Youth and Family Institute by UpAhK8Gj

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									OMHSAS Children’s Bureau
 Youth and Family Institute
       Presentation


  Pennsylvania Council of Children,
    Youth, and Family Services
              2-20-08
         Recovery and Resilience
People who are involved in supportive social
relationships experience benefits in terms of health,
morale, and coping;

Strengthening interpersonal and community ties is a
resilience and development promoting strategy;

Research shows that engaging and empowering youth
and families results in enduring improvement for youth
with behavioral health challenges.
   Transformation Objective


Transform the
children’s behavioral
health system in
Pennsylvania to a
system that is family
driven and youth
guided
 Transformation Implementation

Create an Institute to provide training,
support and monitoring of Youth and Family
Teams

Develop mechanism for Medicaid payment of
Youth and Family Team process

Begin process of implementing Youth and
Family Teams throughout the
Commonwealth
  Youth and Family Institute
Contract with University of Pittsburgh
Utilizing VroonVanDenBerg to provide
consultation and training on High Fidelity
Wraparound
Public presentations
Executive Director
Advisory Board
     Implementation Steps
Utilizing Mercer Government Human
Services Consultants for Medicaid
expertise
Testing the service and financing model in
Allegheny County
Request for counties to be early
implementers
Continue to test, improve, educate.
         What is the Model
The Specifics
High Fidelity Wraparound
A process for supporting youth and families
with complex behavioral health needs
Defined by National Wraparound Initiative
10 principles
Four phases (engagement, plan development,
implementation and transition)
Theory of Change: Needs, self efficacy,
natural supports and an integrated plan
          In Pennsylvania
We have a long history of collaboration and
programs to support children and their families.
We do not have strong evidence of outcomes for
our efforts.
We need to implement and support research
proven approaches, such as
High Fidelity Wraparound.




                                               9
  Development of Wraparound
Grassroots Development
  General Principles
  Applied in many different ways
  Creativity and advances
  200,000 children by 1999

Initial Results
   Life changing success stories
   Strong support
   Mixed evaluation results
   Research shows results match fidelity
        Defining Wraparound

Steps to Define Wraparound
     Duke University meeting on principles
     National Wraparound Initiative
        Who they are
        Process used
        Products produced
     Wraparound Fidelity Assessment System
     Principles for Wraparound
Family Voice and     Culturally Competent
Choice               Individualized
Team Based
                     Strengths Based
Natural Supports
                     Persistence
Collaboration (and
Integration)         Outcome Based and
Community Based      Cost Responsible
 Phases and Activities, and
         Skill Sets
NWI phases and activities
Specific skill sets for wraparound facilitators,
coaches and family support partners
Performance based training and coaching products
Credentialing and Quality Improvement
Used and been in over 35 sites across North
America.
Sites using these products report greatly improved
outcomes and more satisfied families and staff.
     What Does the Research
             Say?
High Fidelity Wraparound can produce significantly better
outcomes for children and families with significant needs
than traditional approaches:
    Decreased restrictiveness of residential environments

    Improved behavior and mental health symptoms

    Improved school and early care outcomes

    Decreased family and child safety issues and risk

      factors
    Increased family engagement and satisfaction with

      services
    Increased family resources to support their own

      children
                               Impact on CAFAS Scores
                                    after 6 Months
                                                    6 months
Chnage In CAFAS Scores




                         10
                          0
                         -10
                         -20
                         -30
                         -40
                         -50
                               Trad MH Services   High Fidelity   Low Fidelity then
                                                  Wraparound         Coaching
                               Impact on CAFAS Scores
                                   after 18 Months
                                                  6 months   18 months
Chnage In CAFAS Scores




                          10
                           0
                         -10
                         -20
                         -30
                         -40
                         -50
                         -60
                         -70
                               Trad MH Services      High Fidelity       Low Fidelity then
                                                     Wraparound             Coaching
        Phases of wraparound

Engagement and team preparation



                  Plan development

                             Implementation


                                      Transition




                              Time
Phases of wraparound planning
Phase                                      Ballpark range
Engagement         Duration of phase       First 2 weeks
                   Frequency of contacts   2 – 5 times/week
                   Intensity               6 – 12 hours/week
Plan development   Duration of phase       Weeks 3 and 4
                   Frequency of contacts   2 – 4 times/week
                   Intensity               6 – 10 hours/week
Implementation     Duration of phase       Weeks 5 on
                   Frequency of contacts   2 – 3 times/week
                   Intensity               3 – 6 hours/week
Transition         Duration of phase       Last 2 months
                   Frequency of contacts   1 – 2 times/week
                   Intensity               1 – 3 hours/week
         Building the team
Good teams blend the family’s natural
supports with professionals
Teams are utilized for planning and action,
not just for “staffing” or admiring the
problems
In wraparound, teams provide the family
with support, ideas, resources and
advocacy
The family’s voice is crucial in selecting the
team
                  The Team
Bring informal and formal resource together
Include family, friends, neighbors, service providers,
spiritual leaders, others who want to help
Include service providers, who fill important roles
Unique to each family
Give everybody involved a chance to achieve consensus
on what to do
Value family and community resources
Can help isolated families get needed support that lasts
as long as it's needed
       The importance of
   informal/natural resources
Build hope and capacity on Family Teams
Through a history of connection and trust, can help
families receive feedback/input in a manner that it would
be difficult for professionals to achieve
Make needed skills more available by including real
people from the child and families world
Meet families where they are and serve as bridges to
where they would like to be
Help ensure that children, adults and families are heard
and respected
Our understanding of evidence-
based programs is much better
  than our understanding of
  successful implementation.

       Implementation is how we take a
  science based practice and implement it
     in communities or statewide in “real
   world” settings that are provided with
    fidelity and produce good outcomes.
 Successful Implementation
Improved satisfaction and outcomes for
children and families
Improved fidelity to treatment model
Decreased time to reach fidelity
Decreased external supports to reach
fidelity
Implementation of High Fidelity Wraparound

             Community
            Context and
             Readiness

                                            Staff
    Program               Organizational
                                           Selection
   Evaluation               Supports




                                            Training
                      Supervision
  Performance
                         and
  Management
                       Coaching
                    Training
Train and Hope does not work
About behavior and system change
Not satisfaction with training
Research on information provision and training
Factors that influence
   Initial motivation and engagement
   System and organizational support
   Organizational climate and control
   Methods of training
    Need for Coaching
Newly-learned behavior is crude compared
to performance by a master practitioner.
Newly-learned behavior is incomplete and
will need to be shaped to be most
functional in a service setting.
Newly-learned behavior is fragile and
needs to be supported in the face of
reactions from consumers and others in
the service setting.
    Supervision and Coaching
Types of coaching
  Live coaching (modeling
                             Characteristics
   and feedback)               Strengths-based

  Videotaped
                               Reflective
  Group sessions
                               Proactive
  Individual sessions
                               Frequency and
  and individual sessions
                                duration
Supervision Process            Change over time

  Assessment

  Individual and group

  Live coaching

  Records review

  Performance plans
                       Supervision Impacts Time to
                                 Fidelity
                        14                              Inconsistent supervision
                        12                              is more crisis and
Months to Fidelity




                        10                              reactive
                         8                              Low frequency
                         6                              supervision meets less
                         4                              than weekly and rarely
                         2                              does in-vivo supervision
                         0                              Proactive supervision
                                                        implements plans for
                                                    e
                                 t

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                                                        professional development
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                                            Pr
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Fidelity Assessment / Improvement


    Two leveled certification competency based
     certification process
    Measures of compliance to the wraparound
     phases and activities
    Measures of fidelity to the wraparound process
    Use of the measures to guide ongoing
     professional development
  Six Types of Certification
Wraparound Novice
Wraparound Practitioner
Family Support Partner
Mentor for Wraparound Process
Coach/Supervisor for Wraparound
Process
Trainer for Wraparound Process
    Certification – Wraparound
             Practitioner
Goal: to define the basic skill sets that must be
  demonstrated to be considered a competent entry level
  wraparound facilitator

Requirements include:
  Has received 3 hours of supervision/coaching per week
  Has a professional development plan
  Has demonstrated competency on wraparound process
  tools
  Has demonstrated competency on each of nine
  practitioner tools
Community Context and Readiness
 Engaging key stakeholders
 Commitment to core wraparound components
 Feasibility assessment
 Staffing and supervision ratios / assignments
 Policies, procedures and documentation
  processes
 Implementation plan
  Youth and Family Institute
Will provide training and certification
Will provide coaching
Will conduct on-going evaluation using the
Wraparound Fidelity Index
Will continue to provide support for
counties as they establish the Youth and
Family Team process
Will provide information and education

								
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