DIVERSEcity Community Resources Society Request for Proposal for External Evaluator for DIVERSEcity’s Building Resilience for Sustainable Recovery project funded by Health Canada’s Substance Use and Addiction Program

Date of Issue: August 5, 2020

Submission Due Date: August 26, 2020

Expected Award Date: September 3, 2020

Inquiries and Proposals should be directed to:

Amanee Elchehimi, Director of Children and Family Services (aelchehimi@dcrs.ca)

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Contents

1.1 Overview of Opportunity ................................................................................................... 3

1.2 Background ..................................................................................................................... 3

1.3 Project Objectives and Brief Description ....................................................................... 5

1.4 Description of Services ................................................................................................... 8

1.5 Deliverables ..................................................................................................................... 9

1.6 Budget.............................................................................................................................. 9

1.7 Evaluator Qualifications .................................................................................................. 9

1.8 Proposal Process ........................................................................................................... 10

1.8.1 Timeline and Submission Requirements .................................................................. 10

1.8.2 Proposal Content ....................................................................................................... 11

1.9 Proposal Evaluation ...................................................................................................... 11

1.9.1 General ....................................................................................................................... 12

1.9.2 Statement of Ownership ........................................................................................... 13

1.9.3 Professional Fee ........................................................................................................ 13

1.9.4 Travel Requirements ................................................................................................. 13

1.9.5 Other Assumptions .................................................................................................... 13

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1.1 Overview of Opportunity

DIVERSEcity is seeking a qualified and experienced evaluator to carry out formative and summative evaluation for its Building Resilience for Sustainable Recovery, a three-year, recently awarded project to pilot, test, and document the role and impact of a collaborative community-based concurrent disorders outreach project delivered by integrated systems specialists (Case Managers/Outreach Concurrent Disorder Therapists) on the resilience, treatment self-determination, functioning, mental health and harm reduction/cessation of 275 adults/youth in Surrey.

The evaluator would work with DIVERSEcity from August 2020 to August 2023 meeting project evaluation and monitoring milestones (see below), ensuring through quarterly KPI reports selected from the performance measurement framework that continuous learning informs the ongoing development of integrated service provision to one of the most vulnerable communities in Surrey.

While initially designed as an outcomes evaluation with identified validated measures, DIVERSEcity is open to revisiting the evaluation approach and outcome measures as part of the initial work plan for evaluation activities scoped for the project.

1.2 Background

DIVERSEcity leverages 40+ years of experience as a keystone settlement and community organization in Surrey, well-known for its specialized and innovative service provision to some of the highest barriered groups in the local community and throughout the Lower Mainland. Its mission is to “inspire belonging in a strong integrated community by empowering newcomers to Canada.” It meets its mandate through the provision of services to newcomer and racialized communities across a range of program areas, including: settlement, community and voluntary, language learning, employment, children and youth, and counselling. Over 2019-2020, 10,000+ clients were served through these program areas.

The organization is a recognized expert on multicultural clinical services (e.g. its landmark I am STRONG! Child and Youth Empowerment Camp for emotional regulation). DIVERSEcity’s Counselling Services department has extensive experience in the delivery of a range of counselling services in numerous languages and culturally appropriate contexts. The in-house expertise of clinicians and managers is well-established in the Service Delivery Area (Surrey, Delta, White Rock and Langley). The organization is at the core of a community response to substance use for the target population, contributing to the City of Surrey - Substance Use Awareness Team (SUAT) as well as on the Tri-Regions Addiction Committee (TRIRAC) and the Regional Addictions Committee (RAC).

For the last 29 years DIVERSEcity has worked in concert with Probation Services to deliver culturally (agile) sensitive, substance use clinical and psychoeducational services (primarily to the South Asian community, N=almost 1000 clients in the last three years). It also partners with Fraser Health Authority to provide group and individual substance use counselling to the Roshni Clinic, which is a supportive substance use program for the South Asian community.

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This work has illuminated gaps in services for those living with concurrent disorders in the region:

• An ongoing lack of services that address both substance use and mental health simultaneously and within cultural context (one out of three people in Surrey is an immigrant). Despite the understanding of an interconnection between substance use and mental health issues, clients may still be excluded from mental health treatment because they are still using and vice versa excluded from drug treatment until they have received mental health support, or are stabilized or not presenting symptoms.

• The lack of a community-based, outreach service staffed by integrated systems specialists who can show up in the right place at the right time AND help clients move between and amongst service tiers across all service sectors (health, community, criminal justice, child protection) needed by this vulnerable group. This service gap prevents those with CD in Surrey from persisting successfully along the pathway to recovery.

• ER services lack an identified service provider that would assist to transition patients who have gone through withdrawal management in the ER to other necessary services, including community-based supports. Krausz et. al. (2015), report that in Canada, “the services for stepped care are mostly missing so the ERs become the inefficient hub of triage and care,” and ERs do not know how to use relevant community services.

• Ongoing confusion for relevant stakeholders of each other's approach, culture and scope of practice, which constrains integrated service provision.

• A need to continue to evolve the evidence base about best practice CD service collaboration to link substance use and mental health service tiers and provide person-focused access and navigation.

Building Resilience for Sustainable Recovery proposes an innovative and new approach to health promotion, prevention, harm reduction and treatment. BC lags behind other jurisdictions in systems collaboration for simultaneous treatment of concurrent disorders (CD). The current provincial mental health and substance use strategy does not explicitly mention concurrent disorders (Ministry of Health, 2017). No other program regionally or provincially could be found that provides a community-based, outreach, extended hours, multi-sectoral CD service in a non-clinical setting, which plays a boundary spanning and transition co-ordination role relative to CD integrated service provision across all the systems that an individual requires for recovery. This project provides a service that will help CD clients transition between all the services they need and connect up the multiple case management fora that they might be involved with simultaneously, e.g. Integrated Case Management (ICM) with MCFD and Assertive Community Teams (ACT) with FHA, as well assisting services to become CD informed and aware.

Besides the direct client services, evaluation and monitoring would contribute to understanding how different stakeholders do and could collaborate to ensure CD clients can move seamlessly within and between service tiers (CCSA, 2013) and in so doing how the program can support a step down approach (particularly in terms of matching clients to community and social supports when symptoms are less severe).

This project is meant to present a model for transition co-ordination and boundary spanning across all of the sectors that CD clients need to access services to support their recovery, a nationally-documented challenge (Virgo Consultants and Island Health, 2014). Moreover, the project could

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provide learning for other community organizations throughout Canada who already work in partnership with child protection, schools, health services and other community resources to meet the needs of those experiencing CD, who want to support system collaboration and ensure screening, brief intervention and referral to treatment. As such, DIVERSEcity will be working with the BC CMHA to disseminate the resources and findings from this project to other local, regional and provincial CMHAs who might wish to explore the potential for this model to be funded in other geographic areas. It will explore the potential of this project to be written up as a case study for the CCSA Supporting Treatment Systems initiative (www.ccdus.ca).

1.3 Project Objectives and Brief Description

This initiative aims to pilot, test, and document the role and impact of a collaborative community-based concurrent disorders outreach project delivered by integrated systems specialists (Case Managers/Outreach Concurrent Disorder Therapists) on the resilience, treatment self-determination, functioning, mental health and harm reduction/cessation of 275 adults/youth in Surrey.

The objectives are to:

• Ensure that Concurrent Disorder Therapists (CDT) and Case Managers (CM) provide integrated, culturally agile (sensitive): systems navigation and referrals, crisis intervention, group and 1-to-1 psychoeducational supports, and comprehensive health and community service planning, connection and bridging for 150 high risk dually diagnosed adults/youth per year of the project (75 youth/75 adults).

• Scope the relationship between the integrated systems specialist support and knowledge translation provided by staff to CD professionals and the delivery of trauma-informed, integrated service provision to clients.

• Investigate if integrated service provision results in improvements to clients’ resilience, functioning/well-being and treatment self-regulation.

• Consider if resilience, functioning/well-being and treatment self-regulation are antecedents of improved mental health and harm reduction/cessation.

• Document the impact of the project on the mental health and harm reduction/cessation on project clients.

This integrated, community-based approach will be guided and informed by a multi-system, multi-stakeholder Steering Committee that will manage the project, direct the work of staff and implement the project sustainability plan. The project will contribute to reducing the gap in the evidence-base on how the integration of outreach, crisis intervention, vocational and social support and recovery services differentially impacts different sub-groups of those with concurrent disorders: men, women, concurrent disorder sub-group type and different cultural groups.

This project will operate primarily on an outreach basis with extended hours (up to 10 pm in the evening, including weekends). CDTs will work with hospitals (e.g. those admitted to psychiatric units), the RCMP and Car 67 (a specialized RCMP car with a mental health worker). The project will

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also work in tandem with government (Ministry for Children and Family Development, Probation Services, Surrey School District, etc.) and community agencies to provide additional support to navigate the complex mental health and addictions and justice systems/processes in Surrey and BC. DIVERSEcity will operationally supervise the staff team, but will utilize a Steering Committee comprised of professionals from partner agencies to help prioritize the work to be done by the team and to work to integrate services at the systems level. This feature makes the project innovative as community stakeholders form an integrated team and will drive the work.

Since CD should be considered an expectation versus an exception there will be multiple entry points to the project with no single agency holding the main referral priority. Recruitment will be continuous. Entry will happen through referrals from: hospitals, ER’s, psychiatric units, schools, parents, self-referral, adult mental health teams, MCFD, Probation Services, community agencies, or any other access point. The goal will be to engage the CDTs immediately and have them begin assessment and case planning as quickly as possible. Direct services will include interventions such as one-to-one therapy, group therapy and connection to psychiatric services. The CDT will also immediately begin working alongside a CM who will take over the planning for each client within 30 days and follow them until they are settled and stable in an appropriate treatment plan while still delivering direct services (groups, counseling, appointment accompaniment, if necessary, etc.). Case Management Services will be delivered up to six months with a 3-month progress report for each client (Case Management appointments will be delivered as dictated by an assessment of CD symptom severity and client need, and frequency decreased as need for services decreases in intensity over time). A relapse plan will be developed at the end of service delivery and recovery monitoring will be facilitated at 3 months and 6-months post-discharge to proactively allow for relapse intakes and relapse prevention. At six and 12 months post the intervention, project outcomes will be measured for evaluation and monitoring activities.

Some evaluation activities will be carried out by staff as part of service provision (e.g. administration of baseline assessment, pre-and post-test, progress reports and follow-ups and KT evaluation feedback forms as well as data entry).

DIVERSEcity will employ an outcomes evaluation approach using mixed methods for performance measurement, including:

• Baseline Survey Assessment of Clients – to assess the severity of mental health and substance use symptoms, to gather demographic data relevant to analyzing the impact of the project in relation to different sub-groups identified and to document ER visits, hospital re/admission and criminal justice system involvement in 12 months previous to commencement of service.

• Pre- and Post-test of Clients relevant to project outcomes – measuring if clients have experienced integrated service provision, improved resilience, improved functioning/well-being, have developed the capacity for self-regulation of treatment to persist on the recovery pathway, reduction/cessation of substance use and improvements in mental health.

• 3-month progress assessment during service delivery – to assess if clients are satisfied with the project, are receiving integrated services and to review client outcomes ratings for therapeutic engagement in the intervention thus far (e.g. have they stayed steady, dis-improved/improved), as well as the extent to which they have gained knowledge and skills relevant to trauma grounding, CBT, goal-setting and service engagement.

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• 6 and 12-month client follow-up – to assess sustainment/dis-improvement of: functioning/well-being, harm reduction, and mental health and rate of recidivism, ER visits and hospital readmission. All clients will be given 6-month follow-up, while any client who completes service prior to Month 22 will receive 12-month follow-up.

• Critical Incident Technique Interviews – with 15 youth and 15 adult clients to explore the attribution of project outcomes to the intervention.

• Knowledge Transfer (KT) creation opportunity feedback – participants at any KT creation opportunity will be invited to offer feedback through an evaluation form that will solicit their views on the extent to which the opportunity contributed to achievement of the outcomes specific to secondary audiences.

• Quarterly Integrated Services Review – by the Steering Committee members to formatively evaluate implementation, barriers and enablers to change, operational management and project governance, fidelity, sustainability and cost-effectiveness and to document the intended and unintended organizational policy, procedure and practice changes as a result of the project.

• In-depth Interviews with Steering Committee Members post the therapeutic activity implementation – to summatively evaluate implementation, barriers and enablers to change, operational management and project governance, fidelity, sustainability and cost-effectiveness and to document the intended and unintended organizational policy, procedure and practice changes as a result of the project. Members will also complete the measures of service integration set out below.

In the project proposal these validated measures/indicators were proposed to measure outcomes:

• Reduction in or cessation of drug and alcohol use – measured by: client self-report using Substance Dependence Severity Scale (Miele et al., 2000 - assesses DSM-IV dependence and abuse and ICD-10 harmful use for alcohol and other drugs for the previous 30 days).

• Mental health – measured by improvements in score for the Symptom Checklist 90-R (Derogatis, 1994).

• Increased Functioning – measured by improvements relative to the WHO Disability Assessment Scale - WHO-DAS 2.0 (World Health Organization, 2017).

• Resilience – measured through The Connor-Davidson Resilience Scale (CD-RISC and CD-RISC2) (Connor, K.M. & Davidson, J.R.T., 2003).

• Health Care Self-determination – measured through the modified Health Care Climate Questionnaire (mHCCQ - Williams et al., 2005; 2007) and Perceived Competence Scale (Ryan, Patrick, Deci, Williams, 2008), the former to measure the extent to which service providers are creating an atmosphere where clients perceive they have self-determination and the latter to measure ability to self-regulate health behaviours.

• Service Integration (Service Provider) – Partnership Self-Assessment Tool (Weiss et al, 2002) and Integration of Human Services Measure (Browne et al. 2000s).

• Hospital Re/admissions – 6-month/One-year rate of repeat hospitalizations (ER or IPU). • Recidivism – 6-month/One-year rate of criminal justice involvement.

Analysis of quantitative data will be done using Statistical Package for the Social Sciences (SPSS), or other appropriate software. Quantitative analysis will involve repeated measures T-test to assess:

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• Whether there is a significant relationship between the intervention and resilience, mental health, health care self-determination, functioning and harm reduction at post-test.

• Whether there is a significant relationship between client outcomes measured at post-test (functioning, resilience, self-determination, mental health) and the outcomes measured at 6-month/12-month follow-up (ER congestion, recidivism, re/admission to hospital).

1.4 Description of Services

The evaluator will:

• Work with DIVERSEcity to refine and confirm the project evaluation approach, including assessing the feasibility of the proposed approach and outcome measures and proposing changes, if appropriate (e.g. recommending alternative outcome measures)

• Write up the project evaluation strategy and plan and complete the performance measurement framework template for submission to the funder

• Ensure that a sex and gender-based analysis of data collected is carried out

• Meet with the Senior Manager/Project Team at agreed milestones

• Confirm client outcome measures/assessments and any licensing/access arrangements and train and support project staff in administration of client measures/assessments (e.g. sourcing measures in different languages if available)

• Set up the project database for data capture (and/or ensure that current systems in DIVERSEcity capture required data and can be easily retrieved for analysis)

• Develop additional evaluation and monitoring data collection tools beyond those related to direct client service

• Develop brief quarterly project monitoring report template and carry out quarterly analysis of monitoring data presenting KPI data to support continuous learning and development

• Facilitate the Integrated Services Quarterly Review with the Project Steering Committee

• Carry out N= 20 Client Critical Incident Interviews

• Schedule Steering Committee Member Interviews

• Carry out summative evaluation interviews with Steering Committee Members

• Carry out a brief literature review (max 20 sources) to update the literature reviewed in the original proposal and inform interpretation of results

• Carry out detailed final analysis of data and writing of evaluation report including blueprint of project model and recommendations about sustainability of project outcomes and continuing integrated service provision for CD clients in Surrey

• Make amendments to the final report.

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1.5 Deliverables

The deliverables and estimated delivery times are as follows (these may change as work plan is revised just before the full implementation phase):

• Evaluation Strategy and Plan document (September 2020)

• Completed Performance Measurement Framework template for the funder (September 2020)

• Data collection tools: client outcome measures, quarterly review learning framework, Critical Incident Interview schedule, Steering Committee Summative Interview schedule, quarterly report template, KT Feedback Forms (November 2020)

• Administration guidelines documents for client outcome measures (November 2020)

• Project database (November 2020)

• 11 Quarterly Reviews with Steering Committee (first one due February/March 2021 and quarterly thereafter - to be aligned with scheduled Steering Committee Meetings)

• 11 KPI Quarterly Reports (first one due February/March 2021 and quarterly thereafter)

• Mid-way KPI Report (February/March 2022)

• Final Project Report (August 2023)

1.6 Budget The total budget for this work is $52,500, with the following breakdown:

• September 1, 2020 – March 31, 2021: $15,000 payment + $750 stipend per month ($19,500) • April 1, 2021 – March 31, 2022: $15,000 payment + $750 stipend per month ($24,000) • April 1, 2022 – March 31, 2023: $750 stipend per month ($9,000)

DIVERSEcity is supportive of the evaluator or evaluation team in applications for grant funding to enhance the overall evaluation effort.

1.7 Evaluator Qualifications

• Five years of demonstrable project evaluation experience, preferably of mental health projects (provide three examples of project evaluation reports)

• Ability to plan and implement a range of evaluation approaches (e.g. developmental, process, outcome, impact)

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• Ability to carry out detailed statistical analyses for correlational research

• Demonstrable breadth of knowledge on available measures to assess the stated project outcomes and the pros and cons of using them in a project of this type (e.g. substance dependency, depression, functioning, etc.)

• Proven experience related to applied research with community-bases initiatives and working constructively with non-profits to ensure that evaluation activities are feasible within, and support project implementation, preferably on projects that aimed to meet the needs of culturally-diverse and multi-barriered/at risk target groups.

• Demonstrated understanding of best practices in culturally competent mental health care and integrated service provision

• Demonstrated experience in carrying out sex and gender-based analysis and cultural analysis informed by an understanding of the intersectionality of oppression.

• Ability to produce publication-ready reports and presentations for non-academic audiences

1.8 Proposal Process

1.8.1 Timeline and Submission Requirements

Activity Deadline

RFP issued and posted August 6, 2020

Deadline for submission of questions August 14, 2020

Questions and answers circulated to respondents August 18, 2020

Proposals due August 26, 2020

Analysis and evaluation of proposals Rolling Evaluation

Firm interviews, if required By September 1, 2020

Respondents advised electronically of the status of their submission September 3, 2020

Contract signed with successful individual/team September 7, 2020

Project initiation meeting by Zoom with successful consultant September 9, 2020

Evaluation Plan Outline October 1, 2020

First draft of final report May 2023

Final report July 2023

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1.8.2 Proposal Content

The proposal must not exceed 20 pages (excluding appendices) and must include supporting narrative in relation to the following elements:

• Brief overview of the individual/s or company submitting the proposal

• Proposed team

• Understanding of DIVERSEcity needs

• Proposed approach/methodology

• Proposed work plan

• Fee proposal and budget

• Previous relevant project references (names and contact details of someone who can be contacted about each one) and overview relevant projects that are related to: 1) mental health of multi-barriered target groups, 2) applied research in a community-based project, and 3) integrated service provision

• Appendix A – Any other supporting documentation the bidder feels is relevant.

• Appendix B – Curriculum Vitae (CV) for each team member (limit of three pages that details the most relevant work pertaining to this project).

1.9 Proposal Evaluation

The following criteria will be used in evaluating proposals.

Criterion Score

Understanding of need /10

Approach and methodology (in light of it as a community-based and applied research project with a multi-barriered population, knowledge of relevant measures)

/30

Demonstrable experience and knowledge of project subject areas in terms of latest research and best practice: mental health/addiction, integrated service provision within step down care)

/20

Relevance of project examples and references /20

Proposal quality and quality of project report examples /10

Experience and qualifications of the proposed evaluator/s /10

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1.9.1 General

This RFP is not a tender and does not commit the Society in any way to select a preferred bidder, or to proceed to negotiations for a contract, or to award a contract. The Society reserves the right to at any time for any reason reject all proposals, terminate this RFP and proceed with the obtaining the services in some other manner.

Notwithstanding any other section of this RFP or any practice or custom of the trade or industry, the Society, in its discretion, reserves the complete right to at any time and from time to time do any or all of the following:

(a) accept any proposal;

(b) disqualify a bidder from this RFP;

(c) reject any proposal for any reason, including without limitation if in the Society’s view the proponent does not have sufficient experience performing the services;

(d) reject all proposals for any reason, terminate this RFP process and, if the Society elects, obtain or proceed with the services in some other manner, including by conducting a new procurement process;

(e) accept a proposal which is not the lowest cost proposal even if the lowest cost proposal conforms in all respects with the requirements set out in this RFP; and

(f) not proceed to review and evaluate, or discontinue the evaluation of, any proposal.

The Society may, in its discretion, reject any proposal which fails to conform to or includes qualifications to the requirements of this RFP, which is materially incomplete, obscure, or irregular, which contains exceptions or variations, or which omits any material information required to be submitted. Notwithstanding anything to the contrary in this RFP, the Society may in its discretion retain any such proposal for consideration and may waive any or all of the foregoing, on such terms and conditions as the Society may consider appropriate, and consider such proposal in the same manner as proposals that fully conform to the requirements of this RFP without qualification.

By submitting a proposal, each bidder agrees that the Society and its employees, advisors and representatives will not under any circumstances be liable for any claims, whether for costs, expenses, losses or damages, or loss of anticipated profits, or for any other matter whatsoever, incurred by the bidder in preparing and submitting a proposal, participating in this RFP process or other activity related to or arising out of this RFP process, including if the Society for any reason cancels this RFP process, rejects any or all proposals, accepts any compliant or non-compliant proposal or breaches any duty of fairness, express or implied term of the proposal documents or other duty to the bidder. Bidders are solely responsible for all costs whatsoever incurred by the bidder in connection with preparing and submitting a proposal and negotiating a contract.

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1.9.2 Statement of Ownership

All products, materials and reports prepared under this activity will be the exclusive property of CPSI. All materials associated with the project must be sent to CPSI with the final report.

1.9.3 Professional Fee

It should be noted that no commission should be sought or accepted from any service provider or accommodation provider. Remuneration therefore will be reflected in the professional fee outlined in the RFP response. 1.9.4 Travel Requirements We expect that much of the work will be done virtually, with limited travel as required for key meetings or information gathering. The proposal may outline anticipated travel; however, the contractor will assume management of all travel within the parameters of the project’s budget.

1.9.5 Other Assumptions

This evaluation is consistent with standard evaluation practices. DIVERSEcity will support this evaluation by providing data, documentation, and ongoing collaboration to ensure that the evaluation is conducted in accordance with the agreed upon timelines. DIVERSEcity staff will establish a schedule of regular meetings with the successful applicant to coordinate and monitor the progress of this project.