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A4 Collaboration of San Diego Wraparound and the Children's System

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					A4 Collaboration of San Diego 

Wraparound and the Children's 

       System of Care 

 Session A, June 7, 2010, 10:30 a.1l1. - 12:00 p.1l1.

Karyn Bingham, Mental Health Systems, Inc. (MHS), Families Forward & MHS
Success First
Benjamin Blake, Fred Finch Wraparound
Judith Goldberg
Carrie Kintz, Center for Children/Stepdown Wraparound
Nilanie Ramos, Child Welfare Services, Residential Services, San Diego County
Barry Fox, Health and Human Services Agency
Michele Solomon, San Diego County Children's Mental Health Services




                             Platinum 3 

   Collaboration of San Diego
Wraparound and the Children's
               System of Care


        June 7, 2010
        Child Welfare Services
        Mental Health
        Probation


                                 StepDown Wraparound




San Diego's Children's System of Care
                              (CSOC)




              Partners within our
       Children's System of Care

 Mission Statement:

 The purpose of the System of Care Council is to
 ensure that all agencies serving San Diego
 County children have coordinated services
 resulting in improved Child..£, family, and system
 outcomes consistent with :;:,ystem of Care
 Values and Principles.

 All four sectors (Family/Youth, Education,
 Public, Private) receive training in
 Wraparound.




                                                       1
         Administrative Oversight
The County Agency Directors and the CSOC Training
Academy Oversight Committee are committed to
ensuring that quality services are provided. This is
achieved by the following:

    • Contract Monitors appointed by County Directors
    • CSOC Council
    • San Diego CSOC Training Academy Oversight
      Committee
    • Family/Youth Roundtable of San Diego County
    • Child and Adolescent Services Research Center




      Interagency Coordination
   .. Top-down, bottom-up!
   • 	 MOUs between Child Welfare Services (CWS),
       Mental Health, and Probation
   • 	 Statements of Work mandate interagency 

       collaboration/integration. 

   • 	 Executive Quarterly Meeting amongst the Chief
       Probation Officer, CWS Director, and Mental
       Health Director
        o 	 Discuss use of wraparound by staff, outcomes,
           cost savings
   • Wraparound Fiscal Oversight Meeting (Quarterly)
           Attended by CWS, Probation, Mental Health,
           Fiscal, Budget Office




                                                            2
                                    Mental Health

                c
   • Provides 	 ontract monitoring and
      oversight for all 3 Wrap programs
   • 	Supports the CSOC Training Academy
      with staff and funds
   • 	Mandates continued training for
      contracted providers
   • provides oversight of EPSDT, Medi-Cal,
      and MHSA funding sources




                           CWS Culture Shift
o Old School
     • "Fail up"
     • "Step Down"
o 	 Recognized Need for Change
     • Access to Wraparound since 2000
     • 	 CWS Wraparound contract, in collaboration with
         Mental Health
     • 	 Focus groups, facilitated by National Consultant Pat
         Miles
o 	 New School
     • Wraparound Liaison to Staff and Programs
     • Team Decision Making Meetings
     • Case Consultation
o Currently 406 CWS youth in group home care.
     • In 2007,613 were in group home care.




                                           Probation
o San Diego County Probation supervises
   approximately 3000 juvenile offenders
o 	Approximately 130 youth are placed in out
   of home care in residential facilities
o San Diego County Probation philosophy
o Wraparound Population:
    • 	 Youth placed in family like setting that are at
        substantial risk of being placed in group home
        care
    • 	 Youth returned to family like setting that would
        have remained in group home care




                                                                3
         Commonalities between the
    San Diego Wraparound Providers
• 	 Wraparound Facilitators/Coordinators
     o Licensed and licensed eligible clinicians

• 	 Family/Youth Support Partners
       Life experience within the public system

• 	 Case load size
       8-10 per Facilitator/Coordinator
     o 15-20 per Family/Youth Partner

• 	 Timeframe of services
      o Up to 12-18 months


    o
    o Supervisors 

      Consultants ­
      Other providers ­

                                                   II




                          Collaborative Oversight
                                 Over Flex Funds
    o Decisions regarding use of flex funds are
      made by the Wraparound Team
        • Driven by the Family Need and the Team
           Process

    o System 	oversight is provided on requests
      in excess of $500

   o Flex fund expenditures are reviewed at
     each program's regular Oversight
     Meetings

                                                   12




                                                        4
                                        Fidelity and Evaluation


            Families Forward and SDCC completed the
            Wraparound Fidelity Index-3 (WFI-3) in 2006.

              0190 families participated. 

               Results showed high fidelity along 8 of the 

               11 elements. 





                  WFI Elements: EMQ & National Data



                  Youth/family 
               •
                                                            I           :
                     Team 

                                                            I
                  Comm-bosod 
                 •




                     Srvcs 
                                                         181

                     Cultural 
                •
                                                            I
                                                                        •


                   CompetenCQ 

                                               I            I           !




                  IndMdualized

                                               I                        I
                                                            •


                                                                                           18:

                                              20           40          60          80            100

Nu!)onal wfl-3 Dataset came from the Wraparound Ewloolion and ReSOfllCh Team proson!alion for the Technk:G!Assislance
Partnership WobiMt on 41W04 by Eric J. Stuns, Ph.D. for "Ensuring High"Quality Wraparound"




      WFI Elements: EMQ & National Data

           Nalur.1 Supports
                                 ~    __   ~   ____      ~      _ _ _ _J""


                Continuation • • • • • • • • • • •                                   Il!~ __

               Collaboration • • • •                                                                   imN3uona~f       I
                                                                                                       'O$a" Oia 0




                                                                       60           80




                                                                                                                15




                                                                                                                            5
                         The Collaboration




            National Experts brought to
          San Diego with CSOC support

a   Pat Miles (June 07)
a   John Vandenberg (April 08)
a   Eric Bruns (Oct 08)
a   Mary Grealish (Jan 09)




                  "Wrap Debrief" Group
a 	Wraparound Program Managers and CWS
   liaison meet monthly
a Topics have included:
    • Funding
    • Paperwork
    • Existing electronic health record (Anasazi)
    • Collaborative issues with 

      CWS/Probation/Special Education 

    • Training needs
    • Fidelity and outcome tools
    • Brainstorming difficult cases




                                                    6
    Wraparound Training Calendar

o 	Wraparound Basics for community 

   members and staff of different sectors ­
   4x year 

o Skills Building 	- for wrap program staff ­
   3x year 

o 	Wraparound Training Collaborative 

   workshops - 2x month 

o Utilizes California Wraparound curriculum
o Advanced Skills Building - May 2010




          Wrap Training Collaborative ­
                 Advanced Workshops
o 	 Tools of the trade
o 	 Needs Assessments
o 	 Keeping Meetings Positive
o 	 Transitioning out from day 1
o 	 Making Wrap fun
o 	 Avoiding Therapy
o 	 Conflict Resolution
o 	 Getting "unstuck"
o 	 Safety Planning
o 	 Effective Mission Statements
o 	 Staff self-care
o 	 Team cohesion
o 	 Roles understanding
o 	 Substance abuse on teams
o 	 The Art of Facilitation
o 	 Successful community outings with clients
o 	 Eliciting a Family's Story




              Wrap Supervisors/Coaching
                           Group Topics

o   Keeping wrap positive
o   Safety planning/crisis management
o   Flex Funds
o   Making strengths functional
o   Maintaining Neutrality of Facilitators
o   Creating a Coaching Feedback form
o   Effective coaching strategies




                                                7
  Moving Forward - Where we hope
     to be a few years from now ....
o Another round of Wrap Fidelity Index
o Implementation of Team Observation
  Measurement (TOM)
o Cross-program coaching (in the field)
o Advocacy for reduced Medi-Cal restraints
o Exemptions for continuing to work with
  families with juvenile hall involvement
o More trainings specifically for family
  support partners
o Decrease the length of stay in group
  home placements




                                             8

				
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