Wraparound

• What has been called wraparound has varied widely across the US and Canada.

• We are dedicated to high fidelity wraparound based on the phases and activities, and principles of the National Wraparound Initiative.

• Chautauqua County received training for facilitators, family support partners, coaches, trainers and process mentors from Vroon VanDenBerg over four years.

Rachel M Ludwig – Chautauqua County Tapestry

PBIS in school continuum

Universal Intervention/ Prevention (All children)

Selected/Targeted Intervention

Intensive Intervention

System of care philosophy:consistent values guide all activities and decisions at the system level AND at the service level:

• Cultural Competence

• Family & Youth Voice

•Strengths Based

• “Seamless”

• Collaborative, Coordinated

• Unconditional Care

•Prevention/Early Intervention

•Effective Services

•Natural Supports

Public health approach: Service intensity matches child/family needs

Wraparound SupportsTargeted intervention for children involved in two or more systems ~5% of Children.

High Fidelity Wraparound ProcessMost intensive intervention for children with the highest levels of need ~1% or less children

Care

of

System

Universal carePositive development, prevention and intervention efforts for all children

Wraparound Enrollment

1. County decided to integrate, build on successful collaboration efforts

2. Funders allowed joint funding of wrap coordinators who work for all systems

3. Wrap Coordinator engaged family, talked to all systems

4. Wrap team was formed and priorities set

Multiple system involvement

Important Points• A diverse team with representatives from all systems, with

the family in the driver’s seat did not try to meet all needs at once. The team prioritized the needs and mobilized the entire team to meet the priority needs.

• The fact that one plan existed, with family ownership and buy-in, ensured that the family was not overwhelmed with help

• Each system gave up the power of single system decision making, but received the gift of outcomes.

• Through an integrated team approach, the mandates of each system were met

• Key aspects of the Wrap Plan involved non-traditional services and use of natural supports

Benefits of an Integrated Approach

• Families have real hope from their plan and process, have more energy each time a goal is met

• The professionals involved get to maximize the use of their own expertise.

• The professionals get to practice integration skills which benefit 1000’s of other families, trading control and autonomy for outcomes at the family level, and more satisfying jobs. Also may decrease professional turnover.

• Taxpayers get return from their investment• Potential multi-generational positive effect• Community building a family at a time.

Positive Outcomes are Not Guaranteed!

Studies indicate that Wraparound teams often fail to:• Incorporate full complement of key individuals on the

Wraparound team;• Engage youth in community activities, things they do well, or

activities to help develop friendships;• Use family/community strengths to plan/implement services;• Engage natural supports, such as extended family members

and community members;• Use flexible funds to help implement strategies• Consistently assess outcomes and satisfaction.

Mutual Perspective

How do the professionals involved

view families? Do they see their role

as “Rescuer” “Stabilizer” “Enforcer” “Supervisor”? How is this helpful…. Or not?

How does the family view the professionals? Is the family asking for help? Does the family want the kind of help that the professionals are

able to give?

What is the connection between fidelity and outcomes with wraparound?

• Provider staff whose families experience better outcomes were found to score higher on fidelity tools (Bruns, Rast et al., 2006)

• Wraparound initiatives with positive fidelity assessments demonstrate more positive outcomes (Bruns, Leverentz-Brady, & Suter, 2008)

When wraparound is implemented as intended…

• High-quality teamwork and flexible funds leads to enhanced creativity, better plans, and better fit between family needs and services/supports

• This in turn leads to greater relevance for families, less dropout

• Strengths, needs, and culture discovery and planning process leads to more complete engagement of families

When wraparound is implemented as intended…• As family works with a team to solve its own

problems, develops family members’ self-efficacy• Individualization and strengths focus enhances

cultural competence, relevance, and acceptability

• Focus on setting goals and measuring outcomes leads to more frequent problem-solving and more effective plans

What does it take to get high fidelity scores?

• Communities with better developed supports for wraparound show higher fidelity scores

• Training and coaching found to be associated with gains in fidelity and higher fidelity

TIC & HFW – Mirrored principles activity• Match the Principles sheet

Phases and Activities of the Wraparound ProcessEngagement and Team Prep• Orient the family to

Wraparound• Stabilize crises• Facilitate conversations about

strengths, needs, culture, and vision of the family

• Engage other potential team members

• Make needed meeting arrangements

Initial Plan Development• Develop a plan of care• Develop a detailed crisis/safety

plan

Implementation • Implement the plan• Revisit and update the plan• Maintain team cohesiveness

and trust• Complete documentation and

handle logistics

Transition • Plan for cessation of wrap• Conduct commencement

ceremonies• Follow-up with the family after

graduation

15

Thinking of Children’s Health Homes

• Quality support should be available and provided to all as needed – public health approach

• Providing services that are at a higher intensity than that that is needed can do more harm than good by over-exposing youth and families and invading a natural experience of success

• Wraparound process is a higher level of care then most families need

• Be strategic in offering HFW – family choice is key