1. MTPD Technology Overview
GetCare
TCARE
Welcome to the MTPD technology overview this course is one course in a series of course developed to help the learner get a high level over for MTPD initiative. These courses were specifically developed for Snohomish County Long Term Care and Aging MAC & TSOA Case Managers.
BarCode
ACES

2. TCARE—Care Planning
Let’s start by looking at the TCARE technology specifically in this course and we are going to be looking at care planning.

3. TCARE—Care Planning Consultation/Plan Caregiver Plan
Let’s look at the learning objectives. We are going to look at two areas in this specific course. First the consultation planning section and then the caregiver plan.

4. Consultation/Plan
The Caregiver Plan is developed from the TCARE Consultation Worksheet. Click on Consultation Plan in the left column.
The Expected Outcomes, Follow-up Triggers, agreed upon Caregiver, and Assessor Responsibilities are added to the plan. Following a conversation between the Assessor and the Dyad where a plan is agreed upon, the final Care Plan is then signed by the caregiver, care receiver and the TCARE Assessor.
Let’s get started. Remember that the caregiver plan is developed from the TCARE consultation worksheet. Because of this is make sense to start the care plan by clicking on the section for the consultation plan so the consultation worksheet can be worked through first so that the caregiver plan will generate. So click on the consultation plan as I had mentioned and then we will get started working on the consultation page. You will want to go to the right where the consultation type drop down bar is and you are going to select what type of consultation this is weather it is an initial or a follow-up. Once you have selected that then you will move to the services list table and you will click on the plus (+) sign. You are going to be of course making the choices following a conversation between the assessor and the Dyad where the plan is agreed upon. The final Care plan is then signed by the caregiver, care receiver and the TCARE Assessor. But this is where to start having that conversation. In this case the (+) sign was selected and then choices that come up where looked at.

5. Consultation/Plan
Click the “+” above the Service List table to search for and choose services beneficial for the Dyad.

6. Consultation/Plan
SERVICE SEARCH- Choose a goal from the dropdown. Choose the Strategy from the dropdown.
Select a Service Category from the Search Results.
The related Service Types will be displayed in the table below.
Next you select a goal from the consultation plan and then a strategy. I find that it is most helpful strategy is the recommended. I found in the majority of cases I get more choices for the services results when I do this. Next you will move down to the service results and scroll down and look for the one that matches to the services list that you are looking to do. In this case Counseling (Develop new perspective and practice skills was selected. If you look then it brings up services types in the table bellow and you would select the service type that matches the choice that you made up above.

7. Consultation/Plan
Select the Service Types by putting a “” in the Select Column
To finish click on Select
This shows specifically please remember to put a check box in the left hand column on the select and you can multi select in the left hand column which is a nice feature. When you are finished making all the selections appropriate for your Dyad, you will want to click select at the bottom.

8. Consultation/Plan
A blank row will be added to the Consultation Plan Worksheet. Define the Service in the Service Name, this will then populate the Service Name in the Service List. Check that Current Stategies Met has mapping identified—if this area is blank, click on the menu button and select the appropriate maps.
This will take you back to the consolation page and you will see that it kind of emerged it populated the selection that you selected. So lets move forward so now we have selected the service and now you got to fill in some information for the consultation plan so that your Dyad will understand what the goals are. So next you are going to move down to the bottom of the screen and you are going to want to define the service in the service name and you will want to fill in some of the other fields here. Check that the current strategies met has map labels if you don’t you will want to click the menu button and select the strategies that fit with the selection that you made and this will be things that you go over in TCARE training. You will also want to select services types
To add additional services click the “+” above the Service List table.

9. Consultation/Plan
Once the Service List is completed, click on Provider in the left column (this will allow the TCARE assessor to match a provider to each service in the list)
Once you have selected this you will need to define who the provider is so you are going to move left hand column on the bellow consultation page and you are going to click on provider.

10. Consultation/Plan
Each Service on the Service List needs to match with a Provider in the Care Plan. Once on the Provider Screen, a Provider is added by clicking on the plus button and filling out the fields. Continue adding Providers until each Service in the Service List has a matching Provider.
This is going to bring up the provider page in TCARE. You are going to click on the plus sign on the provider list table. This will allow you to fill in provider details about that specific clients. You will want to continue adding providers in this list that will match any of the services that you selected on the consultation page.

11. Consultation/Plan
To match each service on the Service List, the TCARE assessor will highlight the service in the Service List and then click on the drop down of the Provider and select the Provider created on the Provider Screen. The TCARE Assessor must select a Status from the drop down selections— Once the status is selected, the status selected date will automatically populate with the current date.
Next you will return back to the consultation page and you will select a provider, so here you will click on each service in the service list. Than you are going to want want to make sure that categories along with the tabs. You will notice bellow there are three tabs Service, Service Plan, and Comments. You are going to want to make sure that the fields on Service and Service Plan are filled out. So lets take a look at that. You can see here in the service list the service highlighted in blue is Adult Day Health Services. So if you go bellow under service tab selected is Adult Day Services. Than you go bellow and select a provider name that you created on the provider page. In this case it is a contracted Adult Day Center. You can see that the service types are filled in you can also see there is a current goal on the right hand side of this page. You are going want to pick a status. As soon as you pick a status in this case it was excepted by the Dyad. It will automatically populate the date. You will want to make sure that print in consultation is checked off if you want it to print in the consultation and of course as we went over before that the current strategies have been meet. Next we are going to move to the Service Plan tab.

12. Consultation/Plan
The TCARE Assessor will next select the Service Plan Tab where the frequency of the service provision, Start Date, End Date, Action Steps and Desired Outcomes must be filled out for the Service Line highlighted in the Service List. The TCARE Assessor must complete each field in the Service Plan Tab that has an asterisk.
Here it is important to fill out the frequency that the dyad is going to be utilizing the services. In this case they will be utilizing Adult Day Health Services weekly. We need to put the start date, the end date, and we mentioned here that its planned because this probably needs a referral made yet. Lets talk about the action steps. Here it says referral to contracted Adult Day Health. So here you may want to expand on that and put a little more detail in. And then Desired Outcomes Caregiver will have respite and care receiver will be engaged in supervised activities. Please note that the TCARE assessor must complete each field in the Service Plan Tab that has an asterisk. Ok lets move forward.

13. Consultation/Plan
The TCARE Assessor will next highlight Additional Info in the left column. The Additional Info Screen will emerge and the TCARE Assessor will fill out the free text areas regarding each Service identified in the Service List.
Next you will want to click on the additional information screen. You are going to want to fill in any detail that will be helpful here. It is important that rolls be identified. That the Dyad knows in the caregiver plan exactly what roll the TCARE assessor will be playing and what the Caregivers responsibilities are and any triggers are for follow-up are listed in this area

14. Consultation/Plan
The TCARE Assessor will next highlight Additional Info in the left column. The Additional Info Screen will emerge and the TCARE Assessor will fill out the free text areas regarding each Service identified in the Service List.
WE are going to go back two slides

15. Consultation/Plan
The TCARE Assessor will next select the Service Plan Tab where the frequency of the service provision, Start Date, End Date, Action Steps and Desired Outcomes must be filled out for the Service Line highlighted in the Service List. The TCARE Assessor must complete each field in the Service Plan Tab that has an asterisk.
And remind folks we have only filled out the information for this this specific Care Plan for Adult Day Health Services. Next you will want to do this same process for the second one on the list. In this instance it Caregiver Consultation you want to make sure that the Service tab and Service Plan tab are filled out. Than you would return to the consultation page and make sure that the Online Support Group the third on the list had the Service tab and Service Plan tab are filled out . Once every area is filled out and you have double checked that every area is filled out.

16. Select Consultation/Plan and then Caregiver Plan.
Once the TCARE Assessor has completed all of the required fields on the Consultation Plan Screen, the Provider Screen and the Additional Info Screen—a Caregiver Plan can be generated. The Caregiver Plan is automatically developed from the TCARE Consultation Plan Worksheet.
Select Consultation/Plan and then Caregiver Plan.
At this point you want to click on the Care Plan remember when all the information is complete in the consultation plan section then the caregiver plan will auto generate. At this point lets click on the Caregiver Plan than click on the Caregiver Plan History table. You will want to click on the plus sign.
Create a new Caregiver Plan – click the “+” button

17. Caregiver Plan Select Plan Type from dropdown. Enter Agreement Date
All the text boxes on both tabs will auto-fill from the Consultation Plan Worksheet.
Once you have clicked on the plus sign. The Caregiver Plan page will emerge. You will want to select a plan type. You can see from the dropdown you will have Initial, Update, or Reassessment. You will want to pick the one that is appropriate for the plan you are working on. You will want to type in an agreement date. You will have a service list appear on the Service list bellow. One of the hints that I find helpful. Is Once you have a service list in place. Lets say you have 5 services for your Dyad. I always take a moment and highlight each one make sure that it turns blue and read the information than that appears in the Service Details. Because that is the information that is going to print in the Caregiver Plan. Make this is accurate before moving on to the next step. If you find and error or see a place that you want to add more information or make an edit. You will want to cancel out of this section on the button bellow that says cancel and go back to the Consultation Plan. Make the edit where necessary before moving forward. If you do make an edit you will need to comeback to the Caregiver plan page and redo this process.

18. Select Consultation/Plan and then Caregiver Plan.
Once the TCARE Assessor has completed all of the required fields on the Consultation Plan Screen, the Provider Screen and the Additional Info Screen—a Caregiver Plan can be generated. The Caregiver Plan is automatically developed from the TCARE Consultation Plan Worksheet.
Select Consultation/Plan and then Caregiver Plan.
You will want to move back to the Caregiver Plan page and click on the plus button. You will need to recreate the plan with the edit. Which actually makes sense.
Create a new Caregiver Plan – click the “+” button

19. Caregiver Plan Select Plan Type from dropdown. Enter Agreement Date
All the text boxes on both tabs will auto-fill from the Consultation Plan Worksheet.
Now if you are at a point that you are confident that your Caregiver Plan is accurate. Than you will want to move on.

20. Caregiver Plan Select Complete Select Yes
The Care Plan is now listed in the Care Plan History Table.
You can print it using the Print Button.
Click on the complete button at the bottom of the page. You will receive an overlay that says. Are you sure that the is ready for completion? If you are confident that it is than click on the Yes button. Then the Care Plan is generated in the system. To view it or to print it the buttons are at the top of the Caregiver Plan History table. You can click on either to View the document or you may want to print the copies for your Dyad. Because you will need to get signatures.

21. MAC and TSOA Case Management Reference Guide
Care Plan Review
MAC and TSOA Case Management Reference Guide
Consultation/Plan
Caregiver Plan
This concludes our Care Plan Course. Lets start with a Care Plan review. In this course we look at the consultation plan it is a required worksheet to develop as it auto generates the Care Plan and then we generated a Care Plan and then we learned out to print and view it. Remember all the information in the online course is available in your MAC and TSOA Case Management Reference Guide.

22. Thank You!
We thank you for participating in this online course and we look forward to partnering with you on the MAC and TSOA Case Management.