Wraparound: What It Is, What It Is Not

1
WraparoundWhat It Is, What It Is Not

• APEX II Summer Institute
• August 2008
• Eric Mann
• Kathleen M Abate

2
What is Wraparound?

• Wraparound is a planning process, based in a
  clear set of values and principles.
• Wraparound teams have dynamic rather than static
  membership.
• Wraparound is a process that begins with the
  strengths of individual youth and families.
• Wraparound is not a service or set of services.

3
What is Wraparound?

• Wraparound is a process that is child centered
  and family focused
• Wraparound connects families to supports and
  services in their communities, and always
  includes a mix of public, private, and natural
  supports.
• Wraparound is a process that respects families
  culture and values.
• Wraparound is led by a trained facilitator.

4
Wraparound Is Not

• A specific set of services offered
• A typical team meeting
• Any meeting held without family or youth
• An immediate or quick solution
• A crisis intervention or response
• A standing interagency team

5
How NOT to do Wrap Around
6
CASSP Values and Principles

• Core Values for the System of Care
• The system of care should be child centered and
  family focused, with the needs of the child and
  family dictating the types and mix of services
  provided.
• The system of care should be community-based,
  with the locus of services as well as management
  and decision-making responsibility resting at the
  community level.
•       17Stroul, B. and Friedman, R. (1986). A
  System of Care for Severely Emotionally Disturbed
  Children Youth. Washington, DCCASSP Technical
  Assistance Center, Georgetown University Child
  Development Center.

7
Wraparound in Simplest Terms

• Work until it works.
• When barriers arise--- People havent failed- the
  plan has failed.
• Strengths plus Needs Actions
• Voice and choice.
• If it doesnt feel like help, it probably isnt.
• No shame, no blame

8
Wraparound Processing Path
1. Concerns Strengths
2. Identify Team Strengths
10. Report and Evaluate
ASK
3. Create Family Vision
9. Document and Implement
LEARN
LISTEN
4. Needs Identification
8. Secure Commitments
5. Prioritize Needs
RESPOND
6. Develop Safety Plan
7. Create Strategies That Match Strengths
9
Critical Elements of High Fidelity Wraparound

• Family-Centered
• Strengths-Based
• Consumer-Driven
• Needs-Driven
• Individualized
• Culturally Relevant
• Unconditional
• Community-Based
• Team-Based

• Accountable
• Accessible
• Outcome-Based
• Cost- Effective
• Flexible
• Promoting Self-sufficiency
• Comprehensive
• Collaborative

10
What do we know in NH

• Wraparound is a promising practice with research
  to support its efficacy when practiced with
  fidelity

11
The Research What has Been Donefrom Burchard,
JD, Bruns, E.J, Burchard, SN The Wraparound
Process and B. Burns, K. Hoagwood, M. English.
Community Based Interventions for Youth, NY
Oxford University Press

• Fifteen studies have been done two qualitative
  case studies, 11 pre-post studies, two quasi
  experimental studies, two studies involving
  clinical trials.
• This research is not sufficient to qualify
  wraparound as an evidence based practice in the
  strictest definition of the term, but is
  significantly promising.

12
Eleven National Published Pre-Post Studies

• Improvement in self-control
• Improvements in home, school, and community, role
  performance
• Decrease in problem behaviors
• 85 decrease in arrests
• Improvement in permanency
• Decrease in hyperactivity
• Decrease in abuse related behaviors
• Decrease in substance use
• Decrease in hospital admissions
• Decrease in out-of-home placements.

13
What Does the Research Add Up To?

• Fidelity to a Practice Model Better Outcomes for
  Children and Families.
• Critical Elements of a good wraparound process
  (i.e. one that will result in good outcomes) have
  been developed and are largely agreed upon by
  experts and practitioners in the field. The
  Portland University Research and Training Center
  has published these critical elements and they
  are becoming widely used.

14
APEX/ACS Wrap Facilitators

• Several APEX/ACS staff have completed wraparound
  training and are working with youth and families.
  At the high school level, we use RENEW as the
  pre-planning framework for Wraparound.
• APEX/ACS Facilitators Tara Veit, Jonathon Drake,
  Maureen Tracey, Betty Santerre, Donna Couture,
  Becky Boutot, Chris San Antonio-Tunis, Kathleen
  Abate, Linda Thomas

15
Data The Big ?

• Can wraparound teams use data-based
  decision-making to prioritize needs, design
  strategies, monitor progress of the
  child/family team?
• more efficient teams, meetings, and plans?
• less reactive (emotion-based) actions?
• more strategic actions?
• more effective outcomes?
• longer-term commitment to maintain success?

16
SIMEO

• NH, via MAST NH and Wraparound NH, has been
  included in the Illinois PBIS networks SIMEO
  pilot project.
• SIMEO is an online system for data management at
  the individual case level of tertiary supports
• SIMEO trained facilitators can track youth
  progress and unmet needs using objective data
  points, and can share that information in ways
  useful to team decision making.

17
Wraparound Case StudyCarlos

• Reason for Referral for Comprehensive Wraparound
  Plan
• Behavior difficulties
• Academic difficulties
• Emotional needs
• Social skills needs

18
Wraparound Case Study Carlos cont.

• Reason for Referral cont.
• Impaired family relationships
• Impaired peer relationships
• Family support needs
• Mental health needs (depression)

19
Wraparound Case Study Carlos cont.

• Student Baseline Information
• Repeated seventh grade
• General ed classroom 100 of day
• Failing academics (GPA 0 59)
• 6 or more detentions
• 2 5 in-school suspensions

20
Wraparound Case Study Carlos cont.Classroom
Functioning From three points in time (11/03
06/04)
21
Wraparound Case Study Carlos cont. Strengths
Sustained at Six Months (11/03 06/04)
22
Wraparound Case Study Carlos cont. Strength
Sustained at Six Months (11/03 06/04)

• Works independently

23
Wraparound Case Study Carlos cont. Need
Becomes Strength at Six Months (11/03 06/04)

• Has enough to do (age-appropriate activities)

24
Wraparound Case Study Carlos cont. Ongoing
Needs/Six Months (11/03 06/04)
25
Wraparound Case Study Carlos cont. Strengths
Gained 2nd Year (11/03 02/05)
26
Wrap-NH Course

• The Wrap-NH course covers content aligned w/ the
  fundamental features of Wrap as outlined by Eber,
  Miles others
• Course now connects participants to SIMEO system
  web-based data system using Wrap fidelity
  instruments designed through the Illinois
  Statewide Technical Assistance Center

27
Technical Assistance and Training

• Introduction to Systems of Care and Wraparound
  (1/2 day or 1 day)
• Wraparound Facilitation 32 hours, participants
  can receive grad credits in education through
  Plymouth State or NASW CEUs

28
Wrap-NH What We Know Now

• Access to skilled Wraparound facilitation is an
  important feature in a continuum of support for
  children families
• 50 People received training through a 30 hour
  Wraparound course thru MAST-NH (in the past 18
  mos)
• 20 more will have opportunity to receive this
  training before MAST-NH ends

29
Continuum of Behavior Supports New Hampshires
System of Care and Education
Effective School-wide and General Education
Classroom Systems Instructional and Behavior
Management Practices Systematic
Screening Positive Parent Engagement
Efficient Tier 1 Intervention for Early
Non-Responders to School-Wide and Classroom
Prevention and Response Systems
Array of Evidence-Based Group Interventions
Addressing Prevalent Functions of Behavior for
Non-Responders to School-Wide Systems and Early
Tier 1 Intervention
Mann Muscott (2007)
Individualized Function-Based Support
Plans Available for SW and Group Non-Responders
School-based Intensive Supports Coordinator
Linkages to Wrap-NH Facilitation
Intensive Behavior Support Plans and Crisis
Intervention
School-based Intensive Supports
Linkages to Community-based Supports
Linkages to Case Centered Collaboratives
30
Wraparound Capacity NH

• 71 facilitators are current in their training in
  NH
• 12 facilitators are at Mentor level- able to
  coach and support facilitators
• Over 200 school and agency staff have received
  training in Wraparound over the last 8 years- not
  all are actively facilitating but most report
  using elements of the process and philosophy in
  their daily work

31
What we know now in NHSIMEO

• 5 NH trained Wrap facilitators have received
  introductory training on the SIMEO system
  building NH and national database and working
  towards an evidence basis that will result in
  improved ability to advocate for funding and
  resources to improve access and delivery

32
What we know now in NH

• A list of competencies for Wrap-NH Mentors has
  been developed and vetted in NH and Illinois
• Mentor training has begun which includes
• Support to achieve the mentor competencies
  developed for MAST-NH
• Review of Wrap fidelity tools facilitators can
  use at each stage of the process,
• Brainstorming with facilitators about where teams
  get stuck and how to help "un-stick" teams
• Build system for collegial support

33
Wrap-NH What We Know Now Regional Capacity/
Support Network

• Strafford Learning Center has taken a leadership
  role in the development of a regional support
  system for Wraparound in the Seacoast region
  which includes the establishment of a regional
  hub for Wraparound
• Recipient of grant from NH Endowment for Health
  to advance work in Wraparound

34
Wrap-NH Systems Development in Seacoast Region

• Development of a referral process (forms/
  procedures/ criteria)
• Information access and dissemination plan
• What is Wraparound? How can the process support
  family engagement and empowerment?
• Capacity for peer/ collegial support for
  Wraparound facilitators
• Commitment to utilize data-based decision making
  through use of SIMEO fidelity tools and input/
  output (summarization) of data
• Commitment to fidelity of practice to enhance
  research base and evidence progress
• Access to Seacoast collaborative allows for
  increased ability address community needs (i.e.
  ability to see patterns of family need address
  capacity-building thru collaborative)

35
Realities

• Of the 70 trained facilitators, many are not
  currently providing Wraparound facilitation with
  families in NH

36
Realities

• Of those providing Wraparound facilitation, many
  are not doing using data-based decision making as
  an on-going process

37
Realities

• We are certain that the need for Wraparound
  exceeds the availability of trained facilitators,
  but we do not know how many families in NH would
  be good candidates for Wraparound (i.e. what is
  the actual gap?)

38
Realities

• Which regions have an established hub for
  Wraparound (or the infrastructure to establish
  such a hub)?
• Is a regional or community hub for Wraparound a
  critical system feature given what we know about
  access to and sustainability of Wraparound?
• What are the organizational components of a
  Wraparound hub?
• What is missing/ needed in each region to develop
  a Wraparound hub?

39
Realities

• We know that schools, MH agencies, and family
  support organizations have minimal knowledge of
  existing Wraparound supports
• We have limited ability to assess to what extent
  schools/ families are satisfied with existing
  Wraparound supports (or if Wrap is being
  facilitated with fidelity)

40
Looking Ahead

• Looking ahead, what should we be our
  recommendations for Wraparound capacity building
  in NH?
• System development
• Finding/ training new potential Wraparound
  facilitators (where?)
• Education/ information dissemination
• Peer support networks/ regional systems
• Political support
• Funding/ 3rd Party Billing
• Other

41
Contact Information

• Kathleen Abate
• GSFFCMH/ACS
• gsffcmh_at_aol.com

• Eric Mann
• SERESC
• emann_at_seresc.net

42
The Wraparound Process and its Current Place
within the Research Base on Treatments for
Children, Youth, and Families Eric J. Bruns,
Ph.D. Acting Assistant Professor University of
Washington Department of Psychiatry and
Behavioral Sciences Division of Public Behavioral
Health and Justice Policy Division of Public
Behavioral Health and Justice Policy ebruns_at_u.wash
ington.edu Grand Rounds University of
Washington Division of Child Adolescent
Psychiatry Childrens Hospital and Regional
Seattle, Washington February 4, 2005