NURS 320: What is Care Coordination Video

What is Care Coordination

  • Definition and Importance

    • Care coordination refers to the process of getting and paying for the right care and treatments for children with special healthcare needs.
    • It is an immensely complicated task that typically involves managing care that includes:
    • Primary care
    • Multiple specialists
    • Outpatient therapies
    • Coordination with school services
    • Navigation of special education
    • Investigation of social and disability programs.
    • Families are tasked with this management alongside day-to-day life demands.
    • The need for care coordination stems from the complexity and numerous moving parts involved in healthcare management.

  • Purpose of Care Coordination

    • To bring everyone involved together to ensure that both the child's and the family's needs are being met.
    • Aims to enhance the effectiveness of care for children with special healthcare needs.

Various Terms in Care Coordination

  • Terminology Overview
    • Different terms used in the field of care coordination include:
    • Care Coordination
    • Case Management
    • Case Coordinator
    • Service Coordination
    • Care Management
    • Health Navigators
    • Medical Home or Health Home
    • Promotora Care Teams
    • Care Notebooks
    • Care Portals
    • Dieded Care
    • Family Navigators.
    • Each term can have different meanings and focuses, such as:
    • Some being family-focused.
    • Others aimed at implementing healthcare recommendations.
    • Some designed specifically to cut costs.
    • The approaches and perspectives can vary widely among families, professionals, and systems.

True Care Coordination

  • Standards of Care Coordination
    • Defined as:
    • A patient and family-centered assessment-driven, continuous team-based activity.
    • Designed to meet the biopsychosocial needs of children and youth.
    • Aims to enhance the caregiving skills and capabilities of both person and family.

Key Components of Effective Care Coordination

  • Patient and Family-Centered Approach

    • Care coordination fosters a respectful partnership between the family and the care team.
    • This collaborative effort recognizes the strengths, cultures, traditions, and expertise of each individual involved.
    • Trust is built through:
    • Listening to the family.
    • Offering assistance linked to their needs.
    • Following through on promises.

  • Assessment Driven

    • Activities in care coordination should focus on interactions that allow everyone involved to understand:
    • What is important to the family?
    • What do they value?
    • What specific needs do they have?
    • This does not entail long forms or medical checklists but rather a team approach that shows genuine concern.

  • Continuous Process

    • Care coordination must be ongoing as children develop and families experience changing priorities.
    • The focus of care should adapt over time, while taking into account history and prior experiences.
    • Understanding prior successes and failures aids in preventing urgent care needs or crisis events.

  • Team-Based Structure

    • Families interact with various professionals, including:
    • Doctors
    • Nurses
    • Therapists
    • Teachers and community members.
    • Team structure prevents dependency on a single individual, leading to collaborative backup.
    • Knowledge sharing and retention by team members ensures continuity in care.

  • Clear Activities and Actions

    • Care coordination activities should be directed by the identified needs and goals of the child and family:
    • Creating a shared plan of care collaboratively is crucial.
    • Planned care visits lead to joint development of care strategies, including:
      • Accessing communication assistance.
      • Coaching on advocacy.
      • Sharing necessary information.
      • Implementing prioritized actions.

Addressing Biopsychosocial Needs

  • Holistic Approach
    • Care coordination must address the complete well-being of the child and family, incorporating biological, psychological, and social dimensions.
    • Support mechanisms help the child and family in all life settings, including:
    • Living
    • Learning
    • Working
    • Playing in their community.
    • It provides a pathway to authentic family-centered care.

Enhancing Caregiving Skills

  • Empowering Families

    • Families remain a constant presence in their children's lives, managing education, social, medical, psychological, and fundamental needs.
    • Understanding how to care for their child effectively is a vital desire for families.
    • Each professional brings unique expertise, yet the integration of care often falls to the family.
    • Care coordination brings in a learning partnership that aids families in navigating uncertainties.
    • A care coordinator aids in improving advocacy, reporting, and decision-making skills.

  • Impact of Real Care Coordination

    • Effective care coordination significantly enhances a family's daily life quality and helps achieve parenting goals.
    • By building a supportive team that works towards a shared care plan, the complexities of treatment and coverage are made more manageable.
    • It serves as a practical embodiment of family-centered care principles.

Conclusion

  • Special thanks to Indiana’s care coordination champions for their contributions.
  • This understanding of care coordination was supported by Grant number D70 MC 275 from the Health Resources and Services Administration, a division of the U.S. Department of Health and Human Services.