Transcript VALUES OF THE WRAPAROUND PROCESS

John VanDenBerg, Ph.D.
1



What has been called wraparound has
varied widely across the US and Canada.
Key early evaluations of system of care and
wraparound showed inconsistent outcomes
The National Wraparound Initiative was
formed and successfully brought standards
to the field, which has led to a series of
scientific studies with consistently positive
outcomes
2
A Process for Supporting Youth and
Families that:
 Is defined by ten principles of how the
process is implemented;
 Is done in four phases and related
activities that describe what is to be
done; and
 Fits the four components of the VVDB
theory of change that explains why it
works.
3





Family Voice and
Choice
Team Based
Natural Supports
Collaboration (and
Integration)
Community Based





Culturally
Competent
Individualized
Strengths Based
Persistence
Outcome Based and
Cost Responsible
4
Engagement & Team Prep





Orient family to Wrap
Stabilize crises
Develop strengths, needs,
and culture discovery
Engage team members
Make meeting arrangements
Initial Plan Development


Develop a plan of care
Develop a detailed crisis and
safety plan
Implementation

Implement the plan

Revisit update plan

Team cohesiveness - trust

Complete documentation
and handle logistics
Transition



Plan for cessation of wrap
Conduct commencement
ceremonies
Follow-up with the family
after graduation
5



Defines the primary reasons why
wraparound can be an effective process
Defines expectations for what we hope to
accomplish through wraparound
Many clinicians do their clinical work based
on a similar theory of change. However, if
their clinical work varies greatly from this
theory of change, outcomes may be less
than desired
6
1.
2.
3.
4.
Families/Youth Identify and Prioritize Their
own needs
Self-Efficacy is reinforced at every
opportunity
Natural Supports are included in support,
planning, and implementation
All systems working with an individual
family/youth use a common process and
have an integrated plan
7



National Health Survey (2008) finds that over
70% of families with a child with SED do not
seek, start or complete behavioral health
services for their children
The primary determinant of success of these
services is parental engagement and buy-in
Families who need wraparound are often
difficult to engage due to their journey
through systems -it takes patience and skills
to be successful
Families tell us that there are a number of factors
that reduce engagement in the process including
 Not feeling listened to
 Past bad experiences with professional staff
and experiences reported by other families
 Treatment goals and plans that do not address
the things that are most important to the
family and thus feel irrelevant
 Treatment approaches that do not match the
family’s culture
 In addition, when treatment is provided
without full parental engagement, many of
youth who do show progress and complete a
service component do not have lasting
progress

The Expert Approach: the responsibility for analyzing the
problem, figuring out the causes, and coming up with solutions all
rests with the Expert. Tends to rely exclusively on professional
knowledge and professional decision making.

The Integrated Approach: Responsibility is shared between the
family and the professional(s), with the family identifying and
prioritizing needs. Both bring complementary knowledge and
strive to combine them to generate positive change, with the
family in a final decision making role.
J Anthony Irsfeld
(adapted by VVDB with permission)
Collaboration: Agencies are familiar with each
other’s missions and roles, key staff work with
each other at the child/family level, but often
retain single system decision making power and
planning.
Integration: Agencies are familiar with each
other’s missions and roles, key staff work with
each other at the child/family level, sharing
decision making in a team format that includes
the family in a lead role, producing a single plan
that meets all system mandates and that is
owned by the entire team.
13
INTEGRATED APPROACH INTO
WRAPAROUND
Common
Registration/Intak
e
Common
Assessment
Single Point of
Accountability
(Facilitator)
Natural
Support
(Pastor, coach,
neighbors)
School
Child
Welfare
Common
Integrated Plan
Peer to
Peer
Support
Juv.
Justice
Housing
Physical
Health
Not for Profit
Service
Agencies
MR/DD
Mental
Health



Wraparound may start with strong
demonstration of the Principles and the
Phases and Activities, with strong the Action
Steps and Core Skills.
Without coaching, certification and
monitoring, drift occurs back to old practices.
The VVDB overall materials were a key part of
the actual submission to the National Registry
of Evidence-Based Practices at a federal level,
15
Engagement & Team Prep





Orient family to Wrap
Stabilize crises
Develop strengths, needs,
and culture discovery
Engage team members
Make meeting arrangements
Initial Plan Development


Develop a plan of care
Develop a detailed crisis and
safety plan
Implementation

Implement the plan

Revisit update plan

Team cohesiveness - trust

Complete documentation
and handle logistics
Transition



Plan for cessation of wrap
Conduct commencement
ceremonies
Follow-up with the family
after graduation
16
Wraparound Facilitator
Peer to Peer Support (Family Support Partner)
Supervisor/Coach
Action Steps/Skills, once defined, can be
coached and learned. VVDB Certification is
proving that each staff knows the core Action
Steps/Skills and can move onto the “Art” of
wraparound.
17
BH Treatment Plan
Wraparound Plan
Separate service from other
services and supports for
family
Integrated process that brings
together, focuses and
streamlines all
Begins with Diagnosis
Begins with strengths, needs
and culture discovery
Treatment options based on
diagnosis
Treatment options based on
family vision and priority needs
Treatment decisions primary
responsibility of clinician
Treatment decisions primary
responsibility of family and
team
Primary work done in sessions
by individual and/or family
Primary work done outside of
team meetings
18
•
•
•
•
Teams consist of the people who can help the
family address their needs
Many youth and families in wraparound have
BH needs which call for a clinician’s
involvement
Often referrals for wraparound come from
clinicians
Clinicians in sites that have been doing
wraparound report a significant shift in their
practice over time and better outcomes for
youth and families


Many communities experience a shortage of
child-trained clinicians
Wraparound can provide additional
information, support, and resources for
clinicians to extend their reach with a
family/youth and maximize the use of their
time, as well as increase effectiveness
20




Not being the “Team Leader”
What to do when the family/youth disagree
with professional recommendations
Family cultural practices which may exclude
traditional clinical interventions
Lack of system integration and presence of
multiple (sometimes competing) planning
processes can lead to family/youth
alienation with all helping professionals –
and at times, blaming of families.
21
Initially, some clinicians are “less than thrilled”
about wraparound, and backlash can occur if
wraparound is not understood. However, a
number of key clinical roles exist, and clinical
support in mature wraparound communities
is very strong. Rider and Penrod (2004)
described key roles for clinicians in the
process, adapted by VVDB with the author’s
permission
22



Often, a clinician is an early referral contact
for a family, already doing some service
coordination at the pre-wraparound level
Provides assessment and clinical input about
the process to an individual family
Helps inform the comprehensive assessment
(strengths, needs and culture discovery)
(Rider and Penrod, 2004)
23


Provide clinical advice and consultation to
the Wraparound Staff
This consultation is a process function;
decisions are still made in a team manner
(Rider and Penrod, 2004)
24



Provide clinical advice and consultation to
the CPT/Wrap Team Members, including
the family
Consultation includes describing why
needs might be priorities, suggesting and
describing options, helping to develop
action steps
Building their treatment plan on the
integrated wraparound (ICP) plan
(Rider and Penrod, 2004)
25


Attends Care Planning Team (CPT)
meetings according to role (core or
consulting) as a vital team member
As clinical issues improve role may shift
from core team member to consultant
(Rider and Penrod, 2004)
26




Most of wraparound happens outside of
team meetings (actual implementation)
May provide direct therapy outside of
CPT/wraparound team meetings, with
therapy driven by the family with team
input.
In this role, clinician operates in close
coordination with the team in one of the
three roles
In this role, clinician focuses on specific
goals established through team planning
(Rider and Penrod, 2004)
27




Youth and families are more engaged in the
process
This process involve the social and physical
environment of the youth
Wraparound can address areas that can not
be addressed through therapy sessions
Other team members can augment important
aspects of the therapeutic process
28

With the national crisis level shortage of
Psychiatrists, wraparound can provide
additional information, support, and
resources for Psychiatrists to extend their
reach with a family/youth
29

Wrap can stabilize a family/youth enough for
the Psychiatrist to do their work – “It is hard
to medicate a rapidly moving object”
30

Wraparound, when used as part of short term
stabilization focused residential care or
psychiatric hospitalization, can improve
effectiveness of residential treatment
31





I have seen and been involved with the
transformative potential of PBIS overall
PBIS provides a focus on all students and not
just the “top of the triangle” youth
PBIS/Illinois innovations changed the ways
schools approach students with complex
needs
PBIS/Illinois innovations focused the field on
what teachers need in addition to what
families and students need
PBIS focused on behavior
32



No family ever has two wraparound plans
Common student identification and referral
mechanisms at the community level
(Integrated System of Care)
Realizing that both MBI/PBIS Wraparound
have aspects that are the same, similar and
different, and there are reasons for the
differences.
33




Schools and Community Agencies are very
different entities
Schools are much more structured and
focused on education as a primary mandate.
PBIS recognizes the role of behavior in the
educational mandate. MBI/PBIS Wraparound is
a part of the overall PBIS model
Communities and community agencies are
often not integrated in focus and mandates
High Fidelity Wraparound is a process of
integration, one family/youth at a time
34



Draft Cross-walk will be refined
OPI and DPHHS are actively working on
integration issues
Lucille and John have collaborated for almost
22 years!
35