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Measuring Wraparound Fidelity

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Using Wraparound Fidelity Index 4.0.

Using Wraparound Fidelity Index 4.0.

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  • Intro: Abram
  • Abram:
  • Catherine: The wraparound process provides individualized, comprehensive, community-based services and supports to children and adolescents with serious emotional and/or behavioral disturbances so they can be reunited and/or remain with their families and communities. “A planning and implementation process that results in a unique set of community services and natural supports that are individualized to meet the child and family’s needs and achieve positive outcomes” (Burns & Goldman, 1999)”
  • Catherine: 1991 – EMQ served 130 emotionally disturbed or mentally ill children in an expensive residential treatment facilities in Santa Clara County. Youths dealt with anger, depression among other things. Many of them ended up worse than when they came in despite receiving treatment for up to a year and half. During this time, EMQ FF’s previous CEO F. Jerome (Jerry) Doyle lead the agency in adopting wraparound, which would be a community-based program, costing much less than the residential services EMQ FF and Santa Clara County directors of social services and mental health services, worked together to change the limited funding for mental health services. In July 1996, Gov. Pete Wilson signed into a law which authorized a pilot project for California’s first Wraparound program. The demonstration project was to be a 5 year program, serving 125 children annually Santa Clara County. In 1997, Legislature expanded the pilot project state wide, which lead to a contract given to the Family Partnership Institute (founded by EMQ) to train the new standards that had been set. Los Angeles County and Sacramento County were included in this expansion of the project. In 2004, Prop 63 allotted new funds only to be used if programs adopted the Wraparound approach or could demonstrate why they shouldn’t. Jerry chaired the committee that wrote the children services portion of prop 63 in the Mental Health Services Act, which made funding available for programs using the wrap approach, or requesters would have to prove why wrap wasn’t the best route to take.
  • Catherine: Yolo, Tulare, and Nevada As of 2008, EMQFF began Wraparound in Yolo, Tulare, and Nevada Counties.
  • Catherine: The foundation of the Wraparound program is its principles. Team-based: The wraparound team consists of individuals agreed upon by the family and committed to the wraparound process Natural Supports: The wraparound team actively seeks out and encourages full participation of team members drawn from the family members’ networks of interpersonal and community relationships. Community-based: The team implements service and support strategies that take place in the most inclusive, responsive, accessible and least restrictive settings possible Cultural Competence: The wraparound process demonstrates respect for and builds on the values, preferences, beliefs, culture, and identity of the youth and family and their community. Family Voice and Choice: Family and youth are prioritized during all phases of the wraparound process. Individualized: The wraparound plan consists of goals laid out for the youth and family and implements a customized set of strategies, supports, and services. Strength-based: The process and plan identifies and builds on the capabilities, knowledge, skills, and assets of the child and family. Collaboration: Team members work together and share responsibility for developing, implementing, monitoring and evaluating the wraparound plan. Persistence: Despite challenges, the team will continue to work towards the goal indicated on the wraparound plan until the team reaches an agreement that formal wraparound process is no longer required. Outcome-Based: The team ties the goals and strategies of the wraparound plan to measurable indicators of success, monitors progress and revises the plan if needed.
  • Catherine: Phase 1: Building trust with the family and wraparound team members are established and a shared vision is established. During this phase, the tone is set for teamwork and team interactions that are consistent with the wraparound principles. Phase 2: Team trust and mutual respect are built during this phase and the team creates an initial plan of care using a high quality planning process that reflects the wraparound principles. During this phase, the youth and family should feel that they are being heard and that the needs chosen are the ones they want to work on. Phase 3: The wraparound plan is implemented, progress and success are continually reviewed and changes are made to the plan if needed. Phase 4: During this phase plans are made for transitioning out of formal wraparound to a mix of formal and natural supports in the community.
  • Catherine: Currently, EMQ FF is serving 586 youths in Wraparound.
  • Catherine:
  • Catherine: Mood Disorder includes: Depression, Anxiety, Bipolar Other includes:
  • Catherine:
  • Catherine: Community includes: Home & Foster Family Facility: Hospital, Justice Related, Residential Other: Other & Shelter/Homeless Unknown At discharge there was an increase in community setting and a decrease in Facility setting.
  • Catherine: EMQ FF has collected the Child Adolescent Scale Functional Scale since 1994. Clinical Staff complete the CAFAS at admission and discharge. The CAFAS assesses the level of behavioral dysfunction of youth It has a rating Scale of 0-30 which scores the Youth’s Functioning CAFAS subscale scores: 0 = Minimal or No Impairment; 10 = Mild Impairment; 20 = Moderate Impairment; 30 = Severe Impairment Subscales are: School/work role performance Home role performance Community role performance Behavior toward others Self-harmful behavior Substance Use Thinking The Total CAFAS Scores is the scores calculated by subscales
  • Catherine: For the purposes of this graph we are looking at the avg total CAFAS score at Admit and at Discharge timeframes. We received over 1500 completed CAFAS that have a paired Admit and Discharge CAFAS. The Avg total CAFAS Score decreased at discharge thus showing the Wraparound youth’s dysfunctional behavior has gotten better as they are discharging from Wraparound. With a p value greater than .001 this shows a statistical significance.
  • Abram:
  • Abram:
  • Abram:
  • Abram:
  • Mary Ann:
  • Number of WFI Youth: 196
  • Mary Ann: Number of Youth Discharged from Wraparound: 50 Average LOS is 13 months.
  • Community includes: Home & Foster Family Facility: Hospital, Justice Related, Residential Other: Other & Shelter/Homeless Unknown
  • EMQ FF has collected the Child Adolescent Scale Functional Scale since 1994. Clinical Staff complete the CAFAS at admission and discharge. Assesses the level of behavioral dysfunction of youth Scale Scores for Youth’s Functioning (0-30) CAFAS subscale scores: 0 = Minimal or No Impairment; 10 = Mild Impairment; 20 = Moderate Impairment; 30 = Severe Impairment Subscales are: School/work role performance Home role performance Community role performance Behavior toward others Self-harmful behavior Substance Use Thinking The Total CAFAS Scores is the mean scores calculated by subscales
  • Mary Ann: Combined N= 384 Facilitator N=182 Caregiver N=114 Youth N=80
  • Family Voice and Choice: Family and youth are intentionally prioritized during all phases of the wraparound process. Planning is grounded in family members’ perspectives. Team-based: The wraparound team consists of individuals agreed upon by the family and committed to the wraparound process Natural Supports: The wraparound team actively seeks out and encourages full participation of team members drawn from the family members’ networks of interpersonal and community relationships. Collaboration: Team members work together and share responsibility for developing, implementing, monitoring and evaluating the wraparound plan. Community-based: The team implements service and support strategies that take place in the most inclusive, responsive, accessible and least restrictive settings possible.
  • Cultural Competence: The wraparound process demonstrates respect for and builds on the values, preferences, beliefs, culture, and identity of the youth and family and their community. Individualized: The wraparound plan consists of goals laid out for the youth and family and implements a customized set of strategies, supports, and services. Strength-based: The process and plan identifies and builds on the capabilities, knowledge, skills, and assets of the child and family. Persistence: Despite challenges, the team will continue to work towards the goal indicated on the wraparound plan until the team reaches an agreement that formal wraparound process is no longer required. Outcome-Based: The team ties the goals and strategies of the wraparound plan to measurable indicators of success, monitors progress and revises the plan if needed.
  • Phase 1: Building trust with the family and wraparound team members are established and a shared vision is established. During this phase, the tone is set for teamwork and team interactions that are consistent with the wraparound principles. Phase 2: Team trust and mutual respect are built during this phase and the team creates an initial plan of care using a high quality planning process that reflects the wraparound principles. During this phase, the youth and family should feel that they are being heard and that the needs chosen are the ones they want to work on. Phase 3: The wraparound plan is implemented, progress and success are continually reviewed and changes are made to the plan then implemented. Phase 4: During this phase plans are made for transitioning out of formal wraparound to a mix of formal and natural supports in the community.
  • Pgm1=LAC Wrap PGM2=NEV County Wrap PGM3=SAC Wrap PGM4= SBC Wrap PGM5=SCC Matrix PGM6=SCC UPLIFT
  • Mary Ann:
  • Michelle:
  • Michelle: Intro of Caregiver
  • Abram:

Transcript

  • 1. Measuring Wraparound Fidelity using the Wraparound Fidelity Index (WFI) 4.0 EMQ FamiliesFirst (EMQ FF) Mary Ann Wong Catherine Aspiras Michelle Coufal Elisha Heruty Abram Rosenblatt Caregiver Presenter: Epifania Marshall
  • 2. Presentation Overview
    • Introduction to Wraparound & Wraparound at EMQ FF
    • Defining Wraparound Fidelity & Implementation of the WFI at EMQ FF
    • WFI Outcomes and Feedback
    • Sharing a Caregiver’s Experience
  • 3. What is Wraparound?
  • 4. EMQ FamiliesFirst’s Influence on Wraparound in California
    • In 1991 EMQ served 130 emotionally disturbed or mentally ill children
    • In July 1996 , Gov. Pete Wilson signed into a law authorizing a pilot project
    • In 1997 , Legislature expanded the pilot project state wide
    • In 2004 , Prop 63 allotted new funds
  • 5. Wraparound Growth in California Green – counties providing Wrap services Yellow – counties planning to implement Wrap Gray – no Wrap
  • 6. EMQ FamiliesFirst’s Wraparound Principles
    • Team-based
    • Natural Supports
    • Community-based
    • Culturally Competent
    • Family Voice and Choice
    • Individualized
    • Strength-based
    • Collaboration
    • Persistence
    • Outcome-based
  • 7. EMQ FamiliesFirst’s Phases and Activities of Wraparound
    • Phase 1: Engagement and team preparation
    • Phase 2: Plan Development
    • Phase 3: Implementation
    • Phase 4: Transition
  • 8. Number of Youth Served
    • Total Number of Youth Served in Wraparound: 3,331
  • 9. Youth’s Profile
    • Average Age at Admission: 14 years
    • 62% Male; 38% Female
    • Youth’s Ethnicity
  • 10. Primary Diagnosis at Admission
  • 11. Living Situation at Admission
  • 12. Outcomes for Discharged Youth
    • Number of Youth Discharged from Wraparound: 2,762
    • Average Length of Stay: 13 months .
  • 13. Living Situation: Admit vs. Discharge
  • 14. Child and Adolescent Functional Assessment Scale (CAFAS)
    • CAFAS Subscale Score: 0 - 30
    • CAFAS Subscales:
      • School/work role performance
      • Home role performance
      • Community role performance
      • Behavior toward others
      • Self-harmful behavior
      • Substance Use
      • Thinking
  • 15. CAFAS Outcomes (n=1,539) p>.001 Timeframe
  • 16. Wraparound Fidelity
    • What is it and why is it important?
    • The Wraparound Fidelity Assessment System (WFAS)
      • Wraparound Fidelity Index, v.4 (WFI-4)
      • Team Observation Measure (TOM)
      • Community Supports for Wraparound Inventory (CSWI)
      • Document Review Measure (DRM)
  • 17. What is the WFI?
    • Measures implementation of wraparound process
    • Set of interviews – Facilitator, Caregiver, Youth, Team Member
      • 40 items for Facilitator, Caregiver, Team Member
      • 32 items for Youth
    • Confidential interviews w/multiple respondents  unique perspectives
  • 18. Evolution of the WFI Measure
    • Earlier versions: (1 through 3)
      • No consistent practice model on which to base items
      • No specification of phases/activities of process
    • WFI version 4
      • Aligned with updated NWI practice model
      • Organized by the 4 phases of wraparound
      • Items measure:
        • Adherence to principles of service delivery
        • Conformance to specific principles of the model
      • Addition of “Team Member” form
  • 19. Wraparound Fidelity Administration
    • WFI Administration at EMQ FamiliesFirst
      • 9 traditional wraparound programs in 8 counties:
        • Santa Clara
        • Sacramento
        • Nevada
        • Yolo
        • Fresno
        • Tulare
        • San Bernardino
        • Los Angeles
    • Selection of families for interviewing
    • Eight trained & certified interviewers
    • Administered in stages during FY10
  • 20. Results
  • 21. Demographics of WFI Youth
    • Average Age at Admission: 13 years
    • 55% Male; 45% Female
    • Youth’s Ethnicity
  • 22. Primary Diagnosis at Admission for WFI Youth
  • 23. Living Situation at Admission for WFI Youth
  • 24. Outcomes for Discharged WFI Youths
  • 25. Living Situation: Admit vs. Discharge for WFI Youth
  • 26. CAFAS Outcomes for WFI Youth p>.001 Timeframe
  • 27. Summary of Respondents
    • 385 interviews were administered over the phone
    • 123 caregiver interviewed
      • 24.9 minutes average time
    • 185 facilitator interviewed
      • 42.3 minutes average time
    • 87 youth interviewed
      • 25.4 minutes average time
    • 10 team member interviewed
      • 25.4 minutes average time
  • 28. EMQ FF vs National Data Overall Fidelity
  • 29. EMQ FF vs National Data Combined Fidelity Scores by Principle
  • 30. EMQ FF vs National Data Combined Fidelity Scores by Principle Con’t
  • 31. EMQ FF vs National Data Fidelity Scores by Phase
  • 32. CAFAS Reliable Change Index (RCI) by Program 18% 28% 18% 18% 9% 14% Worse 17% 23% 24% 23% 23% 0% Same 66% 50% 58% 60% 68% 86% Better PGM 6 (n=756) PGM 5 (n=102) PGM 4 (n=232) PGM 3 (n=420) PGM 2 (n=22) PGM 1 (n=7) EMQ FF Wraparound Programs RCI Level
  • 33. Average Total WFI Scores by Program 18.43 PGM 6 15.32 PGM 5 11.54 PGM 4 15.70 PGM 3 6.38 PGM 2 12.84 PGM 1 Average Total WFI Score EMQ Wraparound Program
  • 34. Data Implications
    • Further studies employing the WFI on Outcomes
      • CAFAS
      • School Information
      • Living Situation
      • CANS (Child and Adolescent Needs and Strength)
  • 35. Challenges
    • New programs and staff
    • Difficult populations
    • Language barriers
    • Ratio of certified interviewers to interviewees
    • Relatively low response rates
  • 36. Lessons Learned
    • Program buy-in
    • Work with Wrap teams
    • Use EMQ FF language certified employees
  • 37. A Caregiver’s Experience
  • 38.
    • Future Directions
  • 39. Q & A
  • 40. References
    • Bruns, E. (nd). Wraparound Fidelity Assessment System. Retrieved April 15, 2010, from Wrap Info website: http://depts.washington.edu/wrapeval/WFI.html
    • Hodges, K. (2000). Child and adolescent functional assessment scale . Ann Arbor, MI: Functional Assessment Systems.
    • Wraparound Evaluation & Research Team. (2010, April 15). The Wraparound Process. Retrieved from http://depts.washington.edu/wrapeval/approach.html
  • 41. Contact Information
    • Mary Ann Wong
      • [email_address] (916) 388-6303
    • Catherine Aspiras
      • caspiras @emqff.org (408) 335-1809
    • Michelle Coufal
      • mcoufal @emqff.org (408) 335-1888
    • Elisha Heruty
      • eheruty @emqff.org (408) 335-1889
    • Abram Rosenblatt
      • arosenblatt @emqff.org (408) 364-4016