage is available (back up clinicians, etc.) in order to cover unplanned absences or leave.
2.11 Pre-Restoration Education. The Subcontractor will work with the FST to identify individuals who may be eligible for pre-restoration education. Pre-restoration education will be reserved for individuals who have been found incompetent to proceed, are awaiting admission to inpatient competency restoration, are deemed by the FST and JBBS as having moderate to low clinical acuity, are involved and engaged in jail-based treatment, and have barriers to bond
Location (if applicable):
WBE/MBE/DBE goals that were applied, if applicable (construction, design, Airport concession contracts):
N/A
Are WBE/MBE/DBE goals met (if applicable)?
N/A
Is the contract new/a renewal/extension or amendment?
Amendment
Was this contractor selected by competitive process or sole source?
For New contracts
Term of initial contract:
Options for Renewal:
How many renewals (i.e. up to 2 renewals)?
Term of any renewals (i.e. 1 year each):
Cost of initial contract term:
Cost of any renewals:
Total contract value council is approving if all renewals exercised:
For Amendments/Renewals Extensions:
Is this a change to cost/pricing; length of term; terms unrelated to time or price (List all that apply)?
Cost, length of time, scope of work
If length changing
What was the length of the term of the original contract?
7/01/2020 - 6/30/2020
What is the length of the extension/renewal?
One year
What is the revised total term of the contract?
7/01/2020 - 6/30/2024
If cost changing
What was the original value of the entire contract prior to this proposed change?
$837,882.91
What is the value of the proposed change?
$310,000
What is the new/revised total value including change?
$1,147,882.91
If terms changing
Describe the change and the reason for it (i.e. compliance with state law, different way of doing business etc.)
Increase in additional funds is due to:
• Direct Costs due to a 3% Cost of Living increase. Direct costs include salaries, benefits, and travel.
• Moving a Psych Candidate from a .9FTE to Full-time
• Addition to a clerical support position
This agreement is tied to our JBBS grant funded programs which requires new Amendatory Agreement annually