The Wraparound Process as a “Tier 3” Component of School-wide Systems of Positive Behavior Supports

Eric Bruns, PhDUniversity of Washington School of Medicine

Washington PBIS Network ConferenceSpokane, WA

November 8, 2013

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www.nwi.pdx.edu

Main Messages

•Problem behavior remains among the most challenging barriers to effective education

•School-wide PBS (with all three tiers) is proving to be both practical and effective at building the positive social cultures that support educational gains.

•Addressing the behavior support needs of those students with the most intense needs is part of school-wide PBS.

Main Messages

•Wraparound is a key “Tier 3” strategy within PBS that emphasizes a collaborative, team based approach to solving behavior problems

•Wraparound requires not just effective process, but administrative coordination.

Primary Prevention:School-/Classroom-Wide Systems for

All Students,Staff, & Settings

Secondary Prevention:Specialized Group

Systems for Students with At-Risk Behavior

Tertiary Prevention:Specialized

IndividualizedSystems for Students

with High-Risk Behavior

~80% of Students

~15%

~5%

SCHOOL-WIDE POSITIVE BEHAVIOR

SUPPORT

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Major Office Discipline Referrals (05-06)

0-1 '2-5 '6+

3%8%

89%

10%

16%

74%

11%

18%

71%

K=6 (N = 1010) 6-9 (N = 312) 9-12 (N = 104)

Mean Proportion of Students

ODR rates vary by level

A few kids get many ODRs

Tier 1/Universal School-Wide Assessment

School-Wide Prevention Systems

SIMEO Tools: HSC-T, RD-T, EI-T

Check-in/ Check-out

Individualized Check-In/Check-Out, Groups & Mentoring (ex. CnC)

Brief Functional Behavioral Assessment/Behavior Intervention Planning (FBA/BIP)

Complex FBA/BIP

Wraparound

ODRs, Attendance, Tardies, Grades, DIBELS, etc.

Daily Progress Report (DPR) (Behavior and Academic Goals)

Competing Behavior Pathway, Functional Assessment Interview, Scatter Plots, etc.

Social/Academic Instructional Groups

Positive Behavior Interventions & Supports:A Response to Intervention (RtI) Model

Illinois PBIS Network, Revised Aug.,2009Adapted from T. Scott, 2004

Tier 2/Secondary

Tier 3/Tertiary

Inte

rven

tio

nAssessm

en

t

What is the Wraparound Process? Wraparound is a family-driven, team-based process for

planning and implementing services and supports. Through the Wraparound process, teams create plans that are

geared toward meeting the unique and holistic needs of these youth and their caregivers and families.

The Wraparound team members meet regularly to implement and monitor the plan to ensure its success. Team members include individuals relevant to the success of the

identified youth, including his or her parents/caregivers, other family members and community members, mental health professionals, educators, system representatives, and others

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Why Wraparound? From the family perspective From the system perspective

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The Evans Family

Crystal, 34 Tyler, 36 David, 14 Kyle, 12 Kaia, 12

Major Problems: Crystal has depression and suicide ideation Tyler is an alcoholic and can not keep a job David has been arrested multiple times for increasing levels

of theft, vandalism, drug and alcohol use and assault David is in juvenile detention and due to lack of progress

may be moving to higher level of care David is two years behind in school and does not seem to

care The twins were abused by their dad and are in specialized

foster case The twins have been diagnosed with bipolar disorders and

are often very aggressive The twins are very disruptive at school and are not working

to grade level

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26 Helpers and 13 Plans

Helpers: School (5) Technical School (2) Bailey Center (2) Child Welfare (1) Specialized Foster Care (2) Juvenile Justice (1) Children’s Mental Health (6) Adult Mental Health (3) Employment Services (2) AA (1) Housing Department (1)

Plans: 2 IEPs (Kyle and Kaia) Tech Center Plan Bailey Center Plan Permanency Plan Specialized Foster Care Plan Probation Plan 3 Children’s MH Tx Plans 2 Adult MH Tx Plans Employment Services

35 Treatment Goals or Objectives

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Monthly Appointments for the Evans Family

Child Welfare Worker 1Probation Officer 2Crystal’s Psychologist 2Crystal’s Psychiatrist 1Dave’s therapist 4Dave’s restitution services 4Appointments with Probation and School 2Family Based 4Twins’ Therapists 4Group Rehabilitation 8Tyler’s anger management 4Children’s Psychiatrist 1Other misc. meetings:, Housing, Medical 5TOTAL 42Also: 16 AA meetings Tyler goes to each month to preserve his sobriety, daily schedule

(School, tech center, and vocational training) and the dozen or more calls from the schools and other providers each month.

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Comments from the Files:

Parents don’t respond to school’s calls Family is dysfunctional Parents are resistant to treatment Home is chaotic David does not respect authority Twins are at risk due to parental attitude Mother is non-compliant with her psychiatrist She does not take her meds Father is unemployable due to attitude Numerous missed therapy sessions Attendance at family therapy not consistent Recommend court ordered group therapy for parents

Traditional services rely on professionals and can result in multiple plans

Behavioral Health

Juvenile Justice

EducationChild

welfare

YOUTH FAMILY

Plan 1 Plan 2 Plan 3Plan 4

Laura Burger Lucas, ohana coaching, 2009 17

In wraparound, a facilitator coordinates the work of system partners and other natural helpers so there is one coordinated plan

Behavioral Health

Juvenile Justice

EducationChild

welfare

Facilitator(+ Parent/youth

partner)

YOUTH

FAMILY“Natural Supports”

•Extended family

•Neighbors

•Friends

“Community Supports”

•Neighborhood

•Civic

•Faith-based

ONE PLAN Laura Burger Lucas, ohana coaching, 2009

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Wraparound and Schools• Wraparound can be integrated into school-

based planning for students with special needs, regardless of special education label or agency involvement.

• The wraparound approach is a critical part of the SW-PBS system as it offers a means for schools to succeed with the 1–2% of students whose needs have become so complex that starting with an FBA/BIP process for one selected problem behavior is not enough

Wraparound and Schools• Full implementation of SW-PBS at the universal level

provides a solid base of lower-level interventions (e.g., primary and secondary) to build on and more effective and supportive environments in which to implement wraparound plans.

• Within a three-tier system of behavioral support, students who need tertiary-level supports also have access to and can benefit from universal and secondary supports. Each level of support in SW-PBS is “in addition to” the previous level. In other words, no student only needs wraparound.

Wraparound and Schools

• Although on the surface wraparound can be seen as similar to the typical special education or mental health treatment planning process, it dedicates more effort to building constructive relationships and support networks among the youth and his or her family (Burchard, Bruns, & Burchard, 2002; Eber, 2005).

• This is accomplished by establishing a unique team with each student and the student’s family that– Is invested in achieving agreed-on quality-of-life indicators.– Follows a response to intervention (RTI) model – Uses more intensive techniques for engagement and team

development – Ensures that a cohesive wraparound team and plan are formed.

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What’s Different in Wraparound?

• An integrated plan is designed by a team of people important to the family

• The plan is driven by and “owned” by the family and youth• The plan focuses on the priority needs as identified by the

family• Strategies in the plan include supports and interventions

across multiple life domains and settings (i.e., behavior support plans, school interventions, basic living supports, family supports, help from friends and relatives, etc)

• Strategies include supports for adults, siblings, and family members as well as the “identified youth”

Unique Fit

Wraparound plans should be uniquely

designed to fit individual students’

needs as opposed to making a student

fit into existing services or a

prescribed program.

Life Domain Areas to Consider

• Physical Needs/Living Situation

• Family/Attachment• Safety• Socialization• Cultural/Spiritual

• Emotional/ Psychological

• Health• Educational/

Vocational• Legal

• 6th grade student • Behavior difficulties and academic failure • GPA 1.25 (2nd quarter)• 6 ODRs (1st two quarters)• 15 Out-of-School Suspensions (safety)• Family support needs –history of mobility

with plan to move at the end current school year. Student moved nine times since first grade

Andy

Why move to Phase I wraparound instead of an FBA around one problem behavior?

– Discussing problem behaviors would not have motivated family to participate on team.

– Probably not the first time schools have approached family in this manner (“let’s talk about behavior”)

– Bigger needs to work on to improve quality of life for youth and family

– Open-ended conversation and use of wrap data tools helped engage family

The team developed a mission statement:

“Andy will be happy and confident in school”

Andy

Using Data to Keep the Team Moving“Celebrate Success of current plan”

Andy

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A practice model:The Four Phases of Wraparound

Time

Engagement and Support

Team Preparation

Initial Plan Development

Implementation

Transition

Phase1A

Phase1B

Phase2

Phase3

Phase4

Phase I: Team Development

Initiating the Wraparound Process

• Prepare for wraparound meetings through individual conversations with core team members is a critical first step.

• The first contact/s with the family should feel different than being invited to a meeting.

• Gather information for a rich strength profile (this will be a valuable tool for action planning).

Team Composition: Roles are the focus (not job titles)

• Parents/caretakers and youth• Person/s the family turns to for support

(extended family, friend of parent or child, neighbor, medical/professionals)

• Person representing strengths/interests (coach, specific teacher)

• Agencies Involved: mental health, DCFS, Juvenile Justice, Early Intervention, etc.

• Spiritual Supports• Facilitator• Mentor

Examples of Natural Supports Found on Wraparound Teams

• Co-workers• Relatives: extended family• Friends• Classmates• Clergy• Storeowners/merchants• Postal Workers• Crossing Guards• Taxi Drivers• Neighbors• Coaches• School custodians• Previous “helpers”

P.Miles, 2004

Phase I: Team Development

Wraparound Facilitator:– Meets with family & stakeholders– Gathers perspectives on strengths & needs– Assess for safety & rest– Provides or arranges stabilization response if

safety is compromised– Explains the wraparound process– Identifies, invites & orients Child & Family Team

members– Completes strengths summaries & inventories– Arranges initial wraparound planning

meeting

Establish Family Voice & Ownership

• Communicate differently…

No blaming, no shamingStart with strengthsFamily’s needs are priorityListen to their story before the meetingValidate their perspective

Checking for Family Voice & Ownership

• Family chooses team members

• Team meets when & where family is comfortable

• Family (including the youth) feels like it is their meeting and their plan instead of feeling like they are attending a meeting the school or agency is having about them.

Needs-based• Assumptions & Values

– Difficult behaviors result from unmet needs– Difficult behaviors tell us important things

about a person’s life– Needs are not services– Allow family/youth to voice their needs

rather than assessing needs for them– Team measures family experience of “met

need” rather than service provided

Patricia Miles, 2002

Needs & Wraparound

• Focus on the “why” of a need not the “how” – Needs to feel competent with academic tasks rather than he

needs to complete his assignments

• Use descriptive terms– To learn, To know, To experience, To feel, To see, To have, To be

• Deal with the “big” stuff– Families/youth deserve to know their teams are dealing with

their larger challenges

• More than one way to meet it– Unlike a goal (John will come to school every day)

• Improves quality of life (as defined by family, youth)

Adapted from P.Miles,2004

Examples of Needs Statements:

• The student needs to feel adults and peers respect him.

• The student needs to feel happy about being at school.

• The parent needs to know her son is getting a fair shake at school.

• The student needs to be reassured that he can complete the work.

Phase II Wraparound: Plan Development

Facilitator:• Holds an initial (or 2) wraparound plan development meeting• Introduces process & team members• Presents strengths & distributes strength summary• Solicits additional strength information from gathered group• Leads team in creating a mission statement• Introduces needs statements & solicits additional perspectives on

needs from team• Facilitates team prioritizing needs• Leads the team in generating strategies to meet needs• Identifies person/s responsible for follow-through with action plan

items• Documents & distributes the plan to all team members

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Phase 2: From listing strengths to identifying and leveraging functional strengths

• “David likes football”• “David likes to watch football with his uncle on

Sundays”• “David enjoys hanging out with his uncle; David does

well in social situations in which he feels like he can contribute to the conversations; Watching football is one activity in which David doesn’t feel anxious or worry.”

Phase III of Wraparound: Plan Implementation & Refinement

• Facilitator– Sponsors & holds regular team meetings– Facilitates team feedback on accomplishments– Leads team members in progress-monitoring

• Plan implementation• Plan effectiveness

– Creates an opportunity for modification• Maintain, modify or transition interventions

– Documents & distributes team meeting minutes

Steps for Developing a Wraparound Action Plan (Phase II-III)

1) Clarify Agenda, logistics, & team rules2) Introduce by Roles and Goals3) Develop/Review a Mission Statement (Big Needs)4) Start Meeting w/Strengths; Celebrate Successes5) Identify Needs across Domains6) Prioritize Needs 7) Develop Actions 8) Follow-up: Assign Tasks, Solicit Commitments, Set

Next Meeting Date

Document, Evaluate, Revise…

Wraparound Phase III

• Develop strategies to meet “big needs” using strengths

• After implementing strategies to improve quality of life (strength-based strategies addressing big needs),

• The team will probably need to zero in on specific behaviors that need function based interventions

Phase IV of Wraparound: Plan Completion & Transition

• Purposeful transition out of ‘formal’ wraparound process with goal of maintaining positive outcomes

• Strategies become more based on natural supports (ex. friendship, sports…)

• Focus on transition is continual (starts in phase I)

• Transition students from more intensive to less intensive supports

• Universal & Secondary strategies

• “Unwrap”

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Phase 4: From professional services to informal/community supports

Professional (Covered) Services/Interventions, i.e., FORMAL SUPPORTS

Community-based and natural supports and services, i.e., INFORMAL SUPPORTS

Time

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What does all of this accomplish?Research indicates two main pathways to outcomes

Services and supports work better, individually and as a “package”

Ten Principles

Phases and activities

Effective, values- based teamwork

High quality, high fidelity wraparound process

Participation in wraparound builds family capacities

Positive child/youth and family outcomes

Theory of change: Outline

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Core components of the wraparound theory of change

• Services and supports work better:– Focusing on priority needs as identified by the family– Creating an integrated plan– Greater engagement and motivation to participate on the

part of the family

• The process builds family capacities:– Increasing self-efficacy (i.e., confidence and optimism that

they can make a difference in their own lives)– Increasing social support

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Does wraparound work?Evidence from Nine Published Controlled Studies is Positive

Study Target population Control Group Design N

1. Hyde et al. (1996)* Mental health Non-equivalent comparison 69

2. Clark et al. (1998)* Child welfare Randomized control 132

3. Evans et al. (1998)* Mental health Randomized control 42

4. Bickman et al. (2003)* Mental health Non-equivalent comparison 111

5. Carney et al. (2003)* Juvenile justice Randomized control 141

6. Pullman et al. (2006)* Juvenile justice Historical comparison 204

7. Rast et al. (2007)* Child welfare Matched comparison 67

8. Rauso et al. (2009) Child welfare Matched comparison 210

9. Mears et al. (2009) MH/Child welfare Matched comparison 121

*Included in 2009 meta-analysis (Suter & Bruns, 2009)

Outcomes of wraparound (9 controlled, published studies to date; Bruns & Suter, 2010)

• Better functioning and mental health outcomes

• Reduced recidivism and better juvenile justice outcomes

• Increased rate of case closure for child welfare involved youths

• Reduction in costs associated with residential placements

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Main Messages

• Problem behavior remains among the most challenging barriers to effective education

• School-wide PBS (with all three tiers) is proving to be both practical and effective at building the positive social cultures that support educational gains.

• Addressing the behavior support needs of those students with the most intense needs is part of school-wide PBS.

• Wraparound is a key “Tier 3” strategy within PBS that emphasizes a collaborative, team based approach to solving behavior problems

• Wraparound has been found to be effective (now listed on the WSIPP inventory of research based practices)

For more information

• http://www.pbis.org• www.nwi.pdx.edu• http://www.pbisillinois.org