Transcript What Predicts Wraparound Fidelity? Findings from the Wraparound Fidelity Index April Sather, MPH, Michael Pullmann, Ph.D., and Eric J.

What Predicts Wraparound Fidelity?
Findings from the Wraparound Fidelity Index
April Sather, MPH, Michael Pullmann, Ph.D., and Eric J. Bruns, Ph.D.
University of Washington School of Medicine – Division of Public Behavioral Health & Justice Policy
Introduction
The Wraparound Fidelity Index, Version 4 (WFI-4)
measures adherence to the principles and activities
of wraparound via structured interviews with
facilitators, caregivers, youth, and other team
members. The Wraparound Evaluation and
Research Team at the University of Washington has
been compiling data collected by over 70 sites
nationally for the last 6 years. During that time
reliability and validity of the WFI-4 has been
established, including several studies indicating
association with more positive child and family
outcomes, and nationally normed percentile scores
have been established for fidelity scores. Given
findings associating fidelity with positive outcomes,
wraparound initiatives and researchers have
frequently inquired what factors may predict
wraparound fidelity as measured by the WFI-4.
Using data collected from over 4,000 wraparound
teams in 50 WFI-4 user sites, we explored what
factors may predict wraparound fidelity, focusing
on associations between overall wraparound fidelity
percentile scores and other variables that are
measured by the WFI-4, such as youth and family
characteristics, wraparound team membership,
duration of enrollment in wraparound, caregiver
relationship to the youth, and other factors.
Methods
Sample Characteristics
Variable
Youth total
Businesses
Sub-sites
Dates
Months
receiving
wraparound
CG FORM
N
Range
3585
50
5-604
160
1-255
6/6/061/26/11
WF FORM
N
Range
4248
48
1-703
126
1-355
2/19/20071/25/2011
YOUTH
N
1323
36
96
10.64
11.46
13.5
Collaborating sites conducted interviews with
caregivers, wraparound facilitators, and youth at
least one month after families began
wraparound. Interviewers were trained to criteria
via manualized procedures. Data were compiled
locally in the Wraparound Online Data Entry and
Reporting System (WONDERS) web portal, and
submitted from over 4000 unique wraparound
teams based in 50 different sites, and included
data from 4004 wrap facilitators, 3382
caregivers, and 1262 youth.
1-48
Table 2: Between-Group Differences in Wraparound Fidelity for
Predictors, by Type of Respondent
1-375
1-134
11/20/200712/25/2010
1-48 mos.
Variable
T-Test Scores
At least one natural support
on team
CG
WF
Y
Mean Difference Scores
3.309%***
6.194%***
4.623%*
(n=890)
(n=771)
(n=203)
Ever been in custody of the
state
2.788%**
-.010%
-3.771%*
(n=1718)
(n=2216)
(n=784)
In custody of at least one
birth parent
2.644%**
1.810%*
-3.421%*
(n=1859)
(n=2310)
(n=695)
-7.404***
-.539
-8.616***
(n=721/3382)
(n=1337/4004)
(n=480/1262)
1.900*
5.028***
3.667*
(n=1534/3382)
(n=1410/4004)
(n=514/1262)
sig. = .015
10.286
9.547***
9.750**
(n=80/3382)
(n=128/4004)
(n=55/1262)
6.758***
7.036***
5.193
(n=305/3382)
(n=389/4004)
(n=93/1262)
WF/CG FORM
YOUTH FORM
Youth is in state/county
custody
Race/Ethnicity
N
%
N
%
Family partner on team
Amer Indian Alaska Native
79
1.9
23
1.8
Asian
18
.4
11
.9
Black or African American
865
21.0
281
22.0
5
.4
Friend of Caregiver on team
Juvenile Justice
representative on team
3.645
-9.023***
2.816
(n=174/3382)
(n=372/4004)
(n=118/1262)
School Representative on
team
.610*
2.625**
1.584
(n=786/3382)
(n=1051/4004)
(n=252/1262)
Social services/Case worker
on team
-1.871
-2.241*
2.966
(n=898/3382)
(n=1151/4004)
(n=375/1262)
Foster parent on team
-1.603
3.571***
-1.858
(n=392/3382)
(n=695/4004)
(n=265/1262)
.597
1.250*
-2.610
(n=1716/3382)
(n=2090/4004)
(n=681/1262)
-1.541
3.482*
5.146
(n=497/3382)
(n=286/4004)
(n=84/1262)
Hawaiin or other Pac
Islander
15
.4
White
2149
52.3
596
46.6
Hispanic or Latino
542
13.2
223
17.4
Mixed Race
339
8.2
95
7.4
Other Race
105
2.6
45
3.5
Total
4112
100&
1279
100%
Missing
136
Friend of Youth on team
44
Table 1: Mean fidelity and population percentile scores for the CG,
WF, and Youth forms of the WFI-4
MH worker on team
Mentor on team
CG FORM
Mean
Fidelity
Score (0100%)
3382
79%
11.8
100
N
Mean
Minimum
Maximum
Mean
Population
Percentile
Score
3382
43.45
1
99
WF FORM
Mean
Fidelity
Score (0100%)
YOUTH FORM
Mean
Population
Percentile
Score
4004
85%
22.5
100
Mean
Fidelity
Score (0100%)
4004
55.54
1
99
1262
76%
12.5
100
Mean
Population
Percentile
Score
1262
56.57
1
99
Figure 1: Trends in National fidelity scores for WFI-4,
2006 - 2011.
Table 3: Correlations between Predictors and Wraparound
Fidelity, by Type of Respondent
CORRELATIONS
CG
WF
Y
N on team (wf=4.86,
CG=4.76, Y=4.86)
.045**
sig .009
(n=3382)
.037*
sig .019
(n=4004)
.040
sig .160
(n=1262)
Quadratic N on team
Non
Significant
R2=.009
β(-.355)
+(.400)***
R2 = .006
β(.302)+
(-.255)*
How many months in wrap
(wf=11.46, CG=10.64,
Y=13.48)
-.0257
sig. .115
(n=3045)
.125***
sig. .000
(n=3736)
-.029
sig.313
(n=1170)
Youth age
.062*
.sig=028
(n=1262)
National Means Trends
2006-2011
90%
Figure 3: Differences in WFI-4 Fidelity Scores When Different
Team Members are Present
85%
80%
60
58.79
60
58.74
75%
50
50
70%
59.12
56.38
56.3
55.07
53.77
46.9
47.35
43.3
44.48
42.58
40
Percent
Fidelity
WF
Form
CG Form
Y Form
40
2006
77%
83%
75%
73%
30
2011
80%
84%
79%
76%
Figure 2: Relationship between fidelity score and Number
of Team Members for Facilitator form of the WFI-4.
20
20
10
0
WF
0
WF
CG
JJ or PO on team
JJ or PO NOT on team
70
70
60
Y
Y
Family partner on team
No Family partner on team
61.89
CG
65.89
64.78
61.38
59.86
56.18
60
55.23
56.14
53.49
As shown in Tables 2 and 3 and Figure 3, a number of factors were found to
be significantly associated with overall wraparound fidelity: The
presence of natural supports, especially friends of parents and youths;
being in the custody of a birth or adoptive parent; and having a family
partner on the team. Older youth reported higher fidelity on the Youth
form of the WFI-4. Certain factors were associated with lower fidelity,
such as the youth being in the custody of the state or county.
Other factors were associated with fidelity but were inconsistently related
across respondents; for example, when representatives of certain
public systems (juvenile justice and child welfare) were part of the
team, fidelity scores were found to be significantly lower as rated by
Facilitators but not Caregivers or Youths. On the other hand, when
school representatives were on teams, Facilitators’ mean WFI-4 scores
were higher. Meanwhile, mean duration of enrollment in wraparound
was associated with higher fidelity for Facilitators but not Caregivers
and Youths.
The relationship between team membership and fidelity scores was also
complex; as shown in Figure 2, for Facilitators, smaller (<4 team
members) and larger (>8 members) teams were associated with higher
fidelity scores, while teams of 5-7 people tended to be associated with
lower fidelity. Conversely, Youth ratings indicated higher fidelity for
medium-sized teams teams of between 4-7 people.
Finally, as shown in Figure 1, mean fidelity scores have increased since the
WFI-4 was introduced in 2006. This could be due to several factors,
including the increased understanding of requirements of wraparound
implementation or attention nationally to training and coaching. The
increase could also be due to greater expectations of programs to
achieve certain levels of fidelity; however, the fact that Facilitator
scores have remained relatively consistent while Caregiver and Youth
fidelity scores have increased counters that explanation somewhat.
Implications
Large sample sizes yielded many significant findings from this
analytic exercise and these results are only correlational.
Nonetheless, results will help aid interpretation of WFI-4 fidelity
data. For example, sites implementing wraparound for youths in
state custody will likely show lower scores and will need to
interpret results accordingly.
Certain relationships found here also point to interesting
implications for wraparound implementation and research:
 As has often been theorized, involving family partners, natural
supports, and friends and advocates of families is likely to be
supportive of model adherent wraparound implementation.
Future research should more rigorously evaluate the impact of
active involvement of such individuals.
 Facilitators may feel that their ability to facilitate high fidelity
wraparound teams are compromised by involvement of certain
team members (e.g., child welfare case workers, probation
officers); this points to the importance of collaboration and good
role definition in wraparound implementation efforts.
30
10
 Increasing fidelity scores over time suggest wraparound
initiatives are likely to increasingly encounter ‘ceiling effects’ in
their scores. Additional or alternative methods for assessing
wraparound quality and fidelity beyond WFI-4 interviews may
need to be considered.
49.59
50
50
WFI total score WF form
Procedures
1-48
FORM
Range
Demographics
Measure
The WFI-4 has versions for wraparound facilitators
(WF), caregivers (CG), other team members
(TM), and youth (Y). WF, CG, and TM forms
include 40 items, and the Y form includes 32
items. Items are organized by the 4 phases of
wraparound: engagement (6 items), planning
(11 items), implementation (15 items), and
transition (8 items). Each item also relates to
one of the 10 principles of wraparound. Items
are scored as Yes, Sometimes/Somewhat, and
No. Several items are reverse-scored, and higher
scores indicate increased wraparound fidelity.
Discussion
43.2
42.84
40
40
30
30
20
20
10
10
0
0
WF
CG
CG has friend on team
No CG friend on team
Number of members on team
References
Bruns, E. J., Suter, J., Force, M.M., Sather, A.K., & Leverentz-Brady, K. (2009). Wraparound
Fidelity Index 4.0: Manual for training, administration, and scoring of the WFI 4.0.
Seattle, WA: Division of Public Behavioral Health and Justice Policy, University of
Washington.
Y
WF
CG
Y
Youth has friend on team
Youth has no friend onteam
Acknowledgments: This work was supported by the Child, Adolescent and
Family Branch of the SAMHSA Center for Mental Health Services and the National
Institute of Mental Health (MH72759, MH07735).