Initial Combined Assessment (ICA) - Department of Public Health

Medi-Cal Managed CareComprehensive Perinatal Service ProgramCOMPREHENSIVE PERINATAL SERVICES PROGRAM 17Prenatal Combined Assessment/ReassessmentInstructions for Use and ProtocolsThe Prenatal Combined Assessment/Reassessment Tool is designed to be completed byany qualified Comprehensive Perinatal Services Program (CPSP) practitioner, as definedin Title 22, Section 51179.7.PURPOSE:The Prenatal Combined Assessment/Reassessment tool permits the CPSP practitioner toassess the client’s strengths, identify issues affecting the client’s health and herpregnancy outcome, her readiness to take action, and resources needed to address theissues. This information, along with the information from the initial obstetricalassessment, is used, in consultation with the client, to develop an Individualized CarePlan (ICP). The combined assessment is ideal for those practice settings in which oneCPSP practitioner is responsible for completing the client’s initial assessment andreassessments. It does not preclude discipline specialists from providing neededservices to the client.This assessment/reassessment tool was designed to meet State WIC requirements for anutrition assessment permitting WIC nutritionists to avoid a duplicative assessment andspend their time in educational or other “value added” activities to benefit pregnant Medi-Cal beneficiaries.PROCEDURES/PROCESS:The prenatal combined assessment tool is designed to be administered by a qualifiedCPSP practitioner (CPHW or other).1. Refer to the CPSP Provider Handbook, pages 2-5 through 2-15.2. Familiarize yourself with the assessment questions and the client’s medical recordbefore completing the assessment.3. The setting should allow for adequate privacy. Due to the sensitive nature of thequestions being asked, it is strongly recommended that the client’s partner and otherfamily members and friends be excluded during the administration of the assessment.This is one way to promote complete honesty in your client’s responses and protecther right to confidentiality. Cultural customs and practices should be taken intoconsideration for each client.Los Angeles AreaPernatal Protocols: 12/23