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Joint | April 21, 2015 | Chamber | 20150421_joint_appropriationshealth

Full MP3 Audio File

Members please take your seats, yes shall install electronic devices we call this meeting, of the Joint and Appropriations Committee on Health and Human Services to order. First I'd like to recognize sergeant arms, you get there. In the house we have young Bay, Bill Morse, Jim mum senate we have Charles Jeffries, Kent Lois, Dell half Our Pages for today are senate pages is Emily Bralen[sp?] home town Stanford Senator Raven Nick Mills, senator Stering, Alina Robinson from Swansboro, Senator Brown, From the house we've Ethan Maystern[sp?] from Sworis, Representative Stephen thank you for being here, Liz O'Brien from Randolf, Representative Hally[sp?], Davis Private, Representative Faircole[sp?] from Dio ford, Joe Swaim from Randolph, Representative Bail Macneil, [sp?] Thank you all for being here and hope you learnt something today. I'd like to welcome everyone to today's committee, it's good to the secretary back with us, and we'll go a head we've a link to the agenda, so we'll go ahead and start the meeting, and madam secretary welcome, thank you for being here. Good morning, and good morning Mr. Chairman and members of the committee, thank you for inviting us back. I'm very pleased to be able to be here today, with you to discuss the next phase of North Carolina families accessing service through technology NC FAST. NC FAST is over half way finished, we have just finished the most difficult stretch of this project. Thankfully, behind us we have the implementation of the food nutritional services medicaid, and the new requirements for the affordable care act. We have to continue on the part of this integrated system. Next for us we will have child protection, child care and energy assistance, and followed by ageing and adult services. We have to get all parts of NC FAST over the finish line. So that by 2018 the individuals, the the counties and the State can fully benefit from one integrated system in the State. Today you're going to hear more about what I believe is the most important investment in this year's DHHS budget. A child protection case management system within NC FAST. The social workers in our counties who keep our children safe have extremely difficult jobs. They must be able to have access to critically information to help them do their work and communicate with each other across county lines, and the states responsibilities to supervise this child protection across our state and without a better information system, we lack the ability to promote the best outcomes for our children with one intergrarted NC first system for all of our human services. Our child care workers will be able to see not only across county lines but across a different programs that we have in all NC first system medicate

any food nutritional programs contains very important information and data. This information and data could be use to help determine what is safe for that child. For example, a case [xx] can look at their screen and see who else lives in that households not only a blood relative.  If you have information you can make the right decision NC fast provides us with information to make the best possible decision to ensure the safety of our children. I haven't asked deputy secretary Bradsha, and NC first director Angela Taylor travel the entire state to get feedback on our child protective system and how we can ensure that this case Management system that we are proposing will be the tool that succeeds. With that very valuable feedback b from those on the ground. Our intergrated NC fast solustion has the support of the Governor, the County Department of Social Service and the Association of County Commissioners. The general assembly and the Governor have worked to make tremendous investments in child protection during this last session. We must continue on this path and must continue our investment in NC Fast. Now, Mr Chairman if I may please recognize Sherry Bradsher our Deputy Secretary for Human Services, thank you Mr Chairman. You're recognized. Thank secretary and thank you chairman Dobson and the committee for allowing me to speak with you today. Child welfare is my back ground and for many years I have been part of the planning forward and the discussions for a child case management system. Workers, supervisors, directors and the state need so the two did the job and in child protection there is no step by two the business matter nine showing on the screen right now which was developed in 1999, stay and county workers including myself spend 12 weeks working together to specifically define what an efficient, effected and accountable service delivery system would entail. This matter this is a business matter of agent to enhance the effect, we have recognised nationally for the station three user guys we compete against 30 states for a grant that would allow us to begin the business process changes that quite honestly could not happen without the support of technology, this matter is  very simple it's the right service at the right time in the right amount. Having all this information in the same place the secretary said is very powerful for social worker, and integrated system allows for functionality such as alerts from case workers to social workers, information about families moving, whether it's within the county or to another county, another child being born into that household, someone moving in someone moving out, social workers need this information. Any of these changes could mean changes to a safety plan for children. Today the only way you know this is when someone tells you. Social workers are often times in the field and case workers are on their phones conducting interviews or seeing someone in their office. This situation creates opportunities for missed and untimely information. Crossing County lines has another level of complexity to the to the equation. All of this goes away with the integrated system. Workers, any worker can have access to a lot noble information with no delays this will create that efficient and effective system that I mentioned. Angela Taylor who lives the and I have traveled across the state just as a secretary I ask listening to social workers, their supervisors, directors and other key communities stakeholders to make sure that what IT does really meets our business needs. With the time that we have

invested I know that we're on the right path. I have full confidence in Angela Taylor her leadership, her expertise in information technology and her knowledge of the work to be performed and with that I will turn it over to Angela Taylor who is our NC FAST to get DHHS Director. Director Taylor. Thank you so what is in NC FAST not to be confused with NCTracks, in NC FAST is an Integrated Case Management System which stands for North Carolina Families Accessing Services through Technology. It's a business solution that is designed to improve the way that the North Carolina department in health and human services in our counties will deliver social services into their business, with NC first it introduces technological tools and business processes that will enable workers to spend less time administrative task in the future and more time assisting families. NC first completed our competitive procurement decision back in 2008 to select an Enterprise Social Service System, that could meet the 11, 000, thousand I've said requirements that meet both the state and the county level needs. With that, what we're doing also is replacing 19 [xx] legacy systems. The oldest one of these is 35 years-old which is our current eligibility system. The youngest is 10 years old with that even though these are solid foundations, these legacy systems are so [xx] disparent, and not well suited to support the growing demands of our economic benefits and versus delivery for our counties as well as our state, and also the information is not shared or integrated very well to be able to cross program lines as well as county lines. So the key thing here is that redundant data entry is what we want to get rid off and be able to share the information with all workers. Within multitude systems it's currently necessary because this systems do not adequately share, they result in duplicate work for our workers and increase the risk of errors as we're trying to key in information multiple times into the systems. DHHS and the county department of social services require a highly integrated case management system across all of our server systems benefits to pull together today's Allan's of information as we have seen within our legacy systems. We want to move towards a single solution and provide this new technologies to serve our families and keep our children safe. With that said we originally started out with a timeline with NC first that would have provided project one, which is our Global case Management food and nutrition services project and what is global case management. Global was to look at all those tools and techniques and information that would need to be captured at the very beginning across all of these programs, not just the first one. So that was what the Global case management was, similar things as demographic information like your name, first, last, middle and then the second part of that was to replace 30 plus year old food information system, so part of project one was very successful, we went in in May of 2012, we rolled out to all 100 counties by March of 2013, and today we're actively excepting food and nutrition services application for all 100 counties. As you can see from the timeline, our next project was to actually we do our eligibility information part one, which was to put a nice fine yard on our legacy system that would be more web enabled if with that, then our third project would have been child protective services. This would allow us to implement the child services earlier to assist delivering the services to protect our children and to get rid of the predominantly paper based system, but as we all are aware health care reform came along and so did the affordable care act so what that did is it pushed project six up and parallel that with project two. Which means that we would be replacing the complete eligibility system a lot earlier than we had planned. In addition to that, we also so we had to add,  project seven which is our health care reform. Golf interface. And also with that we ended up having to deal with meet some very strangest timelines to get the exam. For project two and six we began the effort and we were able to in 2013 of August begin pelleting

with four counties which was Orange, Codaland, Dale and Johnson county. due to the impacts of project seven the affordable [xx] the role out of that project was delayed until August of 2014 and at which time we rolled out to all 100 counties, all the way through November third of 2014. So as you can see right now a lot of our counties are just starting to get really in within the system as far as it relates to our traditional medicare, project two and six the goal of that one was to implement not only our traditional medicare but our first our special system, with that we have now are currently retiring a 35 your old legacy system currently be in retire part of project seven was another deadline and the reason for the delay is that we had to have a modified gross income medicate rules in places by October one to start receiving those applications we were able to meet that deadline on October one and I'm proud to say that North Carolina was one of five states to be ready by January one to be able to start accepting those transactions from the affordable care A. C. A helped [xx]. With that we with regardless of all the challenges that we have faced, the parties of NC Fast  we have stayed leaders within the delivery of our economic benefit programs. We have other states that are reaching out to us to share our information and our [xx] with them. So with them, we have been very successful in delivering all of the programs today on time and within budget. With all the continuity to provide assistance to our state and our county's, we'll provide the same leadership as we start the implementation of our child services and adult and family services moving forward. So what are the benefits of Integrated Case Management Solution? The key benefit of an Integrated Case Management Solution like  NC Fast is the ability for us to have real time chairing of clients and case information across programs and across county lines as most of you are aware that most of our legacy systems, you cannot view information within another county. Within NC fast that ability is there today so now they can see across those county lines services in our economic programs that we've implemented. The other thing is to enable families to provide information one-time not have to come in and give their information over and over to multiple workers and have so much duplicative and the goal too is to provide services like E-pass which is our online application  which allows citizens to do this application at home at their own not have to take time off from work and have to find someone to take care of the children while they go, so those are some key things. The other thing is for integrated is the decision support model that will deliver this timely services and protect North Carolina's most vulnerable children and aging adults. Supporting this truly integrated solution is very important for across functional service delivery. This will move us beyond the solids systems that I have talked about and will also automate this paper based systems that we currently are living with, leveraging all this existing investments in the infrastructures that we already put in place. We will layer these other programs on top of the NC FAST technology that we haven't continued to deliver these services and the programmers and the interfaces that we have, our future is to also start integrating with the other States as well as our health services out of the family. So with that said, with project one that I discussed already in project two, six and seven. The key things is this currently today we are servicing 2.5 million North Carolinians across all 100 counties that are receiving those benefits that I've talked about. With that the projects provides a solid foundation for us to move forward into the services side as well as the last economic benefit program. This is the last economic benefit program that we will be putting in place and once we are done with project three which is our low income energy assistance program which is LAEBP[sp?] also known as. Child care and crisis intervention program we will have all of our benefiting program within the department in [xx]. Our plan is to begin this effort in July of 2015 and we'll be retiring two legacy systems in this effort.

To the project that we're talking about today is our child services which is project four. Our goals here are to not only automate the things at the County level and remove that paper based systems that they have today, but it is also to implement the seventh legacy system that at state level system that support our Counties, our Stay and our federal reporting and information gathering. So, it is to automate the counties as well as provide replacing the V-services. Key things here are the services that we are within these services is our child protective services, our child placement and foster care, and adoption services. And lastly is our project five which will be our dorm and family services. Some of these services are very similar to the services that we'll be delivering in our town services area, so once we have informed minutes, the child service is about 40% of those tools and techniques that will be putting in place will also be leveraged for our dorm family services. Our goal here is to get this and and at last it's project and be completed by 2018. One other thing to be aware of is the sessional that was passed in 2011, the department worked along with our state CO's office to develop a process and a plan to continue to evaluate all case management need within the department to implement a one solution for a single case management throughout the HHS. We continue to use that process today as we identify new case management needs within the department and leveraging NC Fast is that tool to do so. In an ongoing support for the efforts of the NC Fast, the governor have included in the governor's budget the continued implementation support for project seven the affordable care act medicate, project three that we have just discussed the child care low energy income and crisis intervention and project four. So these are key things in moving forward to provide that support. And lastly some of the key things or our ability to integrate our child welfare and eligibility system. The key thing here as you can see in bold is 80% of our families and child welfare are also receiving some other  e-payment services benefits as I said, once we have project three and we have our [xx] benefiting programs in place we'll be able to already have that data available for social workers when they're coming in. That information will be real time, they'll be able to access it at their finger tips. If something changes within the family's make up, they have anew family member coming in, they will be alerted of that information if someone goes in and changes their medicate or food stamps makeup, some other key things also is that workers will no longer need to look up and enter data into multiple systems as we've said before. That results in required data gathering and client and families coming in multiple times discussed and also this real time will provide aligning business operations and having better interoperability it also assists us with enabling us to adopt new policies and improve the outcomes of our children and our adults and the families that we're serving We also have reached out, we have several interfaces with some of our federal partners and some of our other agencies but we currently are reaching out to our Government Data Analytic Center, GDAC and part of that is for us, for the social worker the ability for us to also look at CJLeads in the information that will be there. There are also other information that we will also look at utilizing like gun permits. When a social worker is walking into that home would it not be nice to know that someone has several guns in the home before going in to a critical situation. All of this information and the data sharing that we'll be able to do with NC BASS[sp?] is critical to support the children's service delivery With that said I'm going to hand it off to IBM Neil Arumugam, will be the first speaker, he is a IBM curam executive for the East Coast of the US. You're recognized. Thank you Mr. Chairman, and good morning everyone?

As you look at your agenda you're probably a little perplexed, I am not Ronan Runin the Irish co-founder of Curam software, thank you for the introduction Angela. Ronan was on the route to be here in this meeting today, and I spoke to him mid-afternoon right up until 10 P. M last night he was at LaGuardia Airport. Unfortunately, all the flights to Raleigh cancelled, so he does send his deep regrets, he really did want to attend. So I will do my best to try and give you the messages that Ronan would have liked to deliver provided to you today. A little bit about Ronald background, Ronald is not a stranger to North Carolina. His he told me last night his first trip and meeting here was way back in 2001. So he does have a long history, and his history is deeply rooted in this industry, human services, child welfare, Ronald was a case worker over 20 years ago. And, he founded [xx] software because he felt there would be a way, a better way to do things for case workers, to help them do a better job of looking after children and families. And he partnered with John [xx] who is the other co-founder, who currently runs the [xx] software brand within the IBM organisation. So today, Ronalds role is as director of programs of care within the IBM research division, and that brings us a lot of benefits [xx] that are focused on helping vulnerable populations and helping departments to focus on those populations, didn't do a better job [xx] So last week there was an exciting announcement made, IBM announced the forming of the Watson Health Unit. And word health, not health care. One of the key things that surface in the industry is the impact of social factors on citizens state of health and so the term organisation with an IBM is now moving into the wall flux and health unit which gives us a lot of opportunities, a lot more investments and ability to really to stop up that research work that Alan and his team are doing to bring more benefits to organizations such as ourselves. Key areas are when you think about the amounts of data that are generated by case workers and workers alike and the fact that a lot of this data is unstructured meaning motes or typed in notes they're not in data fields, how do you find all that? And those are the kind of tough problems that we're working to resolve so we look forward to some of the exciting things that will come out of Ronald[sp?] and that group within research. I should point out that some other slides have changed because I'm not Ronald[sp?] and he was picking up the top of [xx] so bear with us you see a slide come up that you don't have to slip to the next one. I think you are able to keep up with us. So early on Ronald himself mentioned a statement. To provide care and protection for citizens and families in need and to help them achieve their social and economic potential, maximizing the social and economic return on investment. What this is really trying to say is that [xx] is not just focused on automating program delivery but really trying to do it in such a way that it changes the outcomes to help citizens move toward self sufficiency and as you know more about the current solution, you will see that's really embodied in the way it's been designed. So this next slide, I'd like to draw your attention to the green circle towards the top, and what it has got Capturing is the state of Oregon's data, which Ronald to a look at way back in 2003, and it shows the overlap between programs. So if you look at the first part of, the top part of the green circle it shows the child welfare population, the next one shows the population that is in child welfare and health insurance, and then the one below, the bottom part of that green circle, that's on the snap population. So looking at this Ronald decided that what was really needed here was a cross program solution, because trying to make decisions and looking at information in program silos is not conducive for doing the best thing for the child or the citizen, and that's the value of the integrated solution, and this was was one of the triggers that got us to where we are today. In fact, if you look at child welfare, one of the things that became apparent early on when it was being developed, was the fact that there was a lot of commonalities between child welfare, aging and adult services and juvenile justice and so as

much as possible we try and leverage the common platform to give 363 view of the senate input and the trial. This slide represent the global footprint for column. As you can see there's a lot of different programs represented and column is in place over agencies, 80 agencies on 41 system covering over 100 programs. You can see we tried to highlight in the sort of yellow orangeish color the US in a top Canadian footprint just for you for ease of identification and if you look towards the top you 'll see our child welfare implementation in Canada, in Alberta, provinces of Saskatchewan, province of Ontario, city of Hamburg different things you might be wondering and so why don't we have more arrows pointed on towards US specifically for child welfare? Well, if you look historically at child welfare implementations across the US. There was a large wave of implementation that sort of light it a down around 2005. That was driven by the administration of children and families funding in child welfare and sacco's implementation so you have peak of implementations that really winded down and then currently child welfare solutions came to market in 2007. We are moving towards another phase we do we expect another wave of these child welfare implementations and we believe IBM is well positioned to take on that opportunity so I think this is propably one of the biggest essential [xx] that I would say today and really just to say that IBM is equally committed to the success of North Carolina. Ronald., myself, others like me, we reference North Carolina and the great job that's has been done here continuously when we talk to other excising clients other prospective clients, I was in a meeting last week with tenth care and VHS and North Carolina came off a lot they want to do it right they've had a couple of field projects and they are doing their due diligence and it was really good for us and proud that we were able to tell a strong positive story like we already have here in North Carolina. So if we look at the child welfare solution that we have This solution was designed by U. S case workers and validated against the global requirements. The IBM solution as I said has been place since 2007 on a proven and scalable platform. So, when you look at the big global map and you see all of those implementations of current. The current foundational platform is the platform that child welfare resides on top of so this is a proven technology and a proven solution. IBM has partnered with the Children's Research Council which was established in 1993 and has been working with 40 states amongst other things to construct actuarial risk assessment instruments and the goal there is to provide informed guidance to case workers to help them make better decissions with the goal of protecting children and we're doing it in such a way that we're not taking away the decision making capability away from the case worker and enhancing their ability to make the right decision or a better decision. So as I traveled across the various states, I covered nine states across the South East. It's become really apparent to me how well NC fasten and VHS has done with this project, and it's so much more than the technology and the software in Tennessee last week they were asking me well what are the contributors to success or failure and the technology is a small part of it. There's so much about project execution and governance and we often like to refer back to North Carolina as a good model for folks to look at when they're taking on some of this high risk projects. So, on behalf of Ronen I'd like to say IBM remains your strategic partner, we'll continue to work to make the students of North Carolina a show case to the right approach to successful implementations. We're committed to the long term success of this program to deliver the right services to the citizens of North Carolina. Now Mr. Chairman, that concludes my portion. I'd like to turn it over to Rachelle Mathew. Miss Mathew. Thank you so after I present a couple of slides I'll be approaching the podium to demonstrate the mobility solution. So as Neil on

behalf Ronen described the Curam Child Welfare Solution was designed by US Child Welfare Workers for the US market, and we've also collaborated with global child welfare domain experts and thought leaders to support best practices and child protection. The Cúram Solution helps connect citizens to the right programs based on each person's or family's unique circumstances, and coordinates service delivery across program boundaries avoiding silos. The Children's Research Center, CRC is a non-profit globally recognized research organisation. They've developed the Structured Decision Making Methodology currently being used by North Carolina Child Services social workers. This evidence and research based model, consists of several assessments proven to help agencies reduce subsequent harm to children, and to speed up permanency. In collaboration with CRC, the Structured Decision Making Methodology has been fully integrated with Cúram for Child Welfare Solution to improve the consistency and validity of caseworker decision making. The Social Program Management Platform is the foundation for NC first and for all the various role based portals in the solution well it is an integrated system not all information is available to every user all the time. This is especially important in the world of children protective services and adoption. So based on the security rules in the system, and also our users individual security profile information is shared appropriately. So some examples of the role base work spaces I'd like to go over Epass was mentioned earlier is an empty fast public self-service portal, this allows to listen to apply for economic benefit programs like food, cash assistant and medical assistant. The supervisor work help supervisors monitor and manage work assigned to the users that report to them. Supervisors can also view operations on dashboards like contacts compliance as well as interactive statistical reports like placement maltreatment recurrent replacement stability.  The administrative in business analyst workspace allow technical and business administrators to configure the system. In NC fast they've already implemented regional county administrative work spaces which allow county administrators to set up their unique regional setting such as their local organization structures, use a reporting hierarchy communication templates and so on, other things that are specific to their county and they also have a state wide administrative work space to configure more general system properties like workflow, notifications and alerts. Mobile applications can be built using coram's mobile development enablement tools and later I'll show you with  demonstration of the coram caseworker  mobile App. First I want to show an example of the caseworker workspace. So this is an example of a raw specific case worker work space. Here Dave Gonzalez who is a child services investigator has logged into the system based on security settings and also his security profile. He can see at a glance activities relevant to his role as an investigator, and he can help him prioritize work ad plan his stay. One thing that Dave does most is conduct face to face interviews with alleged victims of child abuse and neglect. He has to act quickly to high priority situations and also fulfill contact requirements. So the investigator work space shows Dave initial context due in a list form organized by how much time he has left. Dave notices that he's got a couple past due initial contacts Rachel and Derrick so he's going to prioritize those and reach out to those immediately. Dave can also capture initial contacts directly from his landing page without having to navigate and drill down into individual cases. there's also graphical representations so that he can get a quick glance of the status of his initial context including how many are over due and pending. The my task pod shows Dave which tasks have been assigned to him here he notices that he's been that an overdue task shall review the updates

that came in from the food nutrition services program. Dave also have to to wait the family structure to see how it affects it's investigation. So here is a functional summary of the quorum child welfare solution. Not everything is listed because it won't fit on the slide but I wanted to show you the vast amount of functionality available in quorum. On the right hand side in green is the social program management platform. This is functionality which is already in production in NC fast and it covers the economic benefit programs. All the information in NC fast will be immediately available to the child services, social workers once the child services program is implemented. On the left hand side in blue is the child welfare specific functionality which has been built on top of the platform. So case management has been tailored specifically for the child service workers and the solution includes new functionality which supports all the key business processes and child protective services. The solution provides notifications and alerts, Immediate access to family information, a 360 degrees view across counties, departments and agencies, improving communication and collaboration. As mentioned already 80% of the child services clients are likely already receiving economic benefits. The 360 degree view of the client helps case workers gain a more complete and accurate picture of families and individuals. It displays client information across social and economic benefit programs and across counties. collaboration tools provide a way for case workers from across the state and from other systems to share information and provide appropriate and cost effective services to clients. In this screenshot of the 360 view we can see a full picture of a client Jeff Parker, so Jeff is part of many different cases so we can see that he's got a couple of child services in tapes also an investigation and a child services ongoing case. He's a member of an income support case as well as a food assistance case is that at youth services interaction which is juvenile justice, and he's also receiving SSA and DPS benefits. We can also see just family members and even drill down to look in detail at an individual family member to see their specific interaction with the agency, so they may be involved with additional extended families and be receiving other benefits and services as well. We can have full picture of the family situation. And finally child services workers will have access to a prior history review of the client, this allows to drill down from a single point in the system to find details about allegations of abuse and neglect, find out whether they've been substantiated or not, statuses of investigations, child-worker cases and similar. Like all of the information and data in the system, this type of information which is very sensitive is based on the user security profile so, only relevant information is displayed to the user. Next I'd like to show some screens from the life NC fast system because it is a live environment using real client data, we've redrafted the screens to take away sensitive information. so this first screen from NC Fast is the person evidence page. So this shows one party of the client central information which can be made available to different types of cases both for economic benefits programs which is in the current system and also shared with the child services cases. So here we see evidence or data about a client such as the redressed[sp?], the relationships that we have with other individuals in the systems, their address and other demographic information as well. So all of the clients who are currently registered in NC Fast will have this information immediately available to the child services workers. There will be no need to re-enter this data which would be a big effort considering that 80% of the child services population would already be in the system. This next screen shows the NC Fast persons listed cases so

from the clients records we can see a list of all the cases they are a member of. So in NC Fast currently this list show food cash and medical assistance programs. And when child services is implemented, this list will also include child welfare caases and would be filtered based on the user security profile. and finally we see the NC fast online data. So this shows where NC fast is accessing other state level and federal systems to provide information back to the case worker. These sources have already been built into NT fast. And again these information is immediately available to the welfare workers, and can also be viewed from this 360 degree view of the client that I showed you earlier. One other thing to note is child services case workers are going to be tracking photos of their clients, and also their family members when they're documenting investigating child safety and well being the photos will be stored on a client central record, and so it's going to be available also to the economic benefit case workers. So I'd like to approach the podium to show a demonstration So [xx] more here, so Ronald was also going to be demonstrating on his iPad or mobile App, but because he didn't arrive with his iPad, I'm showing you a video recording. Alright, so now that you've seen what the users at their desk at the office or from their laptop at a clients home, I like to show you a mobile application that workers can use when they're in the field. So this demonstration emulates a disconnected user, and since it's likely that the case workers out in the field are probably going to run into internet connectivity problems, we need to be able to ensure that they have access to case data on their device, and that that information is secure. So while the worker has access to the internet or through the WIFI access, they would download information from their case loads securely onto their device, and then they can run it in disconnected mode. Once they get back into WIFI connectivity, have access to the internet. They be able  that information would automatically be uploaded back to the system, and then any information that came in while they were disconnected would be downloaded onto the device. So the demonstration I'm going to show is a Mobility App, still in development. It's available this June. So what you see on the screen is what the case worker will see on their mobile device. So first they will see all of the all of the recently reviewed cases and clients, and at the top, they will be able to search for the clients that they are looking for for their next visit. . So as they type in the search criteria, the clients name, this system uses predictive searching, and it shows results as they type. So I can look and the clients starting with BE, okay, continue to filter that then select the clients that I'm looking for Becky's friends. So once the case plan is loaded for my client. I can see a high overview of the information about my client. On the top-left I can see her picture her address and on the bottom-left I can see the different case plans that she is a apart of. The system supports concurrent case planning, so she is part of the family maintenance plan help hoping to keep the family together as well as a permanency plan. So next to Becky's picture there's an icon for special caution or special alerts and it choose that she's a runaway risk this is important when doing our investigations in our case planning. We can also click on the network icon to see the known network for Becky

and currently what we know about her is about her mother and her father but this could include other individuals who are not related to her that are relevant to our investigation and to our case planning. Now this year I'm going to work on this connected mob just to show you that you could also help to plan the case like other out on the field, figure out where you going to go next and how to get they could use the gps inside the device to help navigate to the location. There is also an icon for the motile disciplinary team, so a motile disciplinary team is a group of individuals who collaborate together using the collaboration was in the system to help identify the best programs and services for the family and the client and this don't have to be internal workers of the system, in fact they are often internal users plus other individuals in the community that work with the family and know them well immediate and often access. So here we see that we've got a school counselor the case supervisor and also a child psychologist on the team. So on the main part of the case plan, there's some attachments there too. you can use your mobile device tools such as taking photos, recording videos and audios and attach those documents to your case plan and that will also be stored into the system along with her case and case plan. So on the main part of the case plan we also have some other information and you can scroll down on this page with your finger on the device, and so at the top we see the recent narratives that we've had during recent home visits, this is the most recent one that we've had, I'll show you what that list looks like in a bit. We can also see the clients on the plan, because it's family centered, we're not just focusing on the child, we're focusing on the entire family. A list of all the activities that the child and family are receiving. The most recent note with the ability to drill down and view historical notes. Also progress on the overall goal of the plan, in this case the family maintenance, and then at the bottom is a list of all the assessments, including some of the structured decision making assessments which have been completed for this child and family. So here's an example of entering in a note so just its using your device to enter into a subject and just some details of the know. You could also use the device to kind of record your voice and have it turned it into the know without having to type with your finger. And then similarly you can do the same for to documents, your home visits and your narratives so we can view all of our narratives to see a list, and then create a new one, so in this example you can see that on the most recent visit we document what happens, we can have unlimited texts here, we just start by capturing some videos and some attachments, so that concludes my demonstration, next up is David Arkinsen[sp?], the director of Human services in [xx] county thank you Mr. Mathew director [xx] Thank you [xx] I appreciate the opportunity to come, I'm here this morning representing County Departments of Social Services. More importantly I'm here this morning representing the end users of what you've seen here. When I was meeting with my staff yesterday prior to leaving to come up here, we talked a little bit about the system, we talked about what were some of their hopes, and one of the things that I asked them is, What would you like for me to say this morning? And first thing they said, Well, don't embarrass us, but then they said, Tell them that we need this system, and they said, Tell them what we've just been talking about, and what we had just been talking about, we'd just been staffing a case that our on-call worker had experienced on Saturday afternoon. We'd received a call from the hospital, a young mother was there in the hospital with a terminal illness, she was unresponsive and so the on-call worker wasn't able to get any information from her in terms of safety resources for her three children so we came back and we began doing a data mine within our own agency because we had a little bit information, but one of the things we've been looking at the current legacy systems,

was that this was a family that had child protective service cases in three other counties and so we began as soon as we got in the office Monday morning, we began making calls to these other counties asking for their records. Now, Thelma we don't have electronic records in child welfare in North Carolina, and so these three other counties were pulling together copies of paper records and as of last night well over 48 hours after the initial report came in and we were still waiting on critical information on this potential safety resources for these children. We didn't want to put them in foster care if there were other appropriate family members that were willing to take these three children. And so what they said was they will tell them this system would have allowed us to respond immediately and identify appropriate family members to place these children. And that was a critical piece for them to me, for me to be able to save you this morning, what excites me about this I am passionate about child welfare well over 25 years ago I began my career as a child protective service worker books on the ground level, knocking on doors investigating child protective service report. Through the years, through my years with the state division of social services and now well over nine is back in the County again as director of human services in Cataract County. Child protective services, child wefare services has been my passion working closely to protect vulnerable children and so, when I think about this potential product it excites me, when I think about especially about the work that has already began on this. Development won't begin until January of next year, what has all already began is the exciting pieces of laying the foundation the important things that time didn't necessarily permit us to do on the other products within NC- First on the FNS and on Medicaid, but that we have the luxury of a little bit more time to step back and do this right and that's the exciting piece about that. Back in January of this year we established a committee that is comprised of members of the state division of social services, members of the NC fast development team, various counties you see on the screen ahead on the left hand side a number of counties are partners with IBM and Accenture, and on the right hand side of the screen you some of the activities that have already began, that are well underway reviewing that the business system functions. Looking at county business process is one of the things that excites me is that we are reaching out to other counties and if I don't push the right button, there we go reaching out to not only other Counties but other States. We're having virtual meetings with Colorado, with Ohio, with Guns and Minnesota, Pennsylvania. Not only learning what they did right, not only learning what they were celebrating, but learning quite harshly where they messed up Learning their failures so that we don't repeat them. And those we're exciting things particularly in Child Welfare because for me every minute counts. No wasted effort on this. We have been doing deep dives with four Counties looking at the processes within those four counties. How they do Child Protective Services, how they manage their Child Welfare Programmes. Right now you heard Deputy Secretary [xx] talk about how there are this listening sessions that are going on all over the State, you see that list of Counties there up on the screens. I believe the last one is coming up and rocking him. These are critical sessions where these committee members that we mentioned a while ago are sitting down with child welfare workers, with county workers saying what work, what doesn't work, what are your needs, what would you like to see? Building wish lists, building things that they don't want to see. These are the exciting times in welfare where we are able to pull all of these information together, and be able to go into the hard development stage with a lot of critical information, that will help us to make sure that we are product that is is absolutely vital for child protective service workers around the state, building a product that these workers can sit back not be in

a situation that my own call worker was this past weekend,  having to make decisions, he and his supervisor having to make decisions almost in the dark about family members that may or may not be available, that will love these children and would keep them safe for the rest of their lives Representative Dabson that concludes my presentation, I don't know this may actually wrap us up. So thank you.  Thank you director Hackinson for your presentation, we thank all of our guests for their presentations, the time we have remaining, we'll open up to questions. Chairman Tucker? Thank you Mr. Chairman I don't know how we can ask about this in 12 minutes with a 40 page presentation the file's on the center of the floor, I'd call the filibuster but I'm not going to do that. Let me move through here as quickly as we can probably would like to talk to someone after this, because there are a number of questions, I think it's fair to say that secretary Bradshow worked with a group in 1999 to come up with plan for child welfare, and in the world of software, we haven't moved any further forward than 2015, we're looking at it now, question Madam secretary, did we look at other systems before we went down the road so far with NC FAST? Was that a plan? Have you already made a decision to go with NC FAST? It looks like with all this work that's been done the last six months, you were certainly not asking us to give you any input into this. It would look like we might kid you're asking for forgiveness rather than permission. So you've already made decision to go with NC FAST. So Senator Tucker I would ask for Angie Taylor to talk about the bid process and the work that was done we purchased the NC FAST Curam software. So Senator Tucker back in 2008 we did do a progressive award where went out with all those to 11, 000 requirements that included the child welfare services as well, and within that it was a competitive bid. We did have vendors proposed and during that time frame the only solution that we were able to come back with that would need all of our needs across all those services was the current framework. It's a framework not just a software tool, but that framework allows us to build these components that are provided plus additional information top of that so we felt as a state that that framework would allow us as we talked about earlier as we look at other case management solution it allows NC first staff touch to expand that beyond what might just be improvisers modules. So you made a decision to move forward and see first that's been made. Is that correct? So at this point and time we're looking at those requirements and as David was saying, we're looking at everything to make sure that this product is the product that we need it to be, and we're working with IBM to make sure that as we move forward that it meets all of the requirements, one of the things we're also doing is making sure that the mobility which wasn't there is also there in this solution. Follow up am sorry just trying to get through this quickly, you have a schedule here with [xx] tracks that was six years behind time, with NC first we had all choose that were developed one is there are sufficient penalty for IBM at their sleeping and the sleep-age in the schedule and where is the NC fast program has been implemented in another state or is [xx] forgive me I cannot pronounce your last name so wouldn't two thirds give me trouble, is there other states and body implemented this and if so where I only saw three child case management China, Mexico and Brazil on the sheet that has been done where we done this in US or are we going to be the how risk of first try of the shoot as he was expressing it in North Carolina would like to do in Tennessee. I know you've lived with this first program, sleepless nights, much overtime, I appreciate your efforts but I don't have much confidence right now at this juncture at your recommendation. So, Senator Tucker, one

of the things, that we're also doing is reaching out to sketch on if I can pronounce it with Senator [xx] and in Ontario we have already implemented the [xx] solution for town welfare and so with that, again, we're working with other states that have been successfully and understanding what they have done, So, while we're the leading state in the U. S for implementing this module. I think you'll see that with the other modules we're also the leading State and that is the reason we have [xx] D. C, South Carolina and the other states coming to us now asking for our code, and our information because we're the leader. So I feel very confident in what we have done and the success that we've had so far but with the specifics around the successes and where they're I'll turn that over to our Avian rep  last followup Mr. Chair then no one else in the U. S has implemented this system as of this day is that correct? Not to it's full capacity like we will be doing Louisiana has implemented some portions of that solution, but they have not done the complete so the answer is no we're the high risk guinea pig state for the U. S  As we were with the others thank you members have about eight minutes and we have five members who want to ask I'll do ask you to limit to one and maybe one followup and if you would keep your answers brief, thank you. Chairman Brisson Mr Chair, I honestly and I know by the time of the presentation we will not go have time for questions I don't the presentation did last too long for questions and I have several questions, I'm sure the other folks have several questions now we're going to push each other and not allowed to ask questions, I just have a problem with that and I'll just forget my one question and pass on and give somebody else a chance. Chairman adds.  Thank you Mr. Chairman, I have two things I wanted to follow up real quick with Mr. [xx]. The first one is looking at this on a county level we this predominaly is system administered by the counties we've said a few things that make me a little nervous a bout the implementation and others that were coming in I see what all the software system is and does and when it's going to go online but you said that all of these records are paper records. They exist for the county in charge protective services and others and a lot of the needs for this is that once it's up and running you need to see the historical information That's in there and available. How long do you expect that it will take to convert all your historical paper records to information that's actually available in the system? And for your child protective case workers what are the new qualifications and skills sets that they're going to need that they have not historically made and how do you plan to make that transition?  Yes, thank you for that question senator Herge. The best way that I can respond to the first part of your question is that, Codarack county volunteered to be a pilot for the food-stamp component of the NCfast, as well as the Medicate component of NC fast. And in Codarack county as in the majority of other counties around the State those were all paper records as well. In my eligibility specialist office at the time that we went live with NC Fast they had over 10, 000 paper records stuffed in their desks that were active cases. Today about two years later they have none those have all been scanned into the system and those are things that we did that we scanned that into our system with laser fusion and they have access to all of the information now and so for Cartey County within two years, well over 10, 000 paper records over 2 million images were scanned into the system and that information is immediately available to them in terms of skill set that child protective services workers need. When I was boots on the ground as a child protective service worker, that 20 something years ago, we didn't know what a computer was. All of our notes were taken on a pen and paper or I do remember in the last stage of my career in the county, I had a little micro casset that my secretary had given me and say, " Here take this notes into this and I will come back and transcribe them into the paper record. " Today every single person that we're hiring in child welfare

has been born in the computer age and so they come hard wired if you will with the ability to take this iPads and these iPhones in the systems that they use in every minute of their lives everyday, and to be able to access information that 20 years ago I could not even imagine and so the exciting thing for me and talking with myself yesterday is that, the audacious things they know I didn't know that 20 years ago. Senator Badger I'm going to be inspired by Senator Mcasick (sp) and ask my question in common in this regard first of all, thank you Senator Tucker and Representative Brasen[sp?] for yielding to me Maya[sp?] Angela says you were supposed to someone when they show you who they are the first time. You folks have been showing us who you are the first time for years. I do not have confidence with this system is going to roll out on time and you're absolutely right Mr. Arkinson[sp?]. This time is critical for our children. The question is centred on tockar as I'm going to ask can a better in a more legalistic way. What are the liquidated damages in this contract if you're late again?. I'm also very offended and I'd like an explanation for why you think North Carolina should be the guinea pig we are quote and quote leaders when we spend our tax payers money our time, our effort for six or seven years something onto the rest of the country can then call us up and say hey, how'd you get it done? I don't want to be in that position again. We need to look around and the best system that's available in this country and implemented in this country, in this state now for our children. I totally believe and totally I'm committed that we need this kind system. We need a case management system but I'm not convinced that this is the way to do it Thank you Mr chair. Director Taylor wold you like to respond? So first let me start with the contract. There is a a current contact with IBM for the software. We are a different project in most projects and that we also have an integrator contract with a center. A centre is the vendor that will assist North Carolina with implementing that solution with IBM as a partner as well. So I think that is one of the reasons we have been successful and we have to all of our projects and on time, so I think that is the key thing to understand we have been on time and within budget, I understand your concerns. We're going out, we're hearing all of the same things within each one of these counties and that's the reason we're listening because we want to implement the right solution the right way that's the reason we have taken 4, 700 requirements just for child welfare and now learn about 4, 800 just putting the mobility in, we are listening to the worker, we are going to design this system and have it implemented based on what North Carolina child welfare workers need, not what everybody in the whole US but what we need here in North Carolina and I think that is key, is why we can take the module that IBM has provided us. We can then take that and build it to our specifications I think that's the key thing to a foundation enterprise solution versus this off the shelf solutions that were not geared specifically for North Carolina. So that's the reason were spending so much time now before we start the the actual implementation starts January of next year. So that we have it right we have all the right requirements and I share your compassion because this when we started way back in 2008 child welfare was supposed to have been the third project and it was not because of other things and I think Sherry shares that with me as well is that we are very passionate were going to make this happen. representative Score, we have time for one quick question if you don't mind. Now I'm sorry Representative Pelton is to be the last one. If we can have this crew back, I agree with some of the other comments so we can have back and I'm happy to hold my question. Thank you I think that's probably a good idea. Miss Jacobs maybe we can work on that with the chairman and maybe set that up for further questioning because I think this does want further discussion and further coming. So, thank you all, thank you presenter, members thank you so much for your teaching today this meeting is adjourned.