OMHSAS Children’s Bureau OMHSAS Children’s Bureau Youth and Family Institute Youth and Family Institute

PresentationPresentation

Pennsylvania Council of Children, Pennsylvania Council of Children, Youth, and Family ServicesYouth, and Family Services

2-20-082-20-08

Recovery and ResilienceRecovery and Resilience

People who are involved in supportive social People who are involved in supportive social relationships experience benefits in terms of health, relationships experience benefits in terms of health, morale, and coping;morale, and coping;

Strengthening interpersonal and community ties is a Strengthening interpersonal and community ties is a resilience and development promoting strategy;resilience and development promoting strategy;

Research shows that engaging and empowering youth Research shows that engaging and empowering youth and families results in enduring improvement for youth and families results in enduring improvement for youth with behavioral health challengeswith behavioral health challenges..

Transformation ObjectiveTransformation Objective

Transform the Transform the children’s behavioral children’s behavioral health system in health system in Pennsylvania to a Pennsylvania to a system that is family system that is family driven and youth driven and youth guided guided

Transformation ImplementationTransformation Implementation

Create an Institute to provide training, Create an Institute to provide training, support and monitoring of Youth and Family support and monitoring of Youth and Family TeamsTeams

Develop mechanism for Medicaid payment of Develop mechanism for Medicaid payment of Youth and Family Team processYouth and Family Team process

Begin process of implementing Youth and Begin process of implementing Youth and Family Teams throughout the Family Teams throughout the Commonwealth Commonwealth

Youth and Family InstituteYouth and Family Institute

Contract with University of PittsburghContract with University of Pittsburgh

Utilizing VroonVanDenBerg to provide Utilizing VroonVanDenBerg to provide consultation and training on High Fidelity consultation and training on High Fidelity WraparoundWraparound

Public presentationsPublic presentations

Executive DirectorExecutive Director

Advisory BoardAdvisory Board

Implementation StepsImplementation Steps

Utilizing Mercer Government Human Utilizing Mercer Government Human Services Consultants for Medicaid Services Consultants for Medicaid expertiseexpertise

Testing the service and financing model in Testing the service and financing model in Allegheny CountyAllegheny County

Request for counties to be early Request for counties to be early implementersimplementers

Continue to test, improve, educate.Continue to test, improve, educate.

What is the ModelWhat is the Model

The SpecificsThe Specifics

High Fidelity WraparoundHigh Fidelity WraparoundA process for supporting youth and families A process for supporting youth and families with complex behavioral health needswith complex behavioral health needs

Defined by National Wraparound InitiativeDefined by National Wraparound Initiative

10 principles10 principles

Four phases Four phases (engagement, plan development, (engagement, plan development, implementation and transition)implementation and transition)

Theory of Change: Theory of Change: Needs, self efficacy, Needs, self efficacy, natural supports and an integrated plannatural supports and an integrated plan

99

In PennsylvaniaIn Pennsylvania

We have a long history of collaboration and We have a long history of collaboration and programs to support children and their families.programs to support children and their families.

We do not have strong evidence of outcomes for We do not have strong evidence of outcomes for our efforts.our efforts.

We need to implement and support research We need to implement and support research proven approaches, such asproven approaches, such as

High Fidelity Wraparound.High Fidelity Wraparound.

Development of WraparoundDevelopment of Wraparound

Grassroots DevelopmentGrassroots DevelopmentGeneral PrinciplesGeneral PrinciplesApplied in many different waysApplied in many different waysCreativity and advancesCreativity and advances200,000 children by 1999200,000 children by 1999

Initial Results Initial Results Life changing success storiesLife changing success storiesStrong supportStrong supportMixed evaluation resultsMixed evaluation resultsResearch shows results match fidelityResearch shows results match fidelity

Defining WraparoundDefining Wraparound

Steps to Define WraparoundSteps to Define Wraparound Duke University meeting on principlesDuke University meeting on principles National Wraparound InitiativeNational Wraparound Initiative

Who they areWho they are

Process usedProcess used

Products producedProducts produced Wraparound Fidelity Assessment SystemWraparound Fidelity Assessment System

Principles for WraparoundPrinciples for Wraparound

Family Voice and Family Voice and ChoiceChoiceTeam BasedTeam BasedNatural Supports Natural Supports Collaboration (and Collaboration (and Integration)Integration)Community BasedCommunity Based

Culturally Competent Culturally Competent

IndividualizedIndividualized

Strengths BasedStrengths Based

PersistencePersistence

Outcome Based and Outcome Based and Cost ResponsibleCost Responsible

Phases and Activities, and Phases and Activities, and Skill SetsSkill Sets

NWI phases and activitiesNWI phases and activitiesSpecific skill sets for wraparound facilitators, Specific skill sets for wraparound facilitators, coaches and family support partnerscoaches and family support partnersPerformance based training and coaching products Performance based training and coaching products Credentialing and Quality ImprovementCredentialing and Quality ImprovementUsed and been in over 35 sites across North Used and been in over 35 sites across North America.America.

Sites using these products report greatly improved Sites using these products report greatly improved outcomes and more satisfied families and staff.outcomes and more satisfied families and staff.

What Does the Research Say?What Does the Research Say?

High Fidelity Wraparound can produce significantly better High Fidelity Wraparound can produce significantly better outcomes for children and families with significant needs outcomes for children and families with significant needs than traditional approaches:than traditional approaches:

Decreased restrictiveness of residential environmentsDecreased restrictiveness of residential environments Improved behavior and mental health symptomsImproved behavior and mental health symptoms Improved school and early care outcomesImproved school and early care outcomes Decreased family and child safety issues and risk Decreased family and child safety issues and risk

factorsfactors Increased family engagement and satisfaction with Increased family engagement and satisfaction with

servicesservices Increased family resources to support their own Increased family resources to support their own

childrenchildren

Impact on CAFAS Scores Impact on CAFAS Scores after 6 Monthsafter 6 Months

-50

-40

-30

-20

-10

0

10

Trad MH Services High FidelityWraparound

Low Fidelity thenCoaching

Chn

age

In C

AFA

S S

core

s

6 months

Impact on CAFAS Scores Impact on CAFAS Scores after 18 Monthsafter 18 Months

-70-60-50-40-30-20-10

010

Trad MH Services High FidelityWraparound

Low Fidelity thenCoaching

Chn

age

In C

AFA

S S

core

s

6 months 18 months

Phases of wraparoundPhases of wraparound

Time

Engagement and team preparation

Transition

Implementation

Plan development

Phases of wraparound planningPhases of wraparound planning

PhasePhase Ballpark rangeBallpark rangeEngagementEngagement Duration of phaseDuration of phase First 2 weeksFirst 2 weeks

Frequency of contactsFrequency of contacts 2 – 5 times/week2 – 5 times/week

IntensityIntensity 6 – 12 hours/week6 – 12 hours/week

Plan developmentPlan development Duration of phaseDuration of phase Weeks 3 and 4Weeks 3 and 4

Frequency of contactsFrequency of contacts 2 – 4 times/week2 – 4 times/week

IntensityIntensity 6 – 10 hours/week6 – 10 hours/week

ImplementationImplementation Duration of phaseDuration of phase Weeks 5 onWeeks 5 on

Frequency of contactsFrequency of contacts 2 – 3 times/week2 – 3 times/week

IntensityIntensity 3 – 6 hours/week3 – 6 hours/week

TransitionTransition Duration of phaseDuration of phase Last 2 monthsLast 2 months

Frequency of contactsFrequency of contacts 1 – 2 times/week1 – 2 times/week

IntensityIntensity 1 – 3 hours/week1 – 3 hours/week

Building the teamBuilding the team

Good teams blend the family’s natural Good teams blend the family’s natural supports with professionalssupports with professionals

Teams are utilized for planning and action, not Teams are utilized for planning and action, not just for “staffing” or admiring the problemsjust for “staffing” or admiring the problems

In wraparound, teams provide the family with In wraparound, teams provide the family with support, ideas, resources and advocacysupport, ideas, resources and advocacy

The family’s voice is crucial in selecting the The family’s voice is crucial in selecting the teamteam

The TeamThe Team

Bring informal and formal resource togetherBring informal and formal resource together

Include family, friends, neighbors, service providers, Include family, friends, neighbors, service providers, spiritual leaders, others who want to help spiritual leaders, others who want to help

Include service providers, who fill important rolesInclude service providers, who fill important roles

Unique to each familyUnique to each family

Give everybody involved a chance to achieve consensus Give everybody involved a chance to achieve consensus on what to doon what to do

Value family and community resourcesValue family and community resources

Can help isolated families get needed support that lasts Can help isolated families get needed support that lasts as long as it's neededas long as it's needed

The importance of The importance of informal/natural resourcesinformal/natural resources

Build hope and capacity on Family Teams Build hope and capacity on Family Teams

Through a history of connection and trust, can help Through a history of connection and trust, can help families receive feedback/input in a manner that it would families receive feedback/input in a manner that it would be difficult for professionals to achievebe difficult for professionals to achieve

Make needed skills more available by including real Make needed skills more available by including real people from the child and families worldpeople from the child and families world

Meet families where they are and serve as bridges to Meet families where they are and serve as bridges to where they would like to bewhere they would like to be

Help ensure that children, adults and families are heard Help ensure that children, adults and families are heard and respectedand respected

Our understanding of evidence-Our understanding of evidence-based programs is much better based programs is much better

than our understanding of than our understanding of successful successful implementation.implementation.

Implementation is how we take a Implementation is how we take a science based practice and implement it science based practice and implement it

in communities or statewide in “real in communities or statewide in “real world” settings that are provided with world” settings that are provided with fidelity and produce good outcomes.fidelity and produce good outcomes.

Successful ImplementationSuccessful Implementation

Improved satisfaction and outcomes for Improved satisfaction and outcomes for children and familieschildren and families

Improved fidelity to treatment modelImproved fidelity to treatment model

Decreased time to reach fidelityDecreased time to reach fidelity

Decreased external supports to reach Decreased external supports to reach fidelityfidelity

Implementation of High Fidelity Wraparound

Community Context and Readiness

StaffSelectio

n

Training

Supervision and

Coaching

Performance

Management

ProgramEvaluatio

n

Organizational

Supports

TrainingTraining

Train and Hope does not work Train and Hope does not work

About behavior and system change About behavior and system change

Not satisfaction with trainingNot satisfaction with training

Research on information provision and trainingResearch on information provision and training

Factors that influenceFactors that influence Initial motivation and engagementInitial motivation and engagement System and organizational supportSystem and organizational support Organizational climate and controlOrganizational climate and control Methods of trainingMethods of training

Need for CoachingNeed for Coaching

Newly-learned behavior is crude compared Newly-learned behavior is crude compared to performance by a master practitioner.to performance by a master practitioner.

Newly-learned behavior is incomplete and Newly-learned behavior is incomplete and will need to be shaped to be most will need to be shaped to be most functional in a service setting.functional in a service setting.

Newly-learned behavior is fragile and Newly-learned behavior is fragile and needs to be supported in the face of needs to be supported in the face of reactions from consumers and others in reactions from consumers and others in the service setting.the service setting.

Supervision and CoachingSupervision and CoachingTypes of coachingTypes of coaching Live coaching (modeling and Live coaching (modeling and

feedback)feedback) Videotaped Videotaped Group sessionsGroup sessions Individual sessionsIndividual sessions and individual sessionsand individual sessions

Supervision ProcessSupervision Process AssessmentAssessment Individual and groupIndividual and group Live coachingLive coaching Records reviewRecords review Performance plansPerformance plans

CharacteristicsCharacteristics Strengths-basedStrengths-based ReflectiveReflective ProactiveProactive Frequency and durationFrequency and duration Change over timeChange over time

Supervision Impacts Time to Supervision Impacts Time to FidelityFidelity

0

2

4

6

8

10

12

14

Mon

ths

to F

idel

ity

Inconsistent supervision Inconsistent supervision is more crisis and is more crisis and reactivereactive

Low frequency Low frequency supervision meets less supervision meets less than weekly and rarely than weekly and rarely does in-vivo supervisiondoes in-vivo supervision

Proactive supervision Proactive supervision implements plans for implements plans for professional developmentprofessional development

Fidelity Assessment / ImprovementFidelity Assessment / Improvement

Two leveled certification competency based Two leveled certification competency based certification processcertification process

Measures of compliance to the wraparound Measures of compliance to the wraparound phases and activitiesphases and activities

Measures of fidelity to the wraparound processMeasures of fidelity to the wraparound process Use of the measures to guide ongoing Use of the measures to guide ongoing

professional developmentprofessional development

Six Types of CertificationSix Types of Certification

Wraparound Novice Wraparound Novice

Wraparound Practitioner Wraparound Practitioner

Family Support PartnerFamily Support Partner

Mentor for Wraparound ProcessMentor for Wraparound Process

Coach/Supervisor for Wraparound Coach/Supervisor for Wraparound ProcessProcess

Trainer for Wraparound ProcessTrainer for Wraparound Process

Certification – Wraparound Certification – Wraparound PractitionerPractitioner

Goal: to define the basic skill sets that must be Goal: to define the basic skill sets that must be demonstrated to be considered a competent entry level demonstrated to be considered a competent entry level wraparound facilitator wraparound facilitator

Requirements include:Requirements include:

Has received 3 hours of supervision/coaching per weekHas received 3 hours of supervision/coaching per week

Has a professional development planHas a professional development plan

Has demonstrated competency on wraparound process Has demonstrated competency on wraparound process tools tools

Has demonstrated competency on each of nine Has demonstrated competency on each of nine practitioner toolspractitioner tools

Community Context and ReadinessCommunity Context and Readiness

Engaging key stakeholdersEngaging key stakeholdersCommitment to core wraparound Commitment to core wraparound

components components Feasibility assessmentFeasibility assessmentStaffing and supervision ratios / Staffing and supervision ratios /

assignmentsassignmentsPolicies, procedures and documentation Policies, procedures and documentation

processesprocessesImplementation planImplementation plan

Youth and Family InstituteYouth and Family Institute

Will provide training and certificationWill provide training and certification

Will provide coachingWill provide coaching

Will conduct on-going evaluation using the Will conduct on-going evaluation using the Wraparound Fidelity IndexWraparound Fidelity Index

Will continue to provide support for Will continue to provide support for counties as they establish the Youth and counties as they establish the Youth and Family Team processFamily Team process

Will provide information and education Will provide information and education