Download - Measuring Wraparound Fidelity
Measuring Wraparound Fidelity using Measuring Wraparound Fidelity using
the the Wraparound Fidelity IndexWraparound Fidelity Index (WFI) 4.0(WFI) 4.0
EMQ FamiliesFirst (EMQ FF)EMQ FamiliesFirst (EMQ FF)Mary Ann WongMary Ann Wong
Catherine AspirasCatherine AspirasMichelle CoufalMichelle CoufalElisha HerutyElisha Heruty
Abram RosenblattAbram RosenblattCaregiver Presenter: Epifania MarshallCaregiver Presenter: Epifania Marshall
Presentation OverviewPresentation Overview• Introduction to Wraparound & Introduction to Wraparound &
Wraparound at EMQ FFWraparound at EMQ FF• Defining Wraparound Fidelity & Defining Wraparound Fidelity &
Implementation of the WFI at EMQ FFImplementation of the WFI at EMQ FF• WFI Outcomes and FeedbackWFI Outcomes and Feedback• Sharing a Caregiver’s Experience Sharing a Caregiver’s Experience
What is Wraparound?What is Wraparound?
EMQ FamiliesFirst’s Influence on EMQ FamiliesFirst’s Influence on Wraparound in CaliforniaWraparound in California
• In In 19911991 EMQ served 130 emotionally disturbed EMQ served 130 emotionally disturbed or mentally ill children or mentally ill children
• In July In July 19961996, Gov. Pete Wilson signed into a law , Gov. Pete Wilson signed into a law authorizing a pilot project authorizing a pilot project
• In In 19971997, Legislature expanded the pilot project , Legislature expanded the pilot project state widestate wide
• In In 20042004, Prop 63 allotted new funds, Prop 63 allotted new funds
Wraparound Growth in CaliforniaWraparound Growth in California
Green – counties providing Wrap servicesYellow – counties planning to implement WrapGray – no Wrap
EMQ FamiliesFirst’s EMQ FamiliesFirst’s Wraparound PrinciplesWraparound Principles
• Team-basedTeam-based
• Natural SupportsNatural Supports
• Community-basedCommunity-based
• Culturally Culturally CompetentCompetent
• Family Voice and Family Voice and ChoiceChoice
• IndividualizedIndividualized
• Strength-basedStrength-based
• CollaborationCollaboration
• PersistencePersistence
• Outcome-Outcome-basedbased
EMQ FamiliesFirst’sEMQ FamiliesFirst’sPhases and Activities of WraparoundPhases and Activities of Wraparound
• Phase 1: Engagement and team Phase 1: Engagement and team preparationpreparation
• Phase 2: Plan DevelopmentPhase 2: Plan Development
• Phase 3: ImplementationPhase 3: Implementation
• Phase 4: TransitionPhase 4: Transition
Number of Youth ServedNumber of Youth Served
• Total Number of Youth Total Number of Youth Served in Wraparound: Served in Wraparound: 3,3313,331
48%
25%
19%
2%
7%
Bay Area Capital Central Inland EmpireLos Angeles
Youth’s ProfileYouth’s Profile• Average Age at Admission: Average Age at Admission: 14 years14 years• 62% Male; 38% Female62% Male; 38% Female• Youth’s EthnicityYouth’s Ethnicity
Native American 1% Other
2%African American
21%
Asian American/Pacific Islander
3%
Latin American30%
Caucasian 43%
Primary Diagnosis at AdmissionPrimary Diagnosis at Admission
5%
52%
31%
3%9%
0%
20%
40%
60%
80%
100%
Adjustment Mood Disorder DisruptiveBehavior
Psychotic Other
Living Situation at AdmissionLiving Situation at Admission
52%
15%0.20% 2%
27%
2% 2%0%
20%
40%
60%
80%
100%
HomeFoster Family
Hospital
Justice
Residential
Shelter/Homeless
Other
Outcomes for Discharged YouthOutcomes for Discharged Youth
• Number of Youth Discharged from Number of Youth Discharged from
Wraparound:Wraparound: 2,7622,762• Average Length of Stay:Average Length of Stay: 13 months13 months..
Living Situation: Admit vs. DischargeLiving Situation: Admit vs. Discharge
64% 71%
32%25%
4% 3% 0.20% 1%
0%
20%
40%
60%
80%
100%
Community Facility Other Unknown
Admit Discharge
Child and Adolescent Functional Child and Adolescent Functional Assessment Scale (CAFAS)Assessment Scale (CAFAS)
• CAFAS Subscale Score:CAFAS Subscale Score: 0 - 30 0 - 30 • CAFAS Subscales:CAFAS Subscales:
– School/work role performanceSchool/work role performance– Home role performanceHome role performance– Community role performanceCommunity role performance– Behavior toward othersBehavior toward others– Self-harmful behaviorSelf-harmful behavior– Substance UseSubstance Use– ThinkingThinking
CAFAS OutcomesCAFAS Outcomes (n=1,539)(n=1,539)
80.96
114.16
0
20
40
60
80
100
120
Admit Discharge
p>.001
Timeframe
Wraparound FidelityWraparound Fidelity• What is it and why is it important?What is it and why is it important?
• The Wraparound Fidelity Assessment The Wraparound Fidelity Assessment System (WFAS)System (WFAS)– Wraparound Fidelity Index, v.4 (WFI-4)Wraparound Fidelity Index, v.4 (WFI-4)
– Team Observation Measure (TOM)Team Observation Measure (TOM)– Community Supports for Wraparound Community Supports for Wraparound
Inventory (CSWI)Inventory (CSWI)
– Document Review Measure (DRM)Document Review Measure (DRM)
What is the WFI?What is the WFI?• Measures implementation of wraparound Measures implementation of wraparound
processprocess• Set of interviews – Facilitator, Caregiver, Set of interviews – Facilitator, Caregiver,
Youth, Team MemberYouth, Team Member– 40 items for Facilitator, Caregiver, Team 40 items for Facilitator, Caregiver, Team
MemberMember– 32 items for Youth32 items for Youth
• Confidential interviews w/multiple Confidential interviews w/multiple respondentsrespondents unique perspectives unique perspectives
Evolution of the WFI MeasureEvolution of the WFI Measure
• Earlier versions: (1 through 3)Earlier versions: (1 through 3)– No consistent practice model on which to base itemsNo consistent practice model on which to base items– No specification of phases/activities of processNo specification of phases/activities of process
• WFI version 4WFI version 4– Aligned with updated NWI practice model Aligned with updated NWI practice model – Organized by the 4 phases of wraparoundOrganized by the 4 phases of wraparound– Items measure:Items measure:
• Adherence to principles of service deliveryAdherence to principles of service delivery• Conformance to specific principles of the modelConformance to specific principles of the model
– Addition of “Team Member” formAddition of “Team Member” form
Wraparound Fidelity AdministrationWraparound Fidelity Administration• WFI Administration at EMQ FamiliesFirstWFI Administration at EMQ FamiliesFirst
– 9 traditional wraparound programs in 8 counties:9 traditional wraparound programs in 8 counties:• Santa ClaraSanta Clara• SacramentoSacramento• NevadaNevada• YoloYolo• FresnoFresno• TulareTulare• San BernardinoSan Bernardino• Los AngelesLos Angeles
• Selection of families for interviewingSelection of families for interviewing• Eight trained & certified interviewersEight trained & certified interviewers• Administered in stages during FY10Administered in stages during FY10
ResultsResults
Demographics of WFI YouthDemographics of WFI Youth• Average Age at Admission: Average Age at Admission: 13 years13 years• 55% Male; 45% Female55% Male; 45% Female• Youth’s EthnicityYouth’s Ethnicity
Caucasian 43%
Latin American30%
Asian American/Pacific Islander
3%
African American21%
Other 2%
Native American 1%
Primary Diagnosis at Admission Primary Diagnosis at Admission for WFI Youthfor WFI Youth
10%
23%31% 30%
2% 5%0%
20%
40%
60%
80%
100%
Adjustment Anxiety MoodDisorder
DisruptiveBehavior
Psychotic Other
Living Situation at Admission for Living Situation at Admission for WFI YouthWFI Youth
43%
16%
0% 1%
39%
1% 1%0%
20%
40%
60%
80%
100%
HomeFoster Family
Hospital
Justice
Residential
Shelter/Homeless
Other
Outcomes for Outcomes for Discharged WFI Discharged WFI
YouthsYouths
Living Situation: Admit vs. Living Situation: Admit vs. Discharge for WFI YouthDischarge for WFI Youth
51%
78%
46%
20%
2% 0% 0% 1%
0%
20%
40%
60%
80%
100%
Community Facility Other Unknown
Admit Discharge
CAFAS Outcomes CAFAS Outcomes for WFI Youthfor WFI Youth
p>.001
Timeframe
112.6
81.2
0
20
40
60
80
100
120
Admit Discharge
Summary of RespondentsSummary of Respondents• 385 interviews were administered over 385 interviews were administered over
the phonethe phone• 123 caregiver interviewed123 caregiver interviewed
– 24.9 minutes average time 24.9 minutes average time
• 185 facilitator interviewed185 facilitator interviewed– 42.3 minutes average time 42.3 minutes average time
• 87 youth interviewed87 youth interviewed– 25.4 minutes average time25.4 minutes average time
• 10 team member interviewed10 team member interviewed– 25.4 minutes average time25.4 minutes average time
EMQ FF vs National Data EMQ FF vs National Data Overall FidelityOverall Fidelity
80 77
8783
77 7579
73
0
20
40
60
80
100
Combined Facilitator Caregiver Youth EMQ FF National Mean
EMQ FF vs National Data EMQ FF vs National Data Combined Fidelity Scores by Combined Fidelity Scores by
PrinciplePrinciple
8883
69 7263 64
87 8577
71
0
20
40
60
80
100
Family Voiceand Choice
Team Based NaturalSupports
Collaboration Community-Based
EMQ FF National Mean
EMQ FF vs National Data EMQ FF vs National Data Combined Fidelity Scores by Combined Fidelity Scores by
Principle Con’tPrinciple Con’t94 91
69 69
86 83 82 82
70 67
0
20
40
60
80
100
CulturallyCompetent
Individualized StrengthBased
Persistence OutcomeBased
EMQ FF National Mean
EMQ FF vs National Data EMQ FF vs National Data Fidelity Scores by PhaseFidelity Scores by Phase
74 76 80 7685 81
71 69
0
20
40
60
80
100
Engagement PlanDevelopment
Implementation TransitionEMQ FF National Mean
CAFAS Reliable Change Index CAFAS Reliable Change Index (RCI) by Program(RCI) by Program
18%28%18%18%9%14%Worse
17%23%24%23%23%0%Same
66%50%58%60%68%86%Better
PGM 6(n=756)
PGM 5(n=102)
PGM 4(n=232)
PGM 3(n=420)
PGM 2(n=22)
PGM 1(n=7)
EMQ FF Wraparound ProgramsRCILevel
Average Total WFI ScoresAverage Total WFI Scores by Programby Program
18.43PGM 6
15.32PGM 5
11.54PGM 4
15.70PGM 3
6.38PGM 2
12.84PGM 1
Average Total WFI Score
EMQ Wraparound Program
Data ImplicationsData Implications
• Further studies employing the WFI on Further studies employing the WFI on OutcomesOutcomes– CAFAS CAFAS
– School InformationSchool Information
– Living SituationLiving Situation– CANS (Child and Adolescent Needs CANS (Child and Adolescent Needs
and Strength)and Strength)
ChallengesChallenges
New programs and staffNew programs and staffDifficult populationsDifficult populationsLanguage barriersLanguage barriersRatio of certified interviewers to intervieweesRatio of certified interviewers to intervieweesRelatively low response ratesRelatively low response rates
Lessons LearnedLessons Learned
Program buy-inProgram buy-inWork with Wrap teamsWork with Wrap teamsUse EMQ FF language certified employeesUse EMQ FF language certified employees
A Caregiver’s ExperienceA Caregiver’s Experience
Future DirectionsFuture Directions
Q & AQ & A
ReferencesReferences
• Bruns, E. (nd). Bruns, E. (nd). Wraparound Fidelity Assessment Wraparound Fidelity Assessment System.System. Retrieved April 15, 2010, from Wrap Info Retrieved April 15, 2010, from Wrap Info website: http://depts.washington.edu/wrapeval/WFI.htmlwebsite: http://depts.washington.edu/wrapeval/WFI.html
• Hodges, K. (2000). Hodges, K. (2000). Child and adolescent functional Child and adolescent functional assessment scaleassessment scale. Ann Arbor, MI: Functional . Ann Arbor, MI: Functional Assessment Systems.Assessment Systems.
• Wraparound Evaluation & Research Team. (2010, April Wraparound Evaluation & Research Team. (2010, April 15). The Wraparound Process. Retrieved from 15). The Wraparound Process. Retrieved from http://depts.washington.edu/wrapeval/approach.htmlhttp://depts.washington.edu/wrapeval/approach.html
Contact InformationContact Information• Mary Ann WongMary Ann Wong
[email protected]@emqff.org (916) 388-6303 (916) 388-6303
• Catherine AspirasCatherine Aspiras [email protected]@emqff.org (408) 335-1809 (408) 335-1809
• Michelle CoufalMichelle [email protected]@emqff.org (408) 335-1888 (408) 335-1888
• Elisha HerutyElisha Heruty [email protected]@emqff.org (408) 335-1889 (408) 335-1889
• Abram RosenblattAbram Rosenblatt [email protected]@emqff.org (408) 364-4016 (408) 364-4016