How to Coordinate Care For Multi-system Served Children for AB 2083

How to Coordinate Care For Multi-system Served Children for AB 2083

This is part 2 of this series. You can access part 1 here or download the entire concept paper here.

What is a coordinated system of care?

A coordinated system of care is a type of healthcare that is designed to provide all the necessary services and resources for a families’ health, safety, and well-being. In a coordinated system of care a family’s needs are met through linkage and referral to resources, and services. Coordinated systems of care are different from traditional care systems because they are designed to deliver comprehensive care for all of a families needs.

Are technology barriers are hindering child and family teaming?

California has worked hard over the last years to develop a successful child and family teaming process. State departments have spent immeasurable efforts developing the Integrate Core Practice Model (ICPM), and it remains to be fully realized due to technological barriers.

What problems are caused by current technology barriers?

• Duplicate Efforts and Wasted Resources. Duplicate assessments are being collected across agencies where data sharing is not technologically possible.

• Uninformed Practice. Important information which could inform practice never reaches the point of care in time.

• Unsupported Data. Local partners have local needs and may use different versions or altogether different screens/assessments. When there are differences, this creates more barriers to capturing and sharing data.

• Uninformed System. It is impossible to evaluate or monitor care for a whole child/youth and family because agency in the system captures only one part of the overall well-being and safety of the child/youth and family.

• Unsupported Collaboration. System partners utilize different electronic systems to capture information, screens/assessments on different timelines. There is no universal system to support a collaborative workflow.

System of care partners are engaged and ready to collaborate in California, and recent legislation, including AB 2083 have made collaboration legally possible and encouraged. We just need to remove the technology barriers.

What technology barriers are addressed by P-CIS?

No Duplication of Efforts.

P-CIS fosters collaboration through its Care Circles. In Care Circles, agencies can set up sharing for sets of people and sets of assessment types and allow for the redaction by assessment question as necessary. Since P-CIS uses a standardized data model for assessment, any type or version of assessment can be shared or unshared at any time. Sharing can happen between any participating partner agencies in Care Collaboration.

Informed Practice.

Since P-CIS Care Circles support secure sharing of data and P-CIS Application Programming Interface (API) supports secure exchange of data between electronic record systems, information about children’s/youth’s and families’ needs and strengths can be available in real time at the point of care. P-CIS can ingest data from Department of Health Care Services, Department of Social Services, other department, agencies, local electronic records and any other standardized data source. In this way, P-CIS will allow every child/youth and family to experience informed practice through a fully supported ICPM.

Supported Data.

P-CIS supports nearly any type of assessment and allows for multiple versions of any type of assessment. In this way, local and state agencies can choose the assessments and the versions of assessment that are right to inform local practice. P-CIS standard and agnostic assessment system allows for easy calibration of nearly any type of assessment in 30 minutes. So not only does P-CIS support any version of the CANS, but it also supports any version of the Strengths and Difficulties Questionnaire (SDQ), the Pediatric Symptom Checklist (PSC), the Wraparound Fidelity Index (WIFI) and tens of thousands of other assessment types, including agency’s own questions. P-CIS also capture youth voice, supported by an Invite to Complete functionality which allows staff to email questionnaires to youth, caregivers, supports and external workers for completion. P-CIS tracks whose voice each assessment represents.

Informed System.

P-CIS acts as a central repository for all assessments and outcomes for children/youth and families served by the system of care. Further, P-CIS integrates analytical engines of R and Python such that data funnels directly into customizable analytic processes. P-CIS comes with standard person-level, family-level, staff-level, program-level, county-level and state-level dynamic analytical dashboards powered by R and Python. In addition, local analytic staff can customize new evaluation models and dashboards through P-CIS open analytical interface. In this way, staff can monitor system outcomes and algorithms for quality, performance, and bias. P-CIS supports any level of ongoing monitoring and supports higher level analytics such as regression, machine learning and artificial intelligence, if desired. P-CIS uniform data and automated analytical models support evidence- informed decisions at a client, local, and state levels.

All models built in P-CIS by Opeeka or local staff are built with a combination of SQL, Python and R code. Therefore, all statistical models built in P-CIS can be exported from P-CIS and implemented in any other system which supports these universal languages. In this way, all development of custom models can be retained through any transition to any other system which supports these standard languages.

Supported Collaboration.

P-CIS serves as the interoperable glue between all types of electronic records used by agencies in a system of care. Acting as a data super highway, P-CIS not only supports uniform data exchange, it also provides secure and judicial sharing of information on one child/youth or sets of children/youth and families. In addition, it provides useful transformation and visualization of data to inform individual care as well as system performance. With P-CIS everyone in the System of Care can work from the same information supporting coordination of assessments, care planning, and outcome monitoring between system partners.

P-CIS Unifies a Circle of Care for Child and Family Teaming and Universal Service Planning

Supporting a System of Care

Continue to Next Blog?

This is Part 2 of the blog. Continue on to Part 3 here or download the entire concept paper here.