CSAs and Networked Coordination: Bridging The Gaps In Care

Jul 7, 2017 | Info for Professionals

The need for coordinated care, particularly for those who suffer from behavioral health issues or for those who are not able to fully access the health services they need on their own, is nothing new. Every day, men and women, even children and youth, receive additional support for accessing and coordinating various services related to medical and behavioral health, parenting supports and special education services by going to nonprofit organizations and independent agencies for the kinds of help they just can not get from their traditional medical teams. This enhanced model of care works very well in Massachusetts, where Community Service Agencies (CSAs) work tirelessly to facilitate access to and ensure coordination of care. In essence, they strive to provide an integrated care experience for children, youth and their families.

Supporting children and youth in a wraparound manner and keeping them out of crisis is the desired goal of every team who cares for them. Ideally, there is frictionless sharing of care information between all the various child-serving systems (e.g., child welfare, special education, juvenile justice, mental health).  Unfortunately, the state of care management creates many gaps in care that can cause a child or youth to get into trouble when services for these gaps would have been protective and warded off any unnecessary trips to the emergency room or court house.

The more support touchpoints a child or youth with behavioral health issues and family stressors has, the better off he or she is. Day programs, special education services, vocational supports, life skill agencies, even shelters and clinics can all be those dots on a child/ youth’s care map that helps him/her succeed in more ways than just taking daily medications. But how do you keep track of a child/ youth’s progress in a way that is meaningful when there is a host of touch points that this child/ youth may have to receive services through? This has not only created a problem with inter-agency care management, but kept the child/ youth’s medical team in the dark about the daily life and situational issues that can be very informative in treatment planning.

Connecting All The Dots On The Care Map For Better Coordination

What would it be like if a child/ youth’s social worker could quickly review any new notes that a CSA entered into an online record before they meet with their client for the month? Would it be valuable if a psychiatric nurse could review any communication from the CSAs that their patient receives services from to see if any symptoms of decompensation are becoming evident as they meet with their patient?

Medical record systems are rigid and siloed. Most CSAs don’t need a client’s entire medical record, just a few documents, such as a medication list or recent hospital stays. They’d probably want to know about any new changes in diagnosis or medical status but they don’t need access to the entire medical history of their client. Wouldn’t it be great if the pertinent medical information the impacts a CSA’s ability to service their client was made available for them to review?

The Future Of Managed Care Is In ACOs And Their Relationship with CSAs

An ACO or Accountable Care Organization is a voluntary group of doctors, hospitals and other care organizations that work together to principally ensure that care is delivered to a patient without unnecessary duplication of care and without error due to communication issues.

Communication management in care of children/ youth who receive multiple health, special education and rehabilitation services has plagued HMOs and medical care institutions from the start. The “HOW TO” on how to properly communicate throughout the medical care system at large has been a burden to anyone involved with caring for a patient. ACOs are poised to be the answer to this problem but the question still remains, “how will they commonly communicate about one patient as a group of individual organizations?”

How eCare Vault Is The Answer To The Communication Problems In Care Management

The proper solution for care management is an organizationally-agnostic care communication and collaboration platform. Up ‘til now, such a platform did not exist. Communication between care organizations was largely via phone and fax machine. How archaic and more importantly, how inefficient! eCare Vault is a HIPAA compliant, cloud-based platform that enables the individual care organizations and professionals to center their collaboration around an individual patient, regardless of who they work for or what medical record system they use.

Seamless sharing of documents and real-time discussion boards accessible 24/7 are key features of this privacy-compliant service. The hallmark feature of eCare Vault is that one can think of it like a care-cloud that follows the child across the lifespan, irrespective of the changing landscape of services and supports, providing a continuous record of care!

Patient-centric communication and collaboration is the only logical solution to the significant care management/communication problem. Isn’t it incredible that it took this long for a patient-centered care to finally catch on?!

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