OMHSAS Children’s Bureau Youth and Family Institute Presentation Pennsylvania Council of Children, Youth, and Family Services

Recovery and Resilience People who are involved in supportive social relationships experience benefits in terms of health, morale, and coping; Strengthening interpersonal and community ties is a resilience and development promoting strategy; Research shows that engaging and empowering youth and families results in enduring improvement for youth with behavioral health challenges.

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

Transformation Implementation Create an Institute to provide training, support and monitoring of Youth and Family Teams Develop mechanism for Medicaid payment of Youth and Family Team process Begin process of implementing Youth and Family Teams throughout the Commonwealth

Youth and Family Institute Contract with University of Pittsburgh Utilizing VroonVanDenBerg to provide consultation and training on High Fidelity Wraparound Public presentations Executive Director Advisory Board

Implementation Steps Utilizing Mercer Government Human Services Consultants for Medicaid expertise Testing the service and financing model in Allegheny County Request for counties to be early implementers Continue to test, improve, educate.

What is the Model The Specifics

High Fidelity Wraparound A process for supporting youth and families with complex behavioral health needs Defined by National Wraparound Initiative 10 principles Four phases (engagement, plan development, implementation and transition) Theory of Change: Needs, self efficacy, natural supports and an integrated plan

9 In Pennsylvania We have a long history of collaboration and programs to support children and their families. We do not have strong evidence of outcomes for our efforts. We need to implement and support research proven approaches, such as High Fidelity Wraparound.

Development of Wraparound Grassroots Development General Principles Applied in many different ways Creativity and advances 200,000 children by 1999 Initial Results Life changing success stories Strong support Mixed evaluation results Research shows results match fidelity

Defining Wraparound Steps to Define Wraparound Duke University meeting on principles Duke University meeting on principles National Wraparound Initiative National Wraparound Initiative Who they are Process used Products produced Wraparound Fidelity Assessment System Wraparound Fidelity Assessment System

Principles for Wraparound Family Voice and Choice Team Based Natural Supports Collaboration (and Integration) Community Based Culturally Competent Individualized Strengths Based Persistence Outcome Based and Cost Responsible

Phases and Activities, and Skill Sets NWI phases and activities Specific skill sets for wraparound facilitators, coaches and family support partners Performance based training and coaching products Credentialing and Quality Improvement Used and been in over 35 sites across North America. Sites using these products report greatly improved outcomes and more satisfied families and staff.

What Does the Research Say? High Fidelity Wraparound can produce significantly better outcomes for children and families with significant needs than traditional approaches: Decreased restrictiveness of residential environments Decreased restrictiveness of residential environments Improved behavior and mental health symptoms Improved behavior and mental health symptoms Improved school and early care outcomes Improved school and early care outcomes Decreased family and child safety issues and risk factors Decreased family and child safety issues and risk factors Increased family engagement and satisfaction with services Increased family engagement and satisfaction with services Increased family resources to support their own children Increased family resources to support their own children

Impact on CAFAS Scores after 6 Months

Impact on CAFAS Scores after 18 Months

Phases of wraparound Time Engagement and team preparation Transition Implementation Plan development

Phases of wraparound planning Phase Ballpark range Engagement Duration of phase First 2 weeks Frequency of contacts 2 – 5 times/week Intensity 6 – 12 hours/week Plan development Duration of phase Weeks 3 and 4 Frequency of contacts 2 – 4 times/week Intensity 6 – 10 hours/week Implementation Duration of phase Weeks 5 on Frequency of contacts 2 – 3 times/week Intensity 3 – 6 hours/week Transition Duration of phase Last 2 months Frequency of contacts 1 – 2 times/week Intensity 1 – 3 hours/week

Building the team Good teams blend the family’s natural supports with professionals Teams are utilized for planning and action, not just for “staffing” or admiring the problems In wraparound, teams provide the family with support, ideas, resources and advocacy The family’s voice is crucial in selecting the team

The Team Bring informal and formal resource together Include family, friends, neighbors, service providers, spiritual leaders, others who want to help Include service providers, who fill important roles Unique to each family Give everybody involved a chance to achieve consensus on what to do Value family and community resources Can help isolated families get needed support that lasts as long as it's needed

The importance of informal/natural resources Build hope and capacity on Family Teams Through a history of connection and trust, can help families receive feedback/input in a manner that it would be difficult for professionals to achieve Make needed skills more available by including real people from the child and families world Meet families where they are and serve as bridges to where they would like to be Help ensure that children, adults and families are heard and respected

Our understanding of evidence- based programs is much better than our understanding of successful implementation. Implementation is how we take a science based practice and implement it in communities or statewide in “real world” settings that are provided with fidelity and produce good outcomes.

Successful Implementation Improved satisfaction and outcomes for children and families Improved fidelity to treatment model Decreased time to reach fidelity Decreased external supports to reach fidelity

Implementation of High Fidelity Wraparound Community Context and Readiness Staff Selection Training Supervision and Coaching Performance Management Program Evaluation Organizational Supports

Training Train and Hope does not work About behavior and system change Not satisfaction with training Research on information provision and training Factors that influence Initial motivation and engagement Initial motivation and engagement System and organizational support System and organizational support Organizational climate and control Organizational climate and control Methods of training Methods of training

Need for Coaching Newly-learned behavior is crude compared to performance by a master practitioner. Newly-learned behavior is incomplete and will need to be shaped to be most functional in a service setting. Newly-learned behavior is fragile and needs to be supported in the face of reactions from consumers and others in the service setting.

Supervision and Coaching Types of coaching Live coaching (modeling and feedback) Live coaching (modeling and feedback) Videotaped Videotaped Group sessions Group sessions Individual sessions Individual sessions and individual sessions and individual sessions Supervision Process Assessment Assessment Individual and group Individual and group Live coaching Live coaching Records review Records review Performance plans Performance plans Characteristics Strengths-based Reflective Proactive Frequency and duration Change over time

Supervision Impacts Time to Fidelity Inconsistent supervision is more crisis and reactive Low frequency supervision meets less than weekly and rarely does in-vivo supervision Proactive supervision implements plans for professional development

Fidelity Assessment / Improvement  Two leveled certification competency based certification process  Measures of compliance to the wraparound phases and activities  Measures of fidelity to the wraparound process  Use of the measures to guide ongoing professional development

Six Types of Certification Wraparound Novice Wraparound Practitioner Family Support Partner Mentor for Wraparound Process Coach/Supervisor for Wraparound Process Trainer for Wraparound Process

Certification – Wraparound Practitioner Goal: to define the basic skill sets that must be demonstrated to be considered a competent entry level wraparound facilitator Requirements include: Has received 3 hours of supervision/coaching per week Has a professional development plan Has demonstrated competency on wraparound process tools Has demonstrated competency on each of nine practitioner tools

Community Context and Readiness  Engaging key stakeholders  Commitment to core wraparound components  Feasibility assessment  Staffing and supervision ratios / assignments  Policies, procedures and documentation processes  Implementation plan

Youth and Family Institute Will provide training and certification Will provide coaching Will conduct on-going evaluation using the Wraparound Fidelity Index Will continue to provide support for counties as they establish the Youth and Family Team process Will provide information and education