Dimensions for Cohesion and Collaboration

Opeeka’s P-CIS: Dimensions for Cohesion and Collaboration

Opeeka’s Solution For Whole-Person Care

It has been a whole year since I moved after serving a statewide children’s system of care for almost two-decades. Many folks have asked what led me to move over to Opeeka, and my answer was simple, “To increase systemic collaborations.” My arriving here at Opeeka was destiny. I can now connect with so many people from all over the world around ways to achieve success-focused care for children/youth, emerging adults, adults, and their families.

Opeeka has developed the solution for preventing fragmented care; it is aptly named Person-Centered Intelligence Solution (P-CIS|pronounced pieces). This solution prevents individuals from having to re-tell their story over and over again. Instead their information will follow them throughout care, rather than being ‘housed’ in a siloed electronic health record or EHR. P-CIS provides a platform for integrating information to be securely shared with other system partners, ultimately accomplishing whole-person care.

Systems of Care has a long history, where it’s philosophical values and principles guide the processes of service-delivery for those involved with multiple systems (child-welfare, juvenile justice, behavioral/mental health, special education). However, there continues to be challenges around ‘sharing information’ to ensure collaborative care planning. Instead, each system gathers a portion of information, about that individual (or family), which they require to complete their work. As a result, the person/family receives fragmented rather than comprehensive care.

When we have fragmented information there is a greater chance to make inaccurate assumptions or even misdiagnoses.  It reminds me of the Blind Men and The Elephant, where six blind men who have never come across an elephant before had to learn to imagine what the elephant was like by touching it. Each of the blind men felt a different part of the elephant’s body, but only one part; the side, trunk, leg, tail, ear or tusk. The point being that each was able to describe in detail what they experienced, which was an accurate depiction of part of an elephant. The most comprehensive understanding of something or someone can only be accomplished when there are multiple perspectives included in the description.

Solutions Exist Now For Support of Collaborative Systems Work

It has been amazing meeting with people from every human-service vector around the world. My work specifically supports ‘solution-focused care’ solutions. In other words, helping to put all the ‘pieces’ of the work together for successful systems of care. Often the solution on how to specifically support the work of wraparound, child/family teams, and the use of TCOM Tools was to unify information gathered. Opeeka’s Person-Centered Intelligence Solution or P-CIS (appropriately called pieces) effectively supports the values and principles of systems of care, by increasing systemic collaborations while monitoring care in ‘real-time.’

P-CIS is not one more layer of technology, where administrators, supervisors and staff must learn to use to serve those in care. Instead, P-CIS brings another dimension, by highlighting the data. Our system can integrate and support any electronic health record with single-sign on capability. The reason is that P-CIS is not an electronic health record (EHR) rather it is a ‘collaborative transformational care planning’ system, allowing for data to be analyzed in ‘real-time’ and brought directly up-front for optimal outcomes in care planning. Additionally, the data from a variety of sources (systems attached to individuals/families) can be incorporated and utilized at the person and population levels for success.

Opeeka’s Success-Focused Artificial Intelligence (SF-AI) learns what works for whom, using real data in real time. Therefore, all members of a treatment team (wraparound), including each service provider, will benefit from using P-CIS where they will differentiate themselves by using SF-AI to evidence the real-time effectiveness of their programs/services. Easy to read dashboards highlight progress in ‘real-time’, which reinforces effectiveness of supervision and supports workforce. P-CIS complies with state/federal privacy protections (HIPAA, 42-CFR) ensuring information is only being shared for what is needed for the team to be successful.

P-CIS Ensures Information Follows Those Being Served

It was my experience that individuals and families had to retell their stories repeatedly to various systems, who were supposed to be part of their team. This is not only frustrating but disrespectful and can even be retraumatizing. So, if the basic tenant of our work is always to ‘do no harm’ then why are we keeping the information siloed? Personal health information must be kept secure and protected. However, that does not mean that pertinent information should be kept from those who are providing care. Instead, with the proper protocols followed, all pertinent information should be made available to those who are engaged in providing whole-person care.

So, is there a way to effectively and securely make sure that information follows those in care? The answer is a resounding, ‘Yes!’ and Opeeka has the solution, which is aptly named P-CIS, pronounced pieces, or Person-Centered Intelligence Solution. Throughout this past year, I have had conversations with individuals from across the United States and well beyond, including Canada, England, Italy, and Uganda. After describing Opeeka’s solution, most replies are filled with intrigue and the preverbal ‘Wow!’

Putting the ‘Pieces’ together was the goal of Dr. Kate Cordell and Ken Knecht, Opeeka’s Co-Founders. They, along with the entire Opeeka Team, wanted to solve this need with a solution. It was time that technology allowed electronic health records (EHRs) to seamlessly share information, just enough information, to put an end to fragmented care. We know that fragmented care is not effective in achieving ‘whole-person’ care. Whole-person care replaces symptom reduction or reducing risk and we can get a step closer to achieving health-equity for all.

Opeeka Supports Goal of Transformational Care-Planning

The work within ‘human-services’ has been redefined by Dr. John Lyons-University of Kentucky’s Director of the Center for Innovation in Population Health (IPH). According to the Praed Foundation:

Transformational Collaborative Outcomes Management (TCOM) is a conceptual framework for managing systems, organizations, and programs whose mission is to help people change their lives is some important way. Originally, rising out of the field of outcomes management and called Total Clinical Outcomes Management (Lyons, 2004), TCOM uses a consensus-based assessment process to ensure the ability of systems to focus the work of the system.  The approach was renamed in 2014 (Israel & Lyons) to highlight how TCOM is different from other approaches to outcomes management—with a focus on personal change and collaboration at all level of the system (Praed, 2022).  

No longer is TCOM just a conceptual framework for systems to ensure effective collaboration at all levels. Opeeka has created an incredible platform, which can be used by an individual agency or organization, county/state systems and national/international systems in support of trauma-informed, evidence-based, culturally responsive care. Opeeka was honored to host a TCOM Town Hall with Dr. John Lyons: Using Technology In Supporting Our Work” back in December of 2021. Dr. Lyons has supported states, regions, and countries in successful implementation of systems of care, serving children/youth, emerging adults and families.

It was incredible to listen to Dr. Lyons describe the importance of transformational collaboration among systems to effectively mitigate the impact of the world-wide pandemic on those who society has historically marginalized. No longer can society stand-by without not only acknowledging the impact of social determinants of health (SoDH) and adverse childhood experiences (ACEs) but must also respond with systemic solutions. Dr. Lyons’ statement during this Town Hall was inspiring and provided hope for the future:

Opeeka might be the only health care technology company out there that really gets it. Their Person-Centered Intelligence Solution has transformed care planning and clinical decision-making. Clinical tools like the CANS are even more dynamic because of the new found capability to measure the resolution of needs and the trajectories of recovery and resilience over time (Dr. Lyons, December 2021).

Full-Circle In System of Care Work: Future Focus

It has been an honor to serve in my many roles within the system of care movement. The decades spent supporting the implementation of a statewide children’s SOC, in as a clinical director for a Care Management Organization and as a researcher/trainer/curricula developer at a behavioral research training institute at a nationally recognized university was incredible. Moving over to Opeeka has allowed me to offer all that I have learned and experienced to support systems of care worldwide.

Since joining ‘Team Opeeka’ I have been afforded the privilege of serving as part of an incredible group of thought-leaders. We, as a team, have dedicated ourselves to transforming systems around the world ensuring health equity for all. The work we do everyday parallels the goals of human-services. It is important to fully understand our past or history. However, these precursors are not meant to be determinants of success, rather they are to provide a context for knowledge of what to focus on in the present day. It is the putting these ‘PIECES’ together where we all have a more complete understanding of those things, we need to work on in developing our future self.

We are stronger as a collective whole; connected to our family, our community, state where we reside, country where we live and to the overall value of our world where we live and serve others together as human-beings. Person-Centered Intelligence Solution (P-CIS) ensures that their full-story follows those we serve, in whatever field they work, so that they are able to pursue what every human-being pursues: being able to live their lives, being loved and to love others, learning in pursuit of knowledge, and for their life to matter, so that everyone’s LEGACY can be known!

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