Academic journal article Child Welfare

Developing a Computerized Health Record in a Protective Services System

Academic journal article Child Welfare

Developing a Computerized Health Record in a Protective Services System

Article excerpt

A computerized health record application was incorporated into the Los Angeles County Department of Children and Family Services Child Information System (CIS) to capture information on the health status and medical needs of over 60,000 children under the department's care and supervision. The Child Health System (CHS) was designed to store health information needed by social workers to provide comprehensive services to children and their families. The CHS stored information concerning the child's current and past health problems, allergies, health examinations, and immunizations. In addition, the CHS also maintained information on the child's educational, psychological, and developmental status, and the child's family health history. A description of the CHS's development and features, along with a brief overview of the 2,688 cases entered into the system during the first seven months of its application, are presented. Although California has recently moved to a statewide system, other jurisdictions currently computerizing their systems may learn valuable lessons from the Los Angeles County experience.

Children entering protective services have been shown to have a significantly increased incidence of both acute and chronic physical and mental health problems [Dubowitz et al. 1992; Klee et al. 1992; Halfon et al. 1992b]. Complex health needs that may have been mismanaged or exacerbated prior to entering protective services are often compounded by multiple placements, frequent changes of social workers, poor record-keeping, and fragmented health care services that place the children at high risk for health complications [Cain & Barth 1990; Simms 1991]. Studies comparing children in out-of-home care to all children receiving services through Medi-Cal* demonstrate that children in care have a 23% greater health care utilization rate; it costs 41% more for their health care services than for those of children less than 18 years of age in the total Medi-Cal program who are not in out-of-home care [Halfon et al. 1992a]. Understanding the unique and demanding health care needs of these children and coordinating their health care services is often an overwhelming task for the child's social worker, whose first priority is to meet the child's safety and welfare needs.

Because the statewide database currently in use had not yet been developed,** Public Health Nurses (PHNs) were brought into the Los Angeles County Department of Children and Family Services (DCFS) in 1992 to work in collaboration with the Children's Social Workers (CSWs) to assist with health care case management efforts. Initially employed jointly by DCFS and the Department of Health Services (DHS), Child Health and Disability Prevention (CHDP) program (California's program directing the federally mandated Early Periodic Screening, Diagnosis, and Treatment [EPSDT] program), and later incorporated into and funded entirely by the DCFS system, the 30 PHNs began assisting with the compilation of health information on over 60,000 children under the care and supervision of Los Angeles County. Quickly inundated with medical information that often took weeks to compile, the nurses were soon confronted with the enormity of the task of organizing the health information obtained and establishing and maintaining medical records that would be easily retrievable and understandable to the users (CSWs, foster parents, and health care providers). In collaboration with the Management Information Division (MID) of DCFS, a multidisciplinary team comprising social workers, computer programmers, and nurses was convened to develop a software application to organize and store health information in the existing Child Information System (CIS), a countywide computerized system that contained information on all children entering into protective services within Los Angeles County. Immediately upon receiving the necessary information from the CSWs, DCFS clerical personnel entered pertinent data concerning the child and family into the CIS database, including identifying demographic information on the child and family, and information on legal services, placement, and payments. …

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