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

mwong@emqff.orgmwong@emqff.org (916) 388-6303 (916) 388-6303

• Catherine AspirasCatherine Aspiras caspirascaspiras@emqff.org@emqff.org (408) 335-1809 (408) 335-1809

• Michelle CoufalMichelle Coufalmcoufalmcoufal@emqff.org@emqff.org (408) 335-1888 (408) 335-1888

• Elisha HerutyElisha Heruty eherutyeheruty@emqff.org@emqff.org (408) 335-1889 (408) 335-1889

• Abram RosenblattAbram Rosenblatt arosenblattarosenblatt@emqff.org@emqff.org (408) 364-4016 (408) 364-4016