Westcoast Children’s Clinic (WCC) has committed itself to practice-improvement in countless ways that have benefited the entire Alameda County system of care. One recent innovation in their intake process is showing promise for increasing engagement, client voice & choice, and TCOM integration. Like many organizations, WCC has traditionally used an initial intake process that is somewhat divorced from assessment and treatment. In this old model, a clinically trained intake clinician would take calls, check Medi-Cal eligibility, and gather relevant information about the client/family presenting issues and needs. Following this hour-long phone intake, the intake clinicians would make clinical determinations about the general course of treatment and would match the client with a clinician who best suited the client’s needs. When clinically indicated, the intake clinician would refer the client to services elsewhere. Although this process was designed to ensure clinical excellence and is conducted with sensitivity to the client’s experience, there are potential disconnections in having a lengthy intake on the phone prior to starting even lengthier assessment process with another WCC team member.
 
In the Spring of 2018, WCC formed a pilot group of about eight clinicians. All were TCOM champions interested in helping to improve engagement practices within their organization. Each was selected by a supervisor or director who recognized their ability to embed TCOM principles into their engagement, assessment and treatment activities. The group was involved in the development and implementation of a strategy to infuse these principles more fully into the WCC intake process.  The resulting pilot approach is called Collaborative Initial Evaluation and it differs from their traditional intake process in significant ways.

The largest difference is that the initial phone contact with a client is very brief and is used primarily to set up a face to face meeting with a Collaborative Initial Evaluation clinician.  This clinician would work with the client for up to 30 days, effectively conducting screening, intake and assessment in an integrated manner as the client’s needs become clarified. In this approach, there is no decision made about the course of treatment without the family’s input. Rather, needs and goals are discussed over the course of the month, allowing the clinician to centralize a relational and deferential stance with the client while also gathering all the information necessary for a complete clinical assessment. To ensure that TCOM and Communimetric principles are at the heart of this process, the clinician and client follow a comprehensive but concise guide. The semi-structured guides lead them through a collaborative conversation about the client’s hopes for transformation in all the potentially relevant life domains covered in Alameda County’s version of the CANS. As this process unfolds, the client’s “top needs” are identified, and only at that point is there a clinical determination of the recommended course of treatment – which could involve ongoing work with the clinician conducting the Collaborative Initial Evaluation or transfer to a better suited clinician.
 
The shift in practice has not been without challenges, but even the challenges have been constructive. For example: Some clinicians have found it challenging to conduct a 30-day evaluation while knowing they may end up transferring the work to a colleague. The tension between relationship building and time-bound information gathering demanded a more pointed approach to assessment. In reflection, some clinicians shared that they worried this approach would feel “intrusive.” If the assessment and treatment are expected to be done by the same person, this fear of intrusion can result in an “either/or” approach where “relationship building” is emphasized over concrete assessment of needs. Collaborative Initial Evaluation forces a “both and” resolution of this tension - giving clinicians the opportunity to sharpen their clinical assessment skills even more while still maintaining their commitment to respectful, relational work.
 
Westcoast Children’s Clinic has since introduced the practice across one of their programs – infusing the implementation process with the wisdom gained from the pilot group. All clinicians in this group were trained in performing the initial evaluations and in “taking a handoff” from another clinician. And all received additional training in team-based care. As this new phase unfolds, WCC continues to refine the protocol, discovering new ways to determine early on what course of assessment and treatment is best given the client’s emerging strengths, needs and goals.  The hope is that this practice will eventually be introduced agency-wide and that it can be shared with and replicated/improved by other organizations. Any questions about this innovative practice can be directed to Cinthya Chin Herrera, Psy.D, WCC Assistant Director of Training (cchinherrera@westcoastcc.org).

In the Dear Collaborative column, we’ll answer YOUR questions about TCOM or the TCOM tools (CANS, ANSA-T, ANSA).
 
Have questions and want answers?  Submit your questions through the Contact page and look for the answer in the next edition of Dear Collaborative. Submissions are treated confidentially.

Q1: I need to certify or recertify for CANS on Schoox. Do I have to do all the learning modules to do so?
A1: No, even though you see the 68 learning modules that provide helpful videos and quizzes on all domains in the CANS, you can scroll past any and all modules you don’t feel you’d like to review. Scroll all the way down to step 68 if you wish and click directly on the “certification exam” and then click “start vignette” for initial certifications or “retake vignette” for recertifications and you’ll be ready to go!
 
Q2: What is the point of the CANS/ANSA? Why do we do it?
A2: The CANS/ANSA helps us make sure we aren't missing part of the picture and are assessing and capturing all areas of risk and strength in a collaborative process with all stakeholders. The CANS/ANSA tool assists us to organize client needs and strengths and gives us a clear metric to help create shared language in treatment planning and track progress throughout our work. CANS/ANSA help protect against clinician and referral source bias, and protect against the ways systems can over and under diagnose client strengths/challenges based on cultural assumptions and personal bias.  The CANS/ANSA manuals give us clear definitions for each rating item. Using CANS/ANSA provides a framework to see change over time which makes it easier to discuss with the client/family the progress that is being made in treatment.
 
Q3: I can’t get past the “I am not a robot” in the Schoox registration process. I am NOT a robot! What do I do?
A3: This is a browser compatibility problem that is easily fixed. Please use Google Chrome, Firefox, Safari, or Internet Explorer-Edge. If you are having trouble with Internet Explorer, you are most likely using an old outdated version. Please upgrade to the newest version, called Edge, or switch to one of the other compatible browsers listed above. You can always seek assistance from support@TCOMTraining.com as well if needed.

Q4: I can’t pass the exam and I don’t know what to do!
A4: There are a couple things you can do to improve your chances of passing next time:

• Take your time (you have 2 full hours available) and print out the manual and rating form.
• Remember that action overrides anchor definitions always. Don’t get stuck on the “anchors” (aka the descriptions for each action level within a given item) and instead focus on the action levels. Ask yourself if this is something you would check on (rating 1) or something you would definitely intervene on (rating 2) or urgently intervene on (rating 3).
• Attend an in-person certification training: trainings are listed on the Alameda TCOM training calendar  and on the Schoox site with on-line registration available.

 
Each newsletter will feature top questions that are submitted to the Alameda TCOM Collaborative. If you have an urgent or critical CANS/ANSA -related question, you can contact your agency's CANS/TCOM Coordinator or one of the Collaborative Members.