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Wraparound Care Coordination: How to Train,
Coach, Supervise, and Measure Quality
Presented at the
Summer 2009 System of Care
Community training
Anaheim, CA
July 29, 2009
Presented by:
Eric J. Bruns – University of Washington
Marlene Matarese
Jennifer Mettrick
Madge Mosby
b
Denise Sulzbach
Maryland Innovations Institute
What is Wraparound?
p
y “Wraparound”
“W
d” is
i a primary
i
mechanism
h i
ffor iimplementing
l
ti SOC ffor
children with complex needs and their families
y Started in the 1980s as “doing whatever it takes” to bring
children/youth home to live in their own communities
y As practice evolved, came to be defined in terms of a value-driven
philosophy
y Wraparound is…
¾
A collaborative team planning process that is …
Ù Family centered and youth guided
Ù Provides care unconditionally
Ù Culturally and linguistically competent
Ù Strengths- and community based
Ù Creative and individualized
| Mobilize
bili naturall and
d community
i supports to meet unique
i
needs
d
A practice model:
The Four Phases of Wraparound
Phase
1A
Engagement and Support
Phase
1B
T
Team
P
Preparation
ti
Phase
2
Initial Plan Development
Phase
3
Implementation
Phase
4
Transition
Time
In theory (i.e., when wraparound is
implemented as intended), good things happen
y High-quality
g q
y teamwork and flexible funds leads to enhanced
creativity, better plans, and better fit between family needs and
services/supports
¾
This in turn leads to greater relevance for families, less dropout
y Strengths,
h needs,
d and
d culture
l
di
discovery and
d planning
l
i process lleads
d
to more complete engagement of families
y As family works with a team to solve its own problems, develops
family members
members’ self-efficacy
self efficacy
y Individualization and strengths focus enhances cultural competence,
relevance, and acceptability
y Focus on setting goals and measuring outcomes leads to more
frequent problem-solving and more effective plans
High-Quality Wraparound: What It Takes
Hospitable
System
y
m *Funding,
g, Policies
Supportive
Organizations
* Training, supervision,
interagency coordination
and collaboration
Effective
Team
* Process + Principles
Types of program and system support for
Wraparound
p
1.
2.
3.
4.
5.
6.
Community partnership: Do we have collaboration across our
key systems and stakeholders?
Collaborative action: Do the stakeholders take concrete steps to
translate the wraparound philosophy into concrete policies,
policies
practices and achievements?
Fiscal policies: Do we have the funding and fiscal strategies to
meet the needs of children participating in wraparound?
Service
i array: Do teams have
h
access to the
h services
i
and
d supports
they need to meet families’ needs?
Human resource development: Do we have the right jobs,
caseloads, and wo
working
king conditions? Aree people suppo
supported
ted with
coaching, training, and supervision?
Accountability: Do we use tools that help us make sure we’re
doing a good job?
Human Resource Development:
Necessary
y Conditions
y The job expectations of people with primary roles for carrying
out wraparound (e.g., wraparound facilitators, parent partners)
affords them adequate time, flexibility, and resources and
encourages them to implement high-fidelity wraparound.
y The job expectations of people who participate on
wraparound teams (e.g., providers and partner agency staff)
affords them adequate time, flexibility, and resources to participate
f ll iin team meetings
fully
i
and
d to carry out their
h i assigned
i
d tasks
k ffor
implementing wraparound plans.
y Caseload sizes for people with primary roles for carrying out
wraparound
d (e.g.,
(
wraparound
d ffacilitators,
ili
parent partners)) allow
ll
them to consistently and thoroughly complete the activities of the
wraparound process.
Human Resource Development:
Necessary
y Conditions
y People with primary roles for carrying out wraparound (e.g.,
wraparound
d facilitators,
f ili
parent partners)) receive
i comprehensive
h
i
training, shadow experienced workers prior to working
independently, and receive ongoing coaching that focuses on
systematically developing needed skills.
y People with primary roles for carrying out wraparound (e.g.,
wraparound facilitators, parent partners) receive regular
individual and group supervision, and periodic "in-vivo"
(observation) supervision from supervisors who are
knowledgeable about wraparound and proficient in the skills needed
to carry out the wraparound process.
y Compensation for people with primary roles for carrying out
wraparound (e.g., wraparound facilitators, parent partners) reflects
their value and encourages staff retention and commitment. These
people
p
p have opportunities
pp
for career advancement based on the skills
they acquire with wraparound.
Obtaining Training, Coaching, and
Technical Assistance
y Recommendations from the National Wraparound Initiative:
¾
¾
¾
TA should attend to the need to facilitate system- and organizational
supports for wraparound
Expectations for all key roles in wraparound should be clearly
defined (e.g., facilitator, family/youth partner, supervisor, coach,
clinicians)
Development of core skills and knowledge,
knowledge through trainings on:
Ù
Ù
Ù
¾
¾
Basics of wraparound
Carrying out key roles
C
Core
skillsets
kill t ((e.g., b
building
ildi and
d using
i strengths,
t
th partnering
t i with
ith ffamilies,
ili
effective team facilitation, organizing details, crisis and safety planning)
Comprehensive approach to coaching and/or supervision
C
Comprehensive
h
i performance
f
measurementt
Wraparound Fidelity
Assessment System
y
TOM – Team
Observation
Measure
WFI-4 –
Wraparound
Fidelity Index
WFAS
CSWI – Community
Supports for
Wraparound
Inventory
DRM - Document
Review Measure
Implementation with High Fidelity Requires…
State
Support
County Context
and Readiness
Program
Evaluation
Organizational
Supports
Staff
Selection
Training
Performance
Management
Supervision
and
Coaching
Regional Care Management Entities (CMEs)
The Role of CMEs in Maryland’s SOC
Provide Supports to Youth and Families:
•Child Familyy Team (CFT)
(
) Facilitation using
g Wraparound
p
Model
•Care Coordination using Standardized Assessment Tools
•Care Monitoring and Review
•Peer Support Partners
Provide System
System-Level
Level Functions:
•Information Management & Web-based Information System
•Provider Network Recruitment and Management
•Utilization
Utilization Review of Service Use, Cost, and Effectiveness
•Evaluation and Continuous Quality Improvement
•Cross-System and Jurisdiction Financing
Populations to Be Served:
•Children’s Cabinet Community Service Initiative (CSI) and Rehab Option
•1915(c) Residential Treatment Center (RTC) Medicaid Waiver
•SAMHSA funded SOC grant(s) – MD CARES and pending Rural CARES
•DHR Place Matters Group Home Diversion using Resource Coordinators
•DJS Out-of-Home Placement Diversion using Wraparound Care Coordination
Maryland’s WFAS Data Collection Process
Start of
Wraparound
1 mo
Families & Team
Members are
provided info on
WFAS
CCs/FSPs notified of
teams eligible for WFI
WFI,
TOM & YSS/YSS-F
Reminder Cards
Sent to Families &
Team Members
6 mo
CCs/FSPs notified of
teams eligible for
YSS/YSS-F follow-up
12 mo
Reminder Cards
S t to
Sent
t Families
F ili &
Team Members
Research Staff
Research Staff
conducts
conducts WFI,, TOM &
YSS/YSS-F
the YSS/YSS-F
(w/consent)
(w/consent)
Goals 1) Collect >70% of possible WFIs & YSS/YSS-F for Caregivers, Youth & Team
Members; 2) Collect 1 TOM per care coordinator every 6 months; 3) collect outcomes data
from the CME at baseline, 6 months and 12 months and/or Discharge
Maryland’s Fidelity Data
January
y 2009
9 State Report
p
100
96
93
91 92
79
Fiidelity Score
80
82 81 81 79
83
82 80
77
73
71
66 60
60
65 66
Care Coordinator
50
Caregiver
Team Member
40
Youth
20
0
Culturally Competent
Fidelity Sccore
100
90 87 87 87
80
Individualized
Strengths Based
Persistent
94 94
81
75 76 70
82
67
61 61
60
92
Outcomes Based
69
50
63 59
65
Care Coordinator
Caregiver
Team Member
40
Youth
20
0
Family Voice/Choice
Team Based
Natural Supports
Collaborative
Community Based
Use of WFAS Data at the Local Level
y Provides standards of quality for Wraparound
y
y
y
y
implementation
Encourages Best Practices for Care Coordination & Family
Support
Encourages Families to “be part of the solution” and
reinforces
i f
Family
il Voice
i
Directly impacts training and coaching strategies
Influences procedural change within Care Management
Entities
Use of WFAS Data at the State Level
y Disseminates State and Local Jurisdiction Reports to the
Governor's Office for Children
y Supports the Wraparound Model to the
State Legislature
y Helped the state obtain approval for the 1915c Medicaid
Demonstration Waiver
(1 of nine states)
y Helped
p to ensure familyy p
peer to p
peer support
pp
was included
in the 1915c waiver
Coaching Model: Certification of Wraparound
Practitioners
y Certification of Family
y Support
pp
Partners and
Supervisors
y Certification of Care Management Staff
y Certification of Youth Support Partners
y Advanced Practitioner Certification
Model for Certification CME Staff
Care Coordinator
y Minimum of one year coaching
y Completion of Core Training and
Training Units (SOCTI)
¾
¾
System of Care 101, Wraparound 101,
Crisis Planning, CANS Assessment,
How to Run Effective Child & Family
Teams, Engagement 101
6 TUs in Knowledge, Skills and Values
y Completion of 3 Passing Team
Observations (1 by Innovations, 2 by
supervisor)
y Completion of 3 Passing Document
Review Forms (1 II, 2 Sup)
y Completion of 12 Professional
Development Worksheets
y After
Aft completion,
l ti
CTUs
CTU required
i d
Supervisor
y Minimum of one year coaching and
training
¾
¾
Same as CCs and in addition:
Directive Supervision, Recruitment &
R
Retention
i within
i hi the
h wraparound
d
process and Supervising utilizing the
Wraparound Fidelity Assessment
System
Completion of a jointl
jointly completed
TOM and DRF
y Completion of 2 TOMs and 2 DRFs
for their team
y Completion of 12 PDWS for their
team
y
Model for Certification FSP Staff
Family Support Partner
Staff
y Minimum of one year
coaching
y Completion of Core Training
and Training Units (SOCTI)
¾
Same as CCs with the addition
of Skills Building for FSPs
y Completion
p
of 3 FSP TOMs
y
y
y
y
y
y
Youth Support Partner
Minimum of one year
coaching
Youth Leadership Retreats
System of Care 101
Wraparound
p
101
Skill building for Youth
Support Partners
3 TU
TUs in
i K
K, S
S, V
Advanced Wraparound Practitioner
Certification
y The development
p
and implementation
p
of the
Advanced Practitioner Certification Program is
design to support jurisdictions in the identification
and
d training
t i i off llocall wraparound
d ttrainers
i
and
d
coaches toward jurisdictional self-sustainability.
These additional requirements consist of:
y Application process, letter of recommendation from
a familyy member and one from an FSP or CC
depending on role of applicant
y Additional requirements described in the Catalog
Maryland’s
y
Financing
g Model
y Since 2006, the Maryland Children’s Cabinet has funded Wraparound
Pilot Sites using State
State-only
only dollars in certain jurisdictions
¾
¾
New funding stream appropriated by the General Assembly
Added to two existing interagency funding streams—Community Services
Initiative and Rehab Option
y Some
S
jjurisdictions
i di ti
had
h d some llocall money tto supportt th
the W
Wraparound
d
Pilot sites, and individual contracts were added from State agencies.
y Maryland is a 1915(c) Community Alternatives to Psychiatric
Residential Treatment Facilities (PRTF) Demonstration Waiver State
¾
¾
¾
Beginning soon, Medicaid will be used to pay for youth enrolled in the
Waiver (transferring all eligible children who were in the Pilot Project into
the Waiver).
State match funds will come from the Children’s Cabinet
The Waiver is eligible for the enhanced Federal Financial Participation rate
under the Stimulus Package
y Next step: Expand the Waiver to the entire state so that all youth being
served through CSI and Rehab Option can be funded through Medicaid.
Wraparound
p
Implementation
p
Resources
y National Wraparound
p
Initiative:
¾ www.rtc.pdx.edu/nwi
y Wraparound Fidelity Assessment System Tools:
¾ http://depts.washington.edu/wrapeval
y Resource Guide to Wraparound:
¾ www.Wrapinfo.org
i f
Where Are You on the Implementation
Ladder?
Human Resource Development
p
and
Accountability Items from the Community
Supports for Wraparound Inventory
Contact Information
Innovations Institute
University of Maryland, School of Medicine, Department of Psychiatry,
Department of Child & Adolescent Psychiatry
737 West Lombard Street,, 4th floor
Baltimore, MD 21201-1023
Phone: 410-706-0961
[email protected]
Presenters:
Marlene Matarese [email protected]
mmatares@psych umaryland edu
Eric Bruns [email protected]
Jennifer Mettrick [email protected]
Pat Mosby [email protected]
mmosby@psych umaryland edu
Denise Sulzbach [email protected]