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HISTORY AND INTRODUCTION TO WRAPAROUND

The wraparound process is rapidly becoming a part of mainstream human services. In the earliest days of the wraparound process in Alaska (VanDenBerg & Minton, 1987; VanDenBerg, 1993), Illinois, Washington, Vermont (Burchard & Clarke, 1990), and in many other states, ''wraparound" was based primarily on the key principles of individualization, unconditional care, strengths-based and increasing family voice and choice. Little, if any, standardization of what the process actually entailed was defined. The first project named Wraparound was based on creative agency­ based individualized planning being done at the Kaleidoscope Agency in Chicago (Kendziora, 1999), which was based on de-institutionalization and normalization efforts from Canada. The first state-wide system of care-based wraparound effort was established in Alaska in 1986 (VanDenBerg & Minton, 1987; Burchard, et.al, 1990). The process has grown to include locally innovated efforts across North America and in other parts of the world. During the over 35 year history of the wraparound process, wraparound has emerged as a primary method of integration and delivery of services and supports for children and. youth with complex behavioral health needs and their families. In many sites, wraparound started in reaction to the common practice of using long-term and sometimes out-of-state placements of children and youth with complex behavioral health needs. States such as Alaska, Michigan, Maine, Wisconsin, Vermont and Kansas used the process to reduce the potentially harmful impact of long – term institutional placements to and serve children an d y o u t h in t h e i r homes. Wraparound has roots in the continuing movement to improve behavioral health services for children and youth, which was accelerated by the work of Jane Knitzer (1982), who wrote Unclaimed Children and stated that two-thirds of all children with severe emotional disturbances were not receiving appropriate services. These children were "unclaimed" by the public agencies responsible to serve them, and there was little coordination among the various child-serving systems. To address this need, Congress appropriated funds in 1984 for the Child and Adolescent Service System Program (CASSP) through the National Institute of Mental Health, which envisioned a comprehensive mental health system of care for children, adolescents and their families. Ongoing Federal grants supported the development of wraparound practice and systems of care across the country.

INNOVATION AND VARIATION IN "WRAPAROUND"

By 1988, early replications of the work in Alaska, Illinois and Vermont had already begun to vary ''wraparound" in quality and in scope. Implementation varied through local innovations and policy and funding constraints. By the mid 1990’s, e f f o r t s in several states to implement ''wraparound" had been identified as failures by implementers, evaluators and funders. Close examination of these efforts revealed that what was called wraparound more closely resembled children's case management with no real individualization, limited family voice and choice, no integration of services, and a focus on deficit-based services. To address this, a meeting was held at Duke University and the first major organized effort to provide consistency to the definition of the wraparound process began (Burns and Goldman, 1998). This meeting helped to clarify the principles but had little direct effect on the process

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variation. In 2001 a larger group of early innovators, providers and family members came together to continue the process of defining and standardizing wraparound. This group grew into the National Wraparound Initiative (NWI) and developed standardized principles, and described the process of wraparound through standard phases and activities (Walker and Bruns 2006). A part of NWI -the Wraparound Evaluation and Research Team (WERT) developed standardized fidelity measures based on pre NWI tools (Rast and Burchard, 1996) and the principles of the process (Bruns, 2007). Many states and provinces have accepted the standardized principles and the phases and activities of the NWI as the definition of the wraparound process, and the field is becoming more consistent.

Vroon VanDenBerg partners Jim Rast and John VanDenBerg were initial core members of NWI who developed the Principles, Phases and Activities and fidelity tools based on more than 20 years of personal experience running programs that served more than 4,000 families and providing consultation in all 50 states and seven Canadian providences. Based on continual implementation of the NWI principles and phases and activities, VVDB has extended the work of NWI to define the roles of the Wraparound Facilitator and Family and Youth Support Partners through function, action steps, and certification processes. In addition, VVDB has defined a theory of change that explains why wraparound works which guides staff to individualize the process they use to do wraparound with individual families and provide a fidelity-based process for coaching and supervision. VVDB has continually addressed challenges to engaging families in wraparound that understands that success in wraparound must focus more with the youth and family than with the team. A major focus and goal of wraparound is to prepare youth and families to get their own needs met and manage their own crisis after wraparound. VVDB teaches that wraparound is equally about addressing current needs and preparing the family for the future. VVDB also recognizes that most people have “teams” of people who support them, but that the “teams” or “go to people” vary with different needs and few supports are involved with even most of the family’s needs. In addition, families have many different ways they prefer to ask for and coordinate services and supports. Most do not choose to have team meetings. Managing wraparound throughout the implementation phase through team meetings does not prepare families to sustain progress after wraparound, and explanations of wraparound that focus more on the team than the family misses this major element of successful wraparound.

VVDB has developed competency-based training for all wraparound staff and defined roles for trainers, coaches, supervisors and wraparound process mentors (consultants and coach trainers). VVDB has developed certification processes for each of these positions. VVDB has also developed advanced training and coaching materials in the VVDB Resource Manual.

THE WRAPAROUND PROCESS: GUIDING PRINCIPLES

The National Wraparound Initiative, led by Eric Bruns, Ph.D., Janet Walker, Ph.D., Trina Osher, Jim Rast, Ph.D., John VanDenBerg, Ph.D., Pat Miles and others, standardized ten guiding principles for wraparound: 1. Family Voice and Choice 2. Team Based

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3. Natural Supports 4. Collaboration 5. Community Based 6. Culturally Competent 7. Individualized 8. Strengths Based 9. Unconditional Care 10. Outcome Based Wraparound is primarily a process to support families gain the skills and confidence to manage their own future and needs. This goal builds on the first principle of wraparound which is voice and choice. The determination of needs, the development of a vision and the prioritization of needs and goals are accomplished by listening to the family (voice) and letting them decide what will work best for them (choice). The family is supported by service providers and natural supports who offer their expertise and support. Together they develop a plan to help the family achieve their vision. The individualized plan is child-centered and family-focused with maximum family involvement, with variation depending on the strengths, culture and needs of the child and family. The process focuses on strengthening the family, extended family and social supports for the child by involving them and having them assume responsibility for planning and implementation. These social supports represent the principle of Natural Supports. Many families who are served through the wraparound process have needs which have traditionally been met by more than one services system (education, mental health, health, juvenile justice, child welfare, developmental disabilities, etc.). Often each of these agencies, providers and organizations has one or more staff working with the youth, siblings and or parents. Each of these individuals has traditionally developed their own plan for the youth and family. This has resulted in youth and families having many plans, some of which may be contradictory. For many families engaged in wraparound the multiple plans are overwhelming and reinforce their feelings of being “bad” parents and a sense of hopelessness. In wraparound these service systems and schools agree to the principle of Collaboration, working together and moving to Integration where all parties work in a team with the family and design and implement one plan. To accomplish this collaboration and integration, wraparound is team-based. In the beginning the family chooses a team from the service providers working with the family and the family’s natural supports, to develop an integrated planning and implementation process. This serves two primary purposes: it brings everyone together to develop a common mission, uses all their experience to brainstorm options based on the unique culture and strengths of the family and team and develop an integrated action plan. The second function is to teach the family how to engage, integrate and utilize their services and supports. Part of the culture is the family’s culture of support. This is how they prefer to ask for, plan with and use the support they are receiving. For some family’s team meetings are their culture of support, but more than 80% of families use one-on-one or small group face-to-face encounters, phone calls, texting, email or social media to manage this process. Families rarely share or ask help for all their needs for the same people but have “go to people” for different areas of their life. During implementation

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the formalized team process shifts to the family’s culture of support which for a few families remains team meetings but for most shifts to a different format. Services and supports are based on the principle of being Community-based. Community-based means that plans for youth and their families support them to be in the community and integrated them into everyday community activities. When residential treatment or hospitalization is accessed, these service modalities are to be used as stabilization resources and not as placements that operate outside of the plan produced by the child and family team. Wraparound staff takes the time to understand the traditions, beliefs, cultural practices and preferences of the youth and family. Together these are defined as family culture and the wraparound process and plans are tailored to the unique culture of each family. The principle of Individualization is at the heart of the wraparound process. Each child, youth, and family has an individualized plan and the process for doing wraparound is individualized for each family. The plan may include services (such as therapy or day treatment) that other plans have included but when they do, the team always evaluates and understands why the service is a precise match for the unique strengths, culture and needs of the youth, and/or family. The wraparound process is strengths-based. To support the primary goal of the wraparound process youth and families must become engaged in the process and gain the self-confidence and skills to manage their own needs. When agencies and services focus on all that is “wrong” with the youth and family, the result is often that families feel ashamed, angry and overwhelmed. This results in them being less confidence and engaged. Wraparound plans are balanced to address needs while concurrently supporting youth to participate in and improve in activities they preferred activities. Wraparound is strengths-based to build engagement, confidence, and youth and family empowerment. Identifying the strengths and positive actions families have already accomplished, helping them develop a positive view of the future, building plans on their strengths, and celebrating and providing feedback on even small accomplishments is a key to successful wraparound. This does not mean we reframe all the needs into strengths but that we address them from a positive framework. By building on these strengths, the plan supports who the child is and how the child will positively progress in life. The plan is focused on typical needs in life domain areas that all persons (of like age, sex, culture) have. These life domains are: independence, family, living situation, financial, educational, social, recreational, behavioral, emotional, health, legal, cultural, safety, and others. Individualization means that the unique needs, strengths and culture of the family are understood and are the basis for how wraparound is provided. Just as important - good wraparound is individualized to the culture of each youth and family. Culture encompasses the family’s values, norms, preferences, traditions, preferred community, preferred learning styles and preferred ways to receive support. When wraparound staff takes the time to understand and use these aspects of culture to guide the wraparound process for each family, long and short term outcomes are greatly improved. The child and family team and agency staff who provide services and supports must make a commitment to the principle of unconditional care in delivery of services and supports. When things do not go well, the child and family are not “kicked out”, but rather, the individualized services and supports are changed. While some small percentage of family’s may not engage in

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the wraparound process, failure to engage families should result in changes in engagement practices not giving up on the family. Wraparound is not implemented in a vacuum. Within a community and state there are many competing demands for a limited amount of resources. Not only does wraparound compete with education, healthcare, police protection, and waste removal, it is implemented in partnership with the other agencies, providers and supports within a community. Planning, services, and supports cut across traditional agency boundaries through multi-agency involvement and funding. Governments at regional and local levels work together with providers to improve services, and provide the best possible use of resources. To be socially responsible and societally supported wraparound must be outcome based. Wraparound often works with families who can potentially use a lot of community resources through high level services (residential placement and day treatment), detention (and even long-term imprisonment), and child welfare residential and treatment costs. For wraparound to be sustainable it must provide better outcomes for the same or less money. The value of outcome-based means that we continually measure the outcomes and quality of wraparound and use the information to continually improves our approach to get better outcomes.

PHASES OF WRAPAROUND PRACTICE

The material above covered the principles of wraparound which define how we do wraparound. This section describes the phases and activities of wraparound which is what we do in wraparound. Wraparound is divided into four overlapping phases which include engagement, planning, implementation and transition. An overview of each phase is described below including what we want to accomplish during each phase. PHASE ONE: ENGAGEMENT AND TEAM PREPARATION. During this phase, the groundwork for trust and shared vision among the family and wraparound team members is established. The most critical objectives of this phase are engaging the family and youth, supporting them to describe their strengths, needs, and culture, and helping them to define their vision for the future. The process begins by meeting with the family and youth and listening to their concerns, explaining the process to them, getting their commitment to move forward with wraparound and addressing immediate crisis, safety and urgent needs. Before any other planning or new services are started, wraparound staff takes the time to actively listen to and understand the unique strengths, needs and culture of each family. From this information the wraparound staff helps the family define their own vision of a better future and prioritize the needs that must be addressed to achieve this vision. Any court ordered plans (child welfare and juvenile justice) are included in this prioritized list. At this point the family chooses the people (team) who will support them. The family and team are prepared for the first team meeting, so people are prepared to come to meetings and collaborate. This phase, particularly through the initial conversations about strengths, needs, culture, and vision, sets the tone for engagement, family empowerment and teamwork that are consistent with the wraparound principles. When initial engagement of the family goes smoothly, the activities of this phase should be completed relatively quickly (within 2 to 3 weeks if possible), so that the team can begin meeting and establish the initial integrated plan as soon as reasonable. It is important, however, to remember that families referred to wraparound often have complex needs and long histories of unsuccessful support from service systems and providers. The process will often fail to achieve positive outcomes if families are not fully engaged and sometimes this will often take longer to accomplish and staff and priorities must be flexible and persistent to make this occur.

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PHASE TWO: INITIAL PLAN DEVELOPMENT. During this phase, team trust and mutual respect are built while creating an initial plan of care using a high quality planning process that reflects the wraparound principles. In particular, the youth and family should feel, that they are heard, that the needs chosen are ones they want to work on, and that the options chosen have a reasonable chance of helping them meet these needs. This phase should be completed during one or two meetings that take place within 1-2 weeks of completion of initial engagement. Getting this initial plan developed and having the team members come together and develop an integrated plan that supports the family’s vision is critical to help the family believe the process can work. Doing this as quickly as the family is comfortable with promotes team cohesion and shared responsibility toward achieving family’s vision. PHASE THREE: IMPLEMENTATION. During this phase, the initial wraparound plan is implemented, progress and successes are continually reviewed, and changes are made to the plan and then implemented. This is the longest phase of wraparound for most families. During this phase wraparound staff supports implementation and fine-tuning of the plan with the family and team. One of the most important objectives of this phase is to gradually transfer control of the process to the family supported by their natural supports as needed. The family wraparound staff supports the skills and resources (transition assets) needed to succeed after wraparound. The “team” may be continually changing as providers finish their work with the family and new providers and natural supports are added to the team. As the family moves through the implementation phase wraparound staff will help them articulate how they will coordinate and manage support in the future. Most will not choose to have physical team meetings but communicate through other means. As the family identifies how they will manage and coordinate needs after the wraparound staff is gone, the process will evolve to match the family’s culture of support while maintaining or building the family’s system of supports. PHASE FOUR: TRANSITION. The final phase of wraparound is transition from having wraparound staff support to moving forward without them. All families have needs and crises throughout their lives. Families including a youth with serious emotional challenges will have many needs and crises throughout their lives and more after wraparound than during wraparound. The goal of wraparound is for family’s to have the resources, skills, confidence and support to move forward successfully. Most of the work around transition occurs before the final phase. The final phase includes activities to celebrate accomplishments and plan for moving forward without wraparound staff.

THE THEORY OF CHANGE

Despite the increasing amount of resources for wraparound, few of these materials and resources address the theoretical foundations of the wraparound process. Wraparound is a complex process that must be individualized for each youth and family. Logic models and program descriptions graphically illustrate program components and help stakeholders identify outcomes, inputs and activities. They generally start with a program and identify program components so at a glance you can see if outcomes and activities are occurring. On the other hand, a theory of change links outcomes and activities to explain how and why the outcomes are expected to occur. The VVDB theory of change articulates a hypothesis about why the

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wraparound process will cause sustainable outcomes for youth and families, why wraparound works, and why it is different from other services and processes. It also sets expectations for what we want to accomplish with and for youth and families. A theory of change defines both what we are trying to accomplish through wraparound and helps the wraparound staff make decisions about how to individualize the process with each youth and family. THE VVDB THEORY OF CHANGE FOR WRAPAROUND BEGINS WITH PURPOSEFUL TRANSITION. THE FUNCTIONS AND

ACTION STEPS OF THE COACH ARE DEMONSTRATED THROUGH THE TOOLS THAT ADDRESS EACH OF THE FUNCTIONS OF

WRAPAROUND COACHING. COACHES ARE CERTIFIED TO COACH WRAPAROUND FACILITATORS, FAMILY SUPPORT

PARTNERS, OR YOUTH SUPPORT PARTNERS. COACHES CAN DO ADDITIONAL CERTIFICATION DEMONSTRATIONS TO

BECOME COACHES FOR MULTIPLE STAFF POSITIONS. THE FOLLOWING PAGE PRESENTS THE OVERALL TRACKING SHEET

FOR ALL COACHES. THE FIRST REQUIREMENT IS THE COMPLETION OF TIER ONE TRAINING. IF THE COACH COMPLETED

PREVIOUS TRAINING THAT CAN BE COUNTED BUT THE COACH WILL BE USING THE NEW MATERIALS FOR TRAINING NEW

STAFF AND THUS THE COACH SHOULD COMPLETE THE NEW MATERIALS SO THEY WILL BE ABLE TO PROVIDE QUALITY

INSTRUCTION AND DEBRIEFING WITH THOSE STAFF. ONE WAY TO DO THIS WOULD BE TO COMPLETE THE TIER ONE

TRAINING WITH YOUR NEXT NEW STAFF. The second requirement is to demonstrate Tier Two wraparound skills for the position you are going to coach. Our experience is that coaches who have not done wraparound are seldom effective. We have developed a modified and shortened version of Tier Two for coaches and supervisors who are already in coaching or supervision positions. The requirements are that you work with at least one family through the first 4 to 6 weeks of wraparound. You can do this in partnership with a new staff person who will take over work with the family once you have it started. You must do the initial engagement with the family, set-up and complete the strengths, needs and culture discovery, do a functional assessment, prepare the family and the team for the first meeting, run the first meeting, run a crisis plan meeting and one follow-up meeting. A certified coach much watches all of these activities and you must meet the same fidelity standards that Tier Two certification requires. You must also prepare all of the related documents and have a certified coach score them. You can speed your certification process by videotaping your activities and scoring your own videos and documents separately from the certified coach and thus get credit for doing and scoring the activities. The third requirement is to demonstrate an ability to score the Tier Two tools for the position you are coaching with inter-rater agreement from a certified coach. The next requirements are to demonstrate staff selection, orientation, shadowing, training support, behavioral rehearsal, live coaching, and group coaching. In staff selection each wraparound agency must develop a description and materials of how they hire the right staff. This can be a combination of previous documents and an added description of how you do other things on the scoring sheet. Once the first group of coaches develop this at a site new coaches will be asked to review it and make suggestions on improvements. There must be one of the packets for each wraparound position (wraparound facilitator and family support partner, and youth support partner if you have them). For orientation each wraparound agency must have a packet of materials that show how they orient new staff to wraparound. This can be a combination of previous documents and an

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added description of how you do other things on the scoring sheet. Once the first group of coaches develop this at a site new coaches will be asked to review it and make suggestions on improvements. Shadowing, Behavioral Rehearsal and Observational Coaching are the Do For, Do With, and Cheer On of coaching. In shadowing a staff person watches another staff do a wraparound activity, in behavioral rehearsal they practice doing the skill in a safe environment. In observational coaching the coach watches them do an activity. In each case the coaching activities are enhanced by preparing the staff for the activity and then debriefing them afterwards. For certification the coach video tapes the preparation and debriefing sessions and these are scored by a certified WPM. In shadowing the coach largely describes what will happen (Do For), in behavioral rehearsal the coach and staff discuss what the staff will do (Do With), and in observational coaching the staff tells the coach what they are going to do (Cheer On). For the two group coaching requirements the coach must provide and video tape a group presentation on any topic related to wraparound practice and in Family Presentations the coach must prepare staff to do a family presentation and then video tape the staff doing (with coach support as needed) the presentation for a group of wraparound staff. For the peer to peer learning and experienced peer coaching the coach supports staff to learn from each other and the requirement is for the coach to write a short description of setting up the situation, what the staff did and your debriefing. No video is required. The final requirement is to develop assessments, plans and progress notes to take two staff through the certification process. These plans are covered in detail in Chapter Eight and examples in the appendices. The wraparound theory of change then builds on evolving needs theory, Bandura’s (1977) theory of self-efficacy, Bronfenbrenner’s (1979) theory of human ecology, and system of care (Stroul & Friedman, 1986) integration of plans, services and supports for the family. Simply put the theory of change is: Meeting the self-defined needs of youth and families, enhancing their confidence and skills to get their own needs met, and strengthening their natural support network while integrating effort by the people helping them, will result in improved engagement, self-efficacy, social support, integration of effort and sustainability of positive outcomes.

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LAWSUITS

Key lawsuits have influenced the speed of the growth of the wraparound process. The first major lawsuit was Willie M. vs. Hunt, in 1980 (Behar, 1986). This lawsuit supported community based system of care services. The Jason K. lawsuit in Arizona led to the inclusion of over 16,000 children and youth in the wraparound process. Emily Q. vs. Bonta (Bird, 2006) resulted in a major expansion of the wraparound process in California. These lawsuits have supported a basic right to effective services and supports. The lawsuits share a similarity – they all have been instigated by parents whose children have been placed outside the home. These cases found the children were not provided with effective services to prepare them for reentry into the community and inclusive and productive future lives. Out of over 30 successive similar class action lawsuits over 25 years, not one has been lost by the advocacy organizations bringing the suits. Now, the field is expanding and many innovative efforts have emerged. The Rosie D. vs. Patrick Remedial Plan, adopted by the Massachusetts Court in February 2007 and finalized in July 2007, provides a mandate to restructure the children’s mental health system in Massachusetts. The mandate included developing a coherent system of care that proceeds along a pathway for accessing home-based services and supports. A new children's mental health system, designed and developed consistent with the Remedial Plan, began in July 2009. The new system ensures that medically necessary home-based services are available both to assist children with serious emotional disturbance to remain in their home, in school, and in the community. The system helped reduce, to the extent reasonably possible, the likelihood that such children will be removed from their homes and home communities because of their mental health needs. The new system provides for screening, mental health evaluations, service coordination, comprehensive assessments, a single treatment team and plan, and an array of home-based services. These services must be implemented with the involvement of families, and delivered through an integrated treatment planning process that includes all relevant state and local agency representatives. To provide services for the children and families with the most intensive needs the state has adopted wraparound and provided services for over 4000 families in the first year of implementation.

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JOAN AMUTO AND HER FAMILY

Joan, age 13, lives in a rent-controlled apartment with her mother, Tammy, and her step-father, and no brothers or sisters. She lives in a city of about a half million people. Joan receives mental health services under Medicaid. She has a diagnosis of conduct disorder and major depression and severe emotional disturbance. After a relatively normal early childhood, in 2005 Joan was hit by a car as she rode her bike. She was severely injured, had a broken arm and ankle which required multiple surgeries. In early 2006, her parents divorced, and her favorite grandmother died later that year. Her mother remarried in 2007. Her father died of AIDS-related diseases in 2008. Joan is having many problems at this time, including major depression, anger, and self-injurious behavior (making deep scratches on her skin). Joan was suspended from school last year for attacking the building principal when he tried to restrain Joan from hitting another student who had been teasing her. This was not an isolated incident and Joan is now in a special classroom due to her behavior problems. She does not get along with her stepfather Sam, and seems to actively try to upset him. Sam feels that Joan is deliberately trying to ruin his marriage and wants her out of the house. Joan’s treatment history includes multiple strategies. She has received counseling and special education services through the school. She has received out-patient and in home therapy but in each case failed to engage with the therapists and the cases were closed. Last year, she went to a mental health residential treatment center for four months, and was discharged at her mother’s request when she spent over a month on a punishment level for refusing to interact with other residents. She does not get along with her mother, and calls her names or generally ignores her. Her mother tries to keep her away from her step-father to reduce fighting in the home. The police have been called by neighbors to the home many times due to loud fighting between Joan and her step-father. This has resulted in an open case with DCFS. Her mother feels like she is at the end of her personal patience level, and that Joan may have to be hospitalized or sent “away”. Joan refuses to see her therapist. Her mental health center has a waiting list for youth who want to work with therapists, but is willing to work with the family and the school. The school feels they have done their best and the principal feels that mental health should step in and send Joan to residential for at least a year. Joan’s mother has tried to get Sam to go to therapy, but he refuses, saying that Joan is the problem. There are clear signs that the marriage is not going to last much longer, and that Tammy feels like she is going to have to choose between Joan and Sam. Meanwhile, Joan is getting into increasing trouble with other youth in the neighborhood, and the family is at risk of getting kicked out of the apartment. Due to the rent control, and a tight rental market, getting kicked out of the apartment will have a severe effect on the family budget.

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LARGE GROUP EXERCISE: JOAN AND HER FAMILY How unusual is Joan’s situation in your experience? Based on 1 being the least complex family you have ever worked with and 10 being the most complex, where would you place Joan and her family? What characteristics would make her situation more complex? Using a planning format of Presenting Problem/Solution, we will design a typical, non-wraparound plan for Joan and her family. What would the predicted results of this plan be? (check one of the following)

A. Joan would be at home, stabilize, do well in school, have a good relationship with Sam, and the family would thrive.

B. Joan would stay at home, with some problems and school issues, but would improve with manageable family relations.

C. Joan would require foster care or group home placement would stabilize in these placements and do better at school. Tammy and Sam would stay together and visit her regularly.

D. Joan would be placed in residential. She would find a routine and have fewer mental health symptoms. Sam and tammy would stay together.

E. Not good, almost total failure of the plan. Joan would be placed in residential treatment and bounce from treatment facility to residential setting

WAIT TO REVIEW THE REST OF THE DOCUMENT UNTIL THIS FIRST PART OF THE EXERCISE IS COMPLETE

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Some of Strengths and Culture Discovery: (by the ICC and Family Partner)

Joan is interested in all types of music. She does not play an instrument, but loves Lady GaGa and Beyonce’, for the beat and energy. She has an excellent voice, and would like to be a singer.

Joan had a close personal friend in sixth grade, who lived in the apartment complex. She has since moved to another state. Joan liked her because she was quiet, liked similar music, and liked the same junk food (Dunkin Donuts).

Joan got a good grade in an English course in fifth grade. She likes poetry and stories. Joan is a competent writer and enjoys self-expression, but never mentions her personal losses in her writing or art.

Joan has been introduced to the dramatic arts teacher who is the coach for the dramatic arts team that puts on plays and competes in dramatic arts contests.

The dramatic arts teacher is willing to help Joan and does sessions at the elementary school to organize performances with the younger children.

Tammy took care of her former husband through many years of medical problems related to his HIV. By all accounts, he was very difficult to care for. She left him after he began a relationship with another woman.

Many staff at the school feel Joan should be placed in residential treatment because of her “rages” that have resulted in aggression to other children and even staff on two occasions. Most days Joan has no problems and she is motivated to not be placed in residential. If residential can be “on the table” the principal is willing to meet with the wraparound team and will support a plan that he feels keeps people safe if it will help Joan.

Tammy comes from a large extended family who lives in the area. She has a brother who has always gotten along well with Joan and who was Tammy’s protector when she was young. Her brother has a young teen daughter who sometimes hangs out at Tammy’s house when things are quiet.

Tammy knows how to make people laugh. Even Joan says that she is funny. Tammy frequently jumps into the middle of fights between Joan and Sam, but she also instigates family activities. She has read self-help books on parenting, and often gets unsolicited advice from her older sisters. She listens to advice from several of her close women friends, who live in the area, and who agree with everything she says.

Joan and Tammy get along best when both are tired and Sam is not around. This is usually on Saturday nights when Sam is at his VFW meetings. Joan and Tammy share a love of music. They often order pizza and listen to music on Saturday night.

Sam is a Desert Storm vet who has PTSD. He gets support from his VFW buddies, who like Tammy and want them to “make it” because almost all of them have had multiple marriages. Sam says that he truly loves Tammy, but can’t stand the fighting and negative “vibes” from Joan.

Sam says that he does not have many fathering skills, and that he does not understand teens, especially girls. When asked if he ever has fun with Joan, he mentioned that he and her were shopping once and ran into a lively street band, and stayed to listen to it. She had laughed at him and rolled her eyes when he started to move around and dance a bit.

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Sam and Tammy enjoy going dancing together. She likes to cook for family gatherings and special nights at home, and is known as a good cook. Tammy works at a diner, she is a fry cook, and is proud of her fry cook skills. She likes the fast pace of the restaurant.

Sam and Tammy dream of having a place of their own, but have never been able to afford a down payment. Joan has her own room, decorated with female singer posters that she likes.

Right now the apartment meets their needs and they certainly don’t want to be evicted. The landlord has agreed to be a consulting member to the team if the plan focuses on a way to prevent the loud altercations.

Tammy would like Joan to go to college rather than get married young like she did. Joan says that school ----‘s and that she would quit if she could.

Tammy has seen a therapist from mental health, but did not feel like she was able to talk with her. She is most comfortable talking with friends.

The DCF worker is concerned about Joan’s safety and her future. She has been on two previous wraparound teams and is willing to support Joan and the family if they stay committed to their plans.

Joan liked her favorite grandmother (deceased) because she listened to her and did not judge her. Sometimes her grandmother would tell her stories about life that helped Joan figure out things for herself.

Joan is good with her younger cousins who live in the area and will organize games and “dramas” for them to perform at family parties.

When asked what her favorite memories of her father were, Joan mentioned that he would read to her, and that “Good night, Moon” was her favorite book when she was a child. Joan has several photos of her dad in her room.

Joan has not been on meds for depression, but feels strongly that she will not ever take meds because a friend of hers did and became a “zombie.”

Oupatient Training November/December 2011 Page 14

Family Support and Training Performance Specifications Family Support and Training is a service provided to the parent /caregiver of a youth (under the age of 21), in any setting where the youth resides, such as the home (including foster homes and therapeutic foster homes), and other community settings. Family Support and Training is a service that provides a structured, one-to-one, strength-based relationship between a Family Partner and a parent/caregiver. The purpose of this service is for resolving or ameliorating the youth’s emotional and behavioral needs by improving the capacity of the parent /caregiver to parent the youth as to improve the youth’s functioning as identified in the outpatient or In-Home Therapy treatment plan or Individual Care Plan (ICP), for youth enrolled in Intensive Care Coordination (ICC), and to support the youth in the community or to assist the youth in returning to the community. Services may include education, assistance in navigating the child serving systems (DCF, education, mental health, juvenile justice, etc.); fostering empowerment, including linkages to peer/parent support and self-help groups; assistance in identifying formal and community resources (e.g., after-school programs, food assistance, summer camps, etc.) support, coaching, and training for the parent/caregiver. Family Support and Training is delivered by strength-based, culturally and linguistically appropriate qualified paraprofessionals under the supervision of a licensed clinician. Family Support and Training services must achieve a goal(s) established in an existing behavioral health treatment plan/care plan for outpatient or In-Home Therapy, or an Individual Care Plan, for youth enrolled in ICC. Services are designed to improve the parent/caregiver’s capacity to ameliorate or resolve the youth’s emotional or behavioral needs and strengthen their capacity to parent. Delivery of ICC may require care coordinators to team with Family Partners. In ICC, the care coordinator and Family Partner work together with youth with SED and their families while maintaining their discrete functions. The Family Partner works one-on-one and maintains regular frequent contact with the parent(s)/caregiver(s) in order to provide education and support throughout the care planning process, attends CPT meetings, and may assist the parent(s)/ caregiver(s) in articulating the youth’s strengths, needs, and goals for ICC to the care coordinator and CPT. The Family Partner educates parents/ caregivers about how to effectively navigate the child-serving systems for themselves and about the existence of informal/community resources available to them; and facilitates the parent’s/caregiver’s access to these resources. FAMILY SUPPORT AND TRAINING Components of Service 1. PROVIDERS - FAMILY SUPPORT AND TRAINING SERVICES ARE OUTPATIENT HOSPITALS, COMMUNITY HEALTH

CENTERS, MENTAL HEALTH CENTERS, OTHER CLINICS AND PRIVATE AGENCIES CERTIFIED BY THE

COMMONWEALTH. PROVIDERS OF FAMILY SUPPORT AND TRAINING SERVICES UTILIZE FAMILY PARTNERS TO

PROVIDE THESE SERVICES. 2. THE FAMILY SUPPORT AND TRAINING SERVICE MUST BE OPERATED BY A PROVIDER WITH DEMONSTRATED

INFRASTRUCTURE TO SUPPORT AND ENSURE

QUALITY MANAGEMENT /ASSURANCE

UTILIZATION MANAGEMENT

ELECTRONIC DATA COLLECTION / IT

CLINICAL AND PSYCHIATRIC EXPERTISE

CULTURAL AND LINGUISTIC COMPETENCE

Oupatient Training November/December 2011 Page 15

3. THE FAMILY SUPPORT AND TRAINING PROVIDER ENGAGES THE PARENT /CAREGIVER IN ACTIVITIES IN THE

HOME AND COMMUNITY. THESE ACTIVITIES ARE DESIGNED TO ADDRESS ONE OR MORE GOALS ON THE YOUTH’S

TREATMENT PLAN FOR OUTPATIENT OR IN-HOME THERAPY, OR ICP, FOR YOUTH ENROLLED IN ICC AND ARE

DESIGNED TO ASSIST HIM/HER WITH MEETING THE NEEDS OF THE YOUTH AND MEET ONE OR MORE OF THE

FOLLOWING PURPOSES:

EDUCATING

SUPPORTING

COACHING

MODELING

GUIDING and may include:

EDUCATION

TEACHING THE PARENT/CAREGIVER HOW TO NAVIGATE THE CHILD-SERVING SYSTEMS AND PROCESSES

FOSTERING EMPOWERMENT, INCLUDING LINKAGES TO PEER/PARENT SUPPORT AND SELF-HELP GROUPS

TEACHING THE PARENT/CAREGIVER HOW TO IDENTIFY FORMAL AND COMMUNITY-BASED RESOURCES (E.G., AFTER-SCHOOL PROGRAMS, FOOD ASSISTANCE, HOUSING RESOURCES, ETC.).

4. THE FAMILY SUPPORT AND TRAINING PROVIDER DEVELOPS AND MAINTAINS POLICIES AND PROCEDURES

RELATING TO COMPONENTS OF CONSUMER PEER SUPPORT SERVICES. THE PROVIDER WILL ENSURE THAT ALL

NEW AND EXISTING STAFF WILL BE TRAINED ON THESE POLICIES AND PROCEDURES. 5. THE FAMILY SUPPORT AND TRAINING PROVIDER DELIVERS SERVICES IN THE PARENT /CAREGIVER’S HOME AND

COMMUNITY. 6. THE FAMILY PARTNER DELIVERS SERVICES IN ACCORDANCE WITH AN EXISTING OUTPATIENT, OR IN-HOME

THERAPY TREATMENT PLAN THAT IS JOINTLY DEVELOPED BY THE OUTPATIENT, OR IN-HOME THERAPY

PROVIDER WITH THE PARENT/CAREGIVER, AND THE YOUTH WHENEVER POSSIBLE, AND MAY ALSO INCLUDE

OTHER INVOLVED PARTIES SUCH AS SCHOOL PERSONNEL, OTHER TREATMENT PROVIDERS, AND SIGNIFICANT

PEOPLE IN THE YOUTH AND PARENT/ CAREGIVER’S LIFE. FOR YOUTH IN ICC, FAMILY SUPPORT AND TRAINING

SERVICES ARE DELIVERED IN ACCORDANCE WITH THE ICP. Staffing Requirements 1. MINIMUM STAFF QUALIFICATIONS FOR A FAMILY PARTNER INCLUDE:

EXPERIENCE AS A CAREGIVER OF A YOUTH WITH SPECIAL NEEDS, AND PREFERABLY A YOUTH WITH MENTAL

HEALTH NEEDS;

BACHELOR’S DEGREE IN A HUMAN SERVICES FIELD FROM AN ACCREDITED UNIVERSITY AND ONE (1) YEAR OF

EXPERIENCE WORKING WITH THE TARGET POPULATION; OR

ASSOCIATE’S DEGREE IN A HUMAN SERVICE FIELD FROM AN ACCREDITED SCHOOL AND ONE (1) YEAR OF

EXPERIENCE WORKING WITH CHILDREN/ADOLESCENTS/TRANSITION AGE YOUTH; OR HIGH SCHOOL

DIPLOMA OR GED AND A MINIMUM OF TWO (2) YEARS OF EXPERIENCE WORKING WITH

CHILDREN/ADOLESCENTS/TRANSITION AGE YOUTH; AND

EXPERIENCE IN NAVIGATING ANY OF THE CHILD AND FAMILY-SERVING SYSTEMS AND TEACHING FAMILY

MEMBERS WHO ARE INVOLVED WITH THE CHILD AND FAMILY SERVING SYSTEMS. 2. FAMILY PARTNERS POSSESSES A CURRENT/VALID DRIVER’S LICENSE AND AN AUTOMOBILE WITH PROOF OF AUTO

INSURANCE. 3. THE FAMILY SUPPORT AND TRAINING PROVIDER PARTICIPATES IN, AND SUCCESSFULLY COMPLETES, ALL

REQUIRED TRAINING.

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4. THE FAMILY SUPPORT AND TRAINING PROVIDER ENSURES THAT FAMILY PARTNERS COMPLETE THE STATE

REQUIRED TRAINING PROGRAM FOR ICC AND HAVE SUCCESSFULLY COMPLETED SKILL AND COMPETENCY-BASED

TRAINING TO PROVIDE ICC SERVICES. 5. THE FAMILY SUPPORT AND TRAINING PROVIDER ENSURES THAT ALL SENIOR FAMILY PARTNERS AND

SUPERVISORY STAFF COMPLETE THE STATE REQUIRED TRAINING PROGRAM FOR ICC AND HAVE SUCCESSFULLY

COMPLETED SKILL- AND COMPETENCY-BASED TRAINING TO SUPERVISE FAMILY PARTNERS. 6. THE FAMILY SUPPORT AND TRAINING PROVIDER ENSURES THAT ALL FAMILY PARTNERS, SUPERVISORY STAFF

AND PROGRAM MANAGERS, UPON EMPLOYMENT AND ANNUALLY THEREAFTER, BEFORE ASSUMING THEIR

DUTIES, COMPLETE A TRAINING COURSE THAT MINIMALLY INCLUDES THE FOLLOWING:

OVERVIEW OF THE CLINICAL AND PSYCHOSOCIAL NEEDS OF THE TARGET POPULATION

SYSTEMS OF CARE PRINCIPLES AND PHILOSOPHY

THE FOUR PHASES OF WRAPAROUND AND THE 10 PRINCIPLES OF WRAPAROUND

ROLE WITHIN A CPT

ETHNIC, CULTURAL, AND LINGUISTIC CONSIDERATIONS OF THE COMMUNITY

COMMUNITY RESOURCES AND SERVICES

FAMILY-CENTERED PRACTICE

BEHAVIOR MANAGEMENT COACHING

SOCIAL SKILLS TRAINING

PSYCHOTROPIC MEDICATIONS AND POSSIBLE SIDE EFFECTS

RISK MANAGEMENT/SAFETY PLANNING

CRISIS MANAGEMENT

INTRODUCTION TO CHILD-SERVING SYSTEMS AND PROCESSES (DCF, DYS, DMH, DESE, ETC.)

BASIC IEP AND SPECIAL EDUCATION INFORMATION

CHINS/JUVENILE COURT ISSUES

MANAGED CARE ENTITIES’ PERFORMANCE SPECIFICATIONS AND MEDICAL NECESSITY CRITERIA

CHILD/ADOLESCENT DEVELOPMENT INCLUDING SEXUALITY

CONFLICT RESOLUTION

DOCUMENTATION OF THE PROVIDER’S TRAINING CURRICULUM IS MADE AVAILABLE UPON REQUEST. 7. THE PROVIDER ENSURES THAT FAMILY PARTNERS RECEIVE SUPERVISION ON A WEEKLY BASIS FROM A SENIOR

FAMILY PARTNER AND A LICENSED CLINICIAN WHO HAS SPECIALIZED TRAINING IN PARENT SUPPORT, BEHAVIORAL HEALTH NEEDS OF YOUTH, FAMILY-CENTERED TREATMENT, AND STRENGTHS-BASED

INTERVENTIONS, AND WHO IS CULTURALLY AND LINGUISTICALLY COMPETENT IN WORKING WITH YOUTH AND

FAMILIES WITH BEHAVIORAL HEALTH NEEDS. 8. THE PROVIDER ENSURES THAT A CLINICIAN LICENSED AT THE INDEPENDENT PRACTICE LEVEL IS AVAILABLE

DURING NORMAL BUSINESS HOURS FOR CONSULTATION, AS WELL AS DURING ALL HOURS IN WHICH ANY

FAMILY PARTNERS PROVIDE SERVICES TO PARENT/ CAREGIVER(S), INCLUDING EVENINGS AND WEEKENDS. Service, Community, and Collateral Linkages 1. THE PROVIDER OFFERING FAMILY SUPPORT AND TRAINING SERVICES WILL ASSIST THE PARENT /CAREGIVER(S)

WITH LEARNING HOW TO NETWORK AND LINK TO COMMUNITY RESOURCES AND SERVICES THAT WILL SUPPORT

THEM IN CARING FOR THE YOUTH. FAMILY PARTNERS TEACH THE PARENT/CAREGIVER HOW TO PROMOTE

LINKAGES WITH OTHER TREATMENT PROVIDERS, AND THE ICC CARE COORDINATOR FOR YOUTH IN ICC, AND

ASSIST THE PARENT/ CAREGIVER IN ADVOCATING FOR AND ACCESSING RESOURCES AND SERVICES TO MEET THE

YOUTH’S AND PARENT/CAREGIVERS’ NEEDS. THIS MAY INCLUDE, BUT IS NOT LIMITED TO, ACCESS TO SUPPORT

Oupatient Training November/December 2011 Page 17

GROUPS, FAITH GROUPS, AND COMMUNITY SUPPORTS THAT WILL ASSIST THE PARENT TO ADDRESS THE

YOUTH’S EMOTIONAL AND BEHAVIORAL NEEDS. 2. FOR YOUTH IN ICC, THE FAMILY PARTNER PARTICIPATES AS A MEMBER OF THE CPT AND CLEARLY OUTLINES

THE GOALS OF CAREGIVER PEER TO PEER SERVICES IN THE ICP. 3. FOR YOUTH WHO ARE NOT ENGAGED IN ICC, THE FAMILY SUPPORT AND TRAINING PROVIDER WORKS CLOSELY

WITH THE FAMILY AND ANY EXISTING/REFERRING BEHAVIORAL HEALTH PROVIDER(S), TO IMPLEMENT THE

OBJECTIVES AND GOALS IDENTIFIED IN THE REFERRING PROVIDER’S TREATMENT PLAN. 4. THE FAMILY PARTNER WILL PARTICIPATE IN ALL CARE PLANNING MEETINGS AND PROCESSES FOR THE YOUTH.

WHEN STATE AGENCIES (DMH, DCF, DYS, DPH, DESE/LEA, DMR, MRC, ORI, PROBATION OFFICE, THE

COURTS, ETC.) ARE INVOLVED AND CONSENT IS GIVEN BY THE PARENT/GUARDIAN/CAREGIVER, THE FAMILY

PARTNER PARTICIPATES AND INTERACTS, AS APPROPRIATE, WITH THESE AGENCIES TO SUPPORT SERVICE/CARE

PLANNING AND COORDINATION, ON BEHALF OF, AND WITH, THE YOUTH AND PARENT/CAREGIVER(S). Quality Management (QM) The identified Family Support and Training provider participates in quality management activities as required. Process Specifications Treatment Planning and Documentation 1. WHEN FAMILY SUPPORT AND TRAINING IS IDENTIFIED AS A NEED IN THE TREATMENT PLAN FOR OUTPATIENT

OR IN-HOME THERAPY, OR AN ICP, FOR THOSE ENROLLED IN ICC, THE REFERRING PROVIDER IS RESPONSIBLE

FOR COMMUNICATING THE REASONS FOR REFERRAL AND THE INITIAL GOALS TO THE FAMILY SUPPORT AND

TRAINING PROVIDER. 2. FOR YOUTH ENGAGED IN ICC, THE FAMILY PARTNER MUST COORDINATE WITH AND ATTEND ALL CPT

MEETINGS THAT OCCUR WHILE THEY ARE PROVIDING FAMILY SUPPORT AND TRAINING. AT THESE MEETINGS, THE FAMILY PARTNER GIVES INPUT TO THE CPT IN ORDER TO CLEARLY OUTLINE THE GOALS OF SERVICE IN THE

ICP AND PROVIDE UPDATES ON THE YOUTH’S PROGRESS. THE FAMILY PARTNER DEVELOPS AND IDENTIFIES TO

THE CPT AN ANTICIPATED SCHEDULE FOR MEETING WITH THE PARENT/CAREGIVER AND A TIMELINE FOR GOAL

COMPLETION. THE FAMILY PARTNER DETERMINES THE APPROPRIATE NUMBER OF HOURS PER WEEK/MONTH

FOR FAMILY SUPPORT AND TRAINING SERVICES BASED ON THE NEEDS OF THE YOUTH AND THE

PARENT/CAREGIVER AS IDENTIFIED IN THE ICP. 3. FOR YOUTH WHO ARE NOT ENGAGED IN ICC, THE FAMILY PARTNER MUST COORDINATE WITH THE REFERRING

PROVIDER AND ATTEND ALL TREATMENT TEAM MEETINGS IN ORDER TO CLEARLY OUTLINE THE OBJECTIVES AND

GOALS OF THE SERVICE AS IDENTIFIED IN THE REFERRING PROVIDER’S TREATMENT PLAN AND TO PROVIDE

UPDATES ON THE YOUTH’S PROGRESS. THE FAMILY PARTNER DEVELOPS AND IDENTIFIES TO THE

REFERRING/EXISTING BEHAVIORAL HEALTH PROVIDER AN ANTICIPATED SCHEDULE FOR MEETING WITH THE

PARENT/CAREGIVER AND A TIMELINE FOR GOAL COMPLETION. THE FAMILY PARTNER DETERMINES THE

APPROPRIATE NUMBER OF HOURS PER WEEK/MONTH FOR FAMILY SUPPORT AND TRAINING SERVICES BASED

ON THE NEEDS OF THE YOUTH AND THE PARENT/CAREGIVER AS IDENTIFIED IN THE TREATMENT PLAN. 4. THE FAMILY SUPPORT AND TRAINING PROVIDER CONTACTS THE PARENT/CAREGIVER TO INITIATE SERVICES

WITHIN THREE (3) BUSINESS DAYS OF RECEIPT OF THE REFERRAL. 5. THE FAMILY SUPPORT AND TRAINING PROVIDER MATCHES THE PARENT /CAREGIVER’S ETHNICITY, CULTURE,

LANGUAGE, NEEDS, AND STRENGTHS AS CLOSELY AS POSSIBLE WITH AVAILABLE FAMILY PARTNERS. 6. THE FAMILY PARTNER HAS AT MINIMUM WEEKLY CONTACT (TELEPHONIC OR FACE TO FACE) WITH THE

PARENT/CAREGIVER OF EACH ENROLLED YOUTH THEY SUPPORT.

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7. THE FAMILY PARTNER HAS AT LEAST ONE CONTACT PER WEEK, AND MORE IF NEEDED, WITH THE YOUTH’S ICC, IN-HOME THERAPY SERVICES, OR OUTPATIENT PROVIDER TO PROVIDE UPDATES ON PROGRESS TOWARD GOALS

IDENTIFIED IN THE TREATMENT PLAN OR ICP. 8. THE FAMILY SUPPORT AND TRAINING PROVIDER ENSURES THAT ALL SERVICES ARE PROVIDED IN A

PROFESSIONAL MANNER, ENSURING PRIVACY, SAFETY, AND RESPECT FOR THE PARENT/ CAREGIVER’S DIGNITY

AND RIGHT TO CHOICE. 9. FAMILY PARTNERS DOCUMENT EACH CONTACT IN A PROGRESS REPORT IN THE FAMILY SUPPORT AND

TRAINING PROVIDER’S RECORD FOR THE YOUTH. 10. FAMILY PARTNERS FOLLOW THE CRISIS MANAGEMENT PROTOCOLS OF THE PROVIDER AGENCY DURING AND

AFTER BUSINESS HOURS. Discharge Planning and Documentation 1. WHEN THE PARENT/ CAREGIVER DECIDES THAT HE/SHE NO LONGER WANTS OR REQUIRES SERVICES, OR THE

REFERRING/CURRENT TREATER(S) ALONG WITH THE PARENT-GUARDIAN-CAREGIVER DETERMINE THAT THERE IS

NO LONGER A NEED FOR FAMILY SUPPORT AND TRAINING, OR THE GOALS OF THE TREATMENT PLAN/ ICP ARE

MET, A DISCHARGE PLANNING MEETING IS INITIATED TO PLAN THE DISCHARGE FROM THE FAMILY SUPPORT

AND TRAINING SERVICE. 2. THE DISCHARGE PLAN IS AGREED UPON AND SIGNED BY THE PARENT/GUARDIAN/CAREGIVER, AND IS SHARED,

WITH CONSENT, WITH CURRENT TREATER(S), OR WITH THE CPT FOR YOUTH IN ICC. 3. THE REASONS FOR DISCHARGE AND ALL FOLLOW-UP PLANS ARE CLEARLY DOCUMENTED IN THE STAFF’S RECORD

FOR THE YOUTH. 4. IF THE PARENT/ CAREGIVER TERMINATES WITHOUT NOTICE, THE PROVIDER MAKES EVERY EFFORT TO CONTACT

HIM/HER TO OBTAIN THEIR PARTICIPATION IN THE SERVICES AND TO PROVIDE ASSISTANCE FOR APPROPRIATE

FOLLOW-UP PLANS (I.E., SCHEDULE ANOTHER APPOINTMENT, FACILITATE AN APPROPRIATE SERVICE

TERMINATION, OR PROVIDE APPROPRIATE REFERRALS). SUCH ACTIVITY IS DOCUMENTED IN THE PROVIDER’S

RECORD FOR THE YOUTH. 5. THE FAMILY PARTNER WRITES A DISCHARGE PLAN THAT INCLUDES DOCUMENTATION OF ONGOING STRATEGIES,

SUPPORTS, AND SERVICES IN PLACE FOR THE YOUTH AND PARENT/CAREGIVER(S), AND RESOURCES TO ASSIST

THE YOUTH AND PARENT/CAREGIVER(S) IN SUSTAINING GAINS. THE PLAN IS GIVEN TO THE PARENT-GUARDIAN-CAREGIVER AND THE CURRENT/REFERRING PROVIDER(S) WITHIN FIVE (5) BUSINESS DAYS OF THE LAST DATE OF

SERVICE.

Oupatient Training November/December 2011 Page 19

FAMILY PARTNER ROLES AND ACTION STEPS

The Family Partner role needs to be much more flexible to support the family to successfully navigate and complete the behavioral health services. The Family Partner has three primary roles which are defined in terms of seven functions which in turn are defined in terms of 97 action steps. FUNCTIONS OF THE FAMILY PARTNER

The FP is a role model for parents for effective personal interactions and behavior.

The FP supports families to identify their own future vision of what their family can be, the most important needs to achieve this future and use their strengths and culture to get these needs met.

The FP shares their own experiences to build relationships with and help families be successful with wraparound.

The FP mentors families to improve their confidence and ability to advocate for and effectively manage the services and supports for their own family.

The FP supports development, reconnection and strengthening of natural supports for families.

The FP partners with the therapeutic staff to provide a high quality process based on CBHI principles

The FP supports development of Family to Family Supports. FP ACTION STEPS FOR ROLES

MODELS EFFECTIVE INTERACTIONS 1. The FP actively listens to the family and develops an engagement link prior to moving

forward with wraparound activities. 2. The FP encourages and models commitment to the family and encourages the family to

believe in their future and to stick with the process. 3. The FP honors the culture of the family by keeping their own views in check. 4. The FP aligns themselves with the family to support the family's choices. 5. The FP engages in strategic and mutually respectful partnerships with the Care coordinator

and other team members. 6. The FP role models strengths-based interactions by not blaming or shaming others in the

presence of the family or other team members. 7. The FP helps the family understand and build on the strengths of their team members. 8. The FP models protection of confidentiality by never talking about wraparound families

outside of the appropriate work setting, without the families’ permission and input. 9. The FP checks in with the family during and at the end of interactions and activities to

determine family satisfaction with the process. ADVOCATES FOR AND SUPPORTS FAMILY’S NEEDS

10. The FP helps the family understand that support can take on many different forms and that the family will determine what the support will look like for them.

11. The FP actively listens to the family and takes notes about support needs, clarifying points with the family and Care coordinator.

Oupatient Training November/December 2011 Page 20

12. The FP shares experiences with families to help them understand how wraparound can help families meet positively framed needs.

13. The FP educates and supports family members on the importance of using their own voice to express their needs and preferences (e.g., “do for, do with, and cheer on”).

14. The FP and family have a running commentary on their current status of doing for themselves and continually plan for the next steps to move in that direction

15. The FP provides direct support for the family while providing the least amount of support that will be successful with planned fading of support (do for, do with and then cheer on).

16. The FP recognizes and values the differences among families, helping families discover their unique culture and using this information to determine how they can best advocate for their family.

17. The FP helps family members understand and explain their culture and strengths to get their plan to match their family culture.

18. The FP understands family needs, culture, strengths and preferences and supports families to advocate for them.

19. The FP helps the family understand the mandates and perspective of other team members, while keeping family perspective at the forefront of team discussions.

SHARING YOUR EXPERIENCE 20. The FP recognizes the need to share experiences and identifies the purpose and intent of

sharing. 21. The FP briefly shares a part of their story (or another family’s story without their names or

identifying information not straying from) the purpose and intent of the family’s need. 22. The FP actively listens to the family as the FP shares their experience to ensure that the

family wants to hear their story and that it is addressing the area of purpose and intent. 23. The FP shares their own experiences to develop a shared sense of understanding and

relationship with families. 24. The FP may share their own experience with wraparound to give the family an

understanding of how the process can be an opportunity for them. 25. The FP may share their own experience with the different activities of the wraparound

process to give the family an understanding of how the process can affect them. 26. The FP may prepare the family for the strengths, needs, and culture discovery

conversations through sharing personal and other family experiences. 27. The FP may give personal examples to help understand the importance of having a team

that includes providers, custodial agencies and natural supports. 28. The FP may share their own experience of how being honest and open helped them to get

better support.

MENTORS FAMILIES TO IMPROVE SELF-EFFICACY (CONFIDENCE THEY CAN BE SUCCESSFUL) 29. The FP helps the family identify their current strengths around areas of self-efficacy (e.g.,

advocating for themselves, getting needed services and supports, managing crisis situations, accessing needed resources and signs of confidence that they can make things work for their family.

30. The FP helps the family identify areas of need around self-efficacy and set some priorities about things they would like to be better at through doing the wraparound process.

31. The FP helps the family set manageable goals and short term objectives for improving their self-efficacy.

Oupatient Training November/December 2011 Page 21

32. The FP works with the family through a “do for, do with, and cheer on” strategy to build the family’s self-efficacy and transfer control of the process to the family

33. The FP observes and interacts with the family to help the family understand and celebrate their strengths and accomplishments.

34. The FP support the family to continually celebrate their successes 35. The FP knows available resources within a community and helps the families in choosing

and accessing those that address their needs and match their culture and strengths. 36. The FP educates and supports the family in the importance of maintaining and using

documentation to advocate and control the process of service and support. 37. The FP helps families to understand how to store and use documentation to support

services for their children. 38. The FP helps and encourages families to find and develop effective self-advocacy skills.

SUPPORTS DEVELOPMENT, RECONNECTION AND STRENGTHENING OF NATURAL SUPPORTS FOR FAMILIES 39. The FP may share personal experiences and reasons why natural supports can be

important for families. 40. The FP actively listens to the family about concerns of having natural supports involved

with the process and helps them understand the checks and balances within wraparound that can address many of these concerns.

41. The FP helps families identify reciprocal relationships (what each person gets from the relationship) that define and sustain natural supports.

42. The FP helps families focus on the strengths of natural supports and the opportunities natural supports provide for the family.

43. The FP brainstorms ways the family can be a stronger support for their supports. 44. When families do not easily identify natural supports, an FP may be enlisted to do more in

depth work with the family to identify potential supports. 45. The FP may work with the family to plan for contacting potential natural support team

members and orienting them to the process. 46. The FP may meet with natural supports to get them ready for initial or follow-up

wraparound meetings. 47. The FP helps families to plan and reconnect with extended family and natural supports

based on family voice and choice. 48. The FP helps families and natural supports work through barriers to partnership. 49. The FP may help the family identify the need for and strategies to develop new natural

supports. Supports Implementation of the Phases and Activities of Wraparound. (The FP partners with the Care coordinator to complete the activities of the wraparound process).

WRAPAROUND PHASE ONE: ENGAGEMENT A. INITIAL ENGAGEMENT

50. The FP may assist the Care coordinator by doing one on one orientation, sharing their own experience with wraparound, and helping the family to understand how wraparound might be a positive opportunity for them.

51. The FP is open and welcoming and engaging the family in conversation identifying the family’s concerns before explaining wraparound in detail.

52. The FP asks the family about their hopes and dreams and helps them to believe that they can accomplish their visions.

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53. The FP helps the family understand what is different about wraparound by explaining wraparound from a family’s perspective.

54. The FP may provide written materials and other resources to help families understand wraparound, review these materials with the family and answer questions.

55. The FP explains their role including what they may do and limits on the role. 56. The FP may assist the Care coordinator in explaining confidentiality and client rights and

responsibilities, and as needed, help ease these fears and answer questions from a family perspective.

57. If a family member is very distrustful of systems and does not want to sign consent and release forms, the FP may need to do some one on one time with the family member to help them understand why sharing could benefit their family.

58. The FP may assist in the development of crisis stabilization plans to make sure the plans are individualized, based on voice and choice and are realistic for the family.

B. STRENGTHS NEEDS AND CULTURE DISCOVERY 59. The FP may help the family prepare for the SNCD by helping the family understand why

sharing their strengths, needs, culture and vision from a family perspective can lead to a better wraparound experience.

60. The FP may help the family prepare for the SNCD by understanding why wraparound works better when focused on positive needs and reframing negative concerns into positive needs.

61. The FP may help the family gather and organize information that they will need to advocate for their child.

62. The FP may help the Care coordinator gather the information for the strengths, needs and culture discovery and ensure that this information truly reflects the opinions and priorities of the family.

63. The FP may take the completed summary document to the family and sit with them and go over it to make sure it is correct and add to the document as needed.

64. The FP may help different members of the family come up with consensus needs, vision and options that can be win/win for all family members

C. PREPARING THE FAMILY FOR TEAM MEETINGS 65. The FP may be able to help the family find natural supports within the community to help

with the planning process. 66. The FP may spend additional time with the family to prepare them for the initial

wraparound meetings making sure they understand each of the parts of the agenda and are prepared to use their voice and choice.

67. The FP may help the family to define strengths and culture that relate to priority needs and do some brainstorming of possible options related to these needs based on the strengths and culture prior to the meeting to better prepare the family for the meeting.

68. If the family wants the FP at planning meetings the FP works with the family to decide the role the FP will play in advance of the meeting.

69. The FP works with the Care coordinator to make sure family needs are met in the scheduling, location and agenda for the wraparound planning meetings.

70. The FP may work with families to contact team members who will need support to get to and participate in the meeting.

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71. The FP models the process of listening to the concerns of the potential team member, explaining wraparound in terms of these concerns and the family vision, and identifying any needs of constraints the person has to participate on the team.

WRAPAROUND PHASE TWO: PLANNING 72. The FP helps other team members to understand the importance of and feel comfortable

with family voice and choice. 73. The FP helps the family understand the needs of other team members and works to find

ways for the family to work with these team members. 74. The FP encourages thinking beyond the usual services and supports. 75. The FP is determined to ensure family voice and choice during needs selection. Ideally, the

FP comes to the meeting with an understanding of family wishes in this area (and on goals and objectives).

76. The FP agrees to take on Action Steps that are compatible with their role and that they have the time and resources to complete them.

77. The FP is careful to ensure that the family understands the reason for the crisis plan and why it is being done.

78. The FP explains the functional assessment process and shares how this process has helped other families and the importance of in-depth accurate information.

79. The FP checks in with the family to ensure they feel they were heard and that the developed plan is individualized to who they are and is realistic.

WRAPAROUND PHASE THREE: IMPLEMENTATION 80. The FP reviews the written plan with the family to make sure they understand it, agree

with it and have any resources or supports needed to implement it. 81. The FP encourages the family in completing Action Steps, through motivation, support and

reminders. 82. The FP works with the family to determine if the plan is working and to decide when they

need to ask for changes in the plan. 83. The FP checks with the family on emerging needs and if the needs should be brought to the

team and if new strategies are needed. 84. The FP may help the family to update their various documents and information used to

advocate for their child and family, helps the family to identify the strengths of their natural support systems and communities and helps them identify ongoing needs to be more connected as needed.

85. The FP constantly checks with the family on their feeling of support from the team, and if they are beginning to feel a lack of support, too much support, or if the family is not content with the team for any reason.

86. The FP can be used to spend additional time with the family to prepare them for follow-up wraparound meetings.

87. The FP works creatively with the family and their team to make sure that progress does not stop when barriers and challenges occur.

88. The FP models positive collaboration with all team members to build team cohesion (togetherness).

89. The FP documents their work with the family through progress notes that meet the criteria set by the participating agencies.

Oupatient Training November/December 2011 Page 24

WRAPAROUND PHASE FOUR: TRANSITION 90. The FP supports the family to identify the needs that will continue to need attention after

formal wraparound ends. 91. The FP helps the family identify the successes they have had and the lessons they have

learned through the wraparound process. 92. The FP checks in with the family to ensure that the modification to the wraparound process

is understood and is culturally competent to the family. 93. The FP checks with the family to see how and if they would like to celebrate success in a

culturally competent manner. 94. Ideally the FP should be committed to remaining with the family as long (and no longer)

than the family needs/desires. The FP supports the family through self-advocacy. Phasing out the FP should be a gradual process as families expand their role.

SUPPORTS DEVELOPMENT OF FAMILY TO FAMILY SUPPORTS 95. The FP may link the family with other graduates of the process who can be team members

and natural supports. 96. The FP gives families opportunities to become part of the larger circle of families where

they can find support from other parents and caregivers with similar experiences. 97. FPs connect families to local family groups and organizations.

Oupatient Training November/December 2011 Page 25

Go to the CBHI webpage where providers can order brochures and the "Companion Guide for professionals" at www.mass.gov/masshealth/cbhi, go to CBHI Brochure & Companion Guide.

CBHI Brochure & Companion Guide CBHI Brochure - for parents/caregivers

The CBHI brochure, "Worried about the way your child is acting or feeling?," provides

family-friendly descriptions of the new and enhanced behavioral-health services available to

certain MassHealth-enrolled children and youth under age 21. The publication also includes

regional contact information for Mobile Crisis Intervention, In-Home Therapy and Intensive

Care Coordination providers. To order, please complete the form below.

Brochures:

Metro Boston (PDF)

Northeast (PDF)

Southeast (PDF)

Central (PDF)

Western MA (PDF)

Black and white versions of the CBHI brochure with the contact information for all regions are

available for download in Spanish, Portuguese and English:

English CBHI Brochure-all regions (PDF)

Spanish CBHI Brochure-all regions (PDF)

Portuguese CBHI Brochure-all regions (PDF)

CBHI Guide - for staff

The CBHI Guide, "Helping Families Access MassHealth Home and Community-Based

Behavioral Health Services for Children and Youth under Age 21," is a companion

publication for staff who can help families find the right behavioral-health service for their child.

The Guide provides detailed information on MassHealth coverage of new and enhanced

behavioral health services, eligibility guidelines, statewide provider listings, and other

information helpful to staff and families. This guide is available only as a PDF or TEXT

download.

* Please note: Providers lists are subject to change. For more information, please contact your

plan or consult the CBHI Contact Information Web page for customer service lines.

To order the CBHI Brochure for "Worried about the way your child is acting or feeling?"

for parents/caregivers, please complete the form below.

Oupatient Training November/December 2011 Page 26

Contact Name*

Organization*

Title

Address*

Ste./Fl.

City*

State* MA

Zip*

Phone* ( 201-555-5555)

Ext.

Email* ( smith@chbi.com)

Region*

Metro Boston

Northeast

Southeast

Central

Western

Select

Language(s)* Quantity

English

Spanish

Portuguese

Submit Order

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