201 training manual | wraparound

1201 Training Manual | WRAPAROUND

2 WRAPAROUND | 201 Training Manual


Wraparound101

Participants will gain knowledge, understanding, and skills to:

1. Build on their understanding of Wraparound gained from the Wrap 101 eLearning course.

2. Identify how Wraparound can support children, youth, young adults and their families.

3. Identify the principles, phases and activities of Wrap-around.

4. Practice applying Wraparound values and principles. 5. Practice skills—engagement, crisis prevention and man-

agement, meeting facilitation, planning, implementation, transitioning, etc.

6. Help families develop and implement long-range visions.7. Identify and involve natural supports in Child and Family

Teams.

8. Practice engaging team members, natural supports, and agency partners.

9. Facilitate productive team meetings, including consensus building, team commitment, team trust and the development of team mission statements.

10. Practice developing Wraparound documentation—Wrap-around Plan or Integrated Care Plan, Crisis Plan, Functional Assessment, Safety Plan, Strengths, Needs, and Cultural Discovery, Transition Plan, etc.

11. Write measurable objectives for families to plan, monitor, and benchmark their progress through Wraparound.

12. Prepare families for cessation of Wraparound services and their ongoing use of Wraparound tools.

Learning Objectives


Wrap 201 Practicum: Nevaeh’s Story

The following case scenario represents one Oklahoma family’s experience with Wraparound. You’ll use this story to develop Wraparound documents that you must bring with you to the Wrap 201 training.

evaeh and Her Family: A Wraparound Story

Nevaeh and her fraternal twin sister, Stella, are 11-year-old girls being raised by G-Ma Dee, their paternal grandmother. The girls’ mother is in prison for

manufacturing and distributing methamphetamine. Nevaeh and Stella were born prematurely with drugs in their systems. After 2 months in the Neonatal Intensive Care Unit, DHS child welfare placed the girls with G-Ma Dee. They have lived with G-Ma Dee ever since. G-Ma Dee has legal custody.

The girls’ father has infrequent contact with them. He is not comfortable in the role of parent and says he just does not know how to be a dad. Currently, he is working on an oil rig in the Gulf of Mexico and sends money regularly to help support the girls. He stays at G-Ma Dee’s home when he is between jobs or on furlough but leaves the parenting to his mother. To Nevaeh and Stella, he seems more like an uncle than a father.

Although Stella is not having behavioral issues, Nevaeh has been acting out. Nevaeh’s school referred her to Wraparound after she was suspended for biting her teacher for the third time this semester. The teacher has difficulty keeping Nevaeh in the classroom, in her seat or focused on the task at hand. Nevaeh has also been asked not to return to her hip hop dance class after several incidents where she has taken things from other children in the class and has been caught tripping and kicking them as well.

Neaeh’s primary care physician prescribed Ritalin just after she started kindergarten. G-Ma Dee says, “I don’t think it helps. I can’t tell the difference when she takes them, and when she doesn’t.” Nevaeh is generally in good health but did have several surgeries to repair a cleft palate as an infant. She will likely need additional surgeries once she has stopped growing. A DHS child welfare investigator visited the home after the school reported concerns about some bruising the school counselor noticed on Nevaeh’s arms. It turned out that one her dance classmates had punched her in the arm in order to get back a hairbrush Nevaeh took. The child welfare worker referred the family to Wraparound after hearing how frustrated G-Ma Dee was with Nevaeh’s behavior. G-Ma Dee is having difficulty finding someone to watch the girls during her dialysis three times a week. G-Ma Dee hopes to be able to get Nevaeh back into school. G-Ma Dee says, “I am too old to be running down to the school every day to pick her up and take her home. She thinks getting sent home is a prize.” G-Ma Dee fears her age and health issues will negatively impact her abililty to care for the girls.

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PREPARATION!You’ll begin your practicum by developing the following Wraparound documentation and bringing it with you to Wrap 201. The story and forms are located in Appendix A on page 76. Please bring the completed forms with you to the training.

1. Strength, Needs, Cultural Discovery (SNCD)2. Functional Assessment3. Crisis / Safety Plan4. Wraparound Plan5. Transition Plan


What’s the Difference Between Systems of Care and Wraparound?

Systems of Care Wraparound• Organizational framework for providing supports for chil-

dren, youth, and young adults with a serious emotional disturbance

• Families are also provided supports • Collaboration across agencies, families, children, youth,

and young adults • Improves access to and expands the array of coordinated

supports for these families

• Team-based planning and implementation process• Aims to help children, youth, young adults, and their fam-

ilies develop problem-solving skills, coping skills, health and wellness, and self-efficacy

• Emphasis on integrating the youth into the community and building the family’s social support network

• Families are also provided supports

What’s the Difference Between Wraparound and Service Coordination?

Wraparound Service Coordination• Intensive Care Coordination• Multiple Systems• High risk of out of home placement • Complex Behavioral Health Needs • Child and Family Teams are required• Often compounded by Social Determinants of Health

• Economic Stability• Education• Social and Community Context• Health and Healthcare• Neighborhood and Built Environment

• May be compounded by Developmental Delays• A Care Coordinator integrates the work of system partners

and other natural helpers so there is one coordinated plan.

• Family has access to a Family Support Provider as an additional resource. As a peer with lived experience in raising a child with similar challenges, a Family Support Provider helps families navigate the Wraparound process.

• Intermediate Care Coordination• Behavioral Health Needs• System Involvement• Child and Family Teams are highly encouraged• May be compounded by Social Determinants of Health

• Economic Stability• Education• Social and Community Context• Health and Healthcare• Neighborhood and Built Environment

• A Care Coordinator coordinates the work of providers & informal supports to ensure coordination & accountability of all services and supports

• Time-limited with support for decreased involvement with systems while working to build connections and supports for the family through community-based resources

• Created to operationalize values within a SOC framework around a care coordination model for youth with lesser complex needs, but who still are system involved, at risk of deeper system involvement, and who’s challenges exceed the resources of a single organization

he Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) provides state wide training and continuing professional development to Wraparound facilitators, children’s behavioural health care providers, and child-serving agency staff.

ODMHSAS provides these resources as a strategy to ensure that providers continue to strengthen their practice throughout their career. The complexity of implementing Wraparound with high fi-delity is so great that almost half of Wraparound Care Coordina-tors leaving Wraparound had been in their jobs less than a year (Walker, 2017). Even experienced Wraparound facilitators con-front great challenges with state policies, agency requirements, billing and productivity issues, advances in technology, and

serving families, children, youth, and young adults with serious emotional disturbances and complex needs. Child, youth, young adult, and family outcomes are improved when Wraparound is implemented with high fidelity.

ODMHSAS has developed Wraparound 101 and 201 to guide Oklahoma Systems of Care (OKSOC) providers in the implemen-tation of high fidelity Wraparound.

• Wraparound 101 eLearning Course• Prerequisite to Wrapaund 201• Online, self-paced, and web-based• Continuing Education Units (CEUs) through ODMH-

SAS

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Wraparound is family driven. Family members are integral parts of the team and must have owner-ship of the Wraparound Plan. No planning sessions occur without the participation of the family.

Wraparound is youth guided. Youth are engaged as equal partners in creating systems change in policies and procedures at the individual, family, community, state, and national levels.

Wraparound is team based. The Wraparound Plan is developed by a Child and Family Team, which consists of the family, natural supports, and formal supports who care about and best know the child, youth, or young adult and their family. The Team is selected by the family, and typically no more than half of the team is made up of professionals.

Wraparound is community based. Residential treatment or inpatient hospitalization are used as stabilization resources and not as placements that operate outside the Wraparound Plan.

Wraparound is collaborative. All parties involved work as a team with the family to design and implement one Wraparound Plan. Planning, services, and supports cut across traditional agency boundaries through multiagency involvement and funding.

Wraparound is strengths based. The Wraparound Plan is based on the unique strengths, needs, values, norms, preferences, culture, and vision of the child, family, and community.

Wraparound is individualized. Each child, youth, or young adult has an individualized, integrated, compre-hensive Wraparound Plan. Their family needs are also included in the individualized Wraparound Plan. The Wraparound Plan may include services such as therapy or day treatment, but the Team always evaluates and understands why the service is a good match for the family's unique needs.

Wraparound is unconditional. The Wraparound providers will never give up on, blame, or reject a child, youth, young adult, or their family. When faced with challenges, the team will continue to work toward meeting the family's goals and needs.

Wraparound is reinforced by the family's natural supports. Wraparound is designed to enhance the natural supports available to the family through their network of personal, family, and community relationships. Natural supports can include extended family members, friends, neighbors, and other community members.

Wraparound is outcome-based and cost responsible. Governments at both regional and local levels work together with providers to improve services. Both Systems of Care issues and issues of individu-al Wraparound Plan are considered. Outcome measures are identified, and individual plans are frequently evaluated.

Wraparound is culturally and linguistically competent. Services and supports must be tailored to the unique culture of the child, youth, or young adult and their family. Family culture refers to family race and ethnicity, as well as, for example, family habits, preferences, beliefs, languages, rituals, and dress. Wraparound providers discover the unique cultural aspects of the family and ensure that those aspects are embedded in the Wraparound Plan.

Principles of Wraparound


• Wraparound 201 In-Person Experiential Training• In-person training with ODMHSAS State Wrapa-

round Coaches• Hands-on exercises, role-playing, situational coach-

ing, real-time feedback, and real-world assignments• Continuing Education Units (CEUs) through ODMH-

SAS

Wraparound

Wraparound is a process utilized to improve the lives of children with complex needs and their families by developing individ-ualized plans of care-, known as Wraparound Plans. The key element of the process is a Wraparound plan developed by a family-centered team, individualized based on the strengths and culture of the child and her/his family, and driven by needs rather than services. In addition to addressing the needs of the identified youth, the needs of caregivers and siblings are also addressed in the design of comprehensive Wraparound plans. Through the team-based planning and implementation process, Wraparound also aims to develop the problem-solving skills, coping skills, health and wellness, and self-efficacy of the young person and family members. Finally, there is an emphasis on integrating the youth into the community and building the fam-ily’s social support network. Wraparound is how we implement the System of Care at the child and family level. Essentially, it is the service delivery component offered through a local System of Care.

Purpose of Wraparound

Wraparound works to help the family discover the basic unmet needs that are the driving forces behind their current situation. Wraparound facilitators then work with families in designing a unique set of actions, services, and supports that draw on the family’s strengths to address those needs and help the family experience concrete, positive, and measurable improvements in their lives. Emphasis is also placed on integrating the youth into the community and building the family’s social support network.

Role of Wraparound Facilitators--Care Coordinators and Family Support Providers

Wraparound facilitators--Care Coordinators and Family Support Proviiders act to advance the process and progress of a child/youth/young adult and their family through Wraparound. They act as part of a thoughtful process for individualizing care and assistance--coordinating different services and supports and joining them together in a collaborative effort. They help the team craft and implement a creative Wraparound Plan to measure its impact and modify it as needed to maximize its

effectiveness.

They personify the guiding principles and values of Wraparound.

Care Coordinator (CC)• Coordinate the development of child and family teams• Facilitate child and family team meetings • Develop and implement the Wraparound Plan• Collaborate with community systems, child-serving agen-

cies, and natural supports• Discover the strengths and needs of families

Family Support Provider (FSP)• Model effective interaction and behavior• Advocate for and support families to meet identified

needs• Mentor families to improve self-efficacy• Share personal story and experiences • Strengthen natural support systems with families• Partner with the care coordinator to provide high fidelity

Wraparound• Develop family to family supports

Role of System of Care Providers

Systems of Care staff support the work of Wraparound facilita-tors in leadsership, administrative, and direct service provision to families.

Direct Service Provision

• Behavioral Health Aide (BHA)/Children’s Health Home Specialist• Provide focused, short term assistance to help a

young person address a specific challenge in the home, school, or community

• Build alternative habits• Establish new coping skills• Forge new social connections• Improve self-care and wellness skills

• Peer Recovery Support Specialist (PRSS)• Serve as local youth group point of contact• Ensure child and youth involvement in Wraparound

meetings, family teams, and other meetings• Works with youth and young adults ages 16 to 25

• Nurse Care Managers• Communicate with the primary caregiver regarding

the need for the youth to be seen by their primary care practitioner;

• Ensure that children taking multiple psychotropic medications are seen by their primary care practi-tioner at least once per year.


• Embedded Care Cooridinators• Embedded Care Coordinators (ECCs)work with youth

who are in custody of Child Welfare and their foster and birth families.

• Supporting stable placements, minimizing place-ment changes, and facilitating reunifications.

• Wellness Coach• Understand how mental health and physical health

are linked;• Help family/child/youth/young adult assess their

current level of wellness;• Collaborate with others to identify the personal

strengths and goals of family/child/youth/young adult;

• Assist in developing plans of action to reach goals; and

• Understand and utilize the Eight Dimensions of Wellness.

• Therapist• Conduct initial and ongoing clinical assessments,

including diagnoses;• Provide oversight of the course of treatment• Provide individual, family, and group psychotherapy

services

Leadership Roles

• Project Director or Assistant Project Director• Supervise the implementation of services and

supervise staff;• Assist with planning activities, such as convening

child and family teams;• Provide guidance and assistance to staff; and• Act as the chief liaisons to the community to ensure

community involvement.• Supervisor• Clinical Directors• Internal Coaches

• Review and provide feedback on Wraparound docu-mentation

• Provide support to front line staff

Administrative Roles

• Support Staff• Data Entry/Data Managers• Billing

Wraparound Facilitator Essentials

• Person-firstapproach: getting to know people rather

than their labels or diagnoses. This requires self-correct-ing when prejudices and habits lead to treating people as problems or stereotypes.

• Acceptance and appreciation: relating to families in a way that demonstrates that each person’s perspective has been heard, understood, and respected. This also means being warm, genuinely curious, and respectful of the family’s culture.

• Empathy: attempting to experience another person’s world and then communicating an understanding of and compassion for that person’s experience. Communi-cating with empathy results in more openness between people.

• Authentic strengths discovery: listening to a family’s story and reflecting their strengths. This does not mean asking the family to list their strengths; rather, the family should tell their story and the family’s strengths should be identified through a discussion about the family story and a strengths-based observation of the family’s interactions.

• Purposeful partnership: working with the family to identify shared goals and forming mutual commitments to work together. This involves building a reciprocal relationship with the family and with the people who are in the family’s circle of support to help the family achieve improvements in their situation.

Culture

Culture refers to the special background or characteristics which each person possesses. Culture can include race, eth-nicity, gender, orientation, demographics (urban vs. rural) and can even include economics (the culture of poverty). Culture is also the shared values, traditions, norms, customs, arts, history, folklore and institutions of a group of people or individual.

Culture communicates the world as children and families expe-rience it. To best serve those in need of services and supports, providers must recognize and appreciate the cultural lens through which families perceive Wraparound facilitators and partnering agency providers, and even Wraparound Plans.

Diversity

Diversity refers to all the ways that people are both similar and different. Diversity encompasses more than race and gender to include all those differences that make us unique. The differ-ences matter, especially the ones that may not matter to you but may matter to someone else.


Cultural Competency

Cultural Competency refers to the process by which individuals and systems respond respectfully and effectively to people of all cultures, languages, classes, races, ethnic backgrounds, religions and other factors in a manner that recognizes, affirms and values the worth of individuals, families and communities and protects and preserves the dignity of each.

Operationally defined, OKSOC Cultural Competence is the inte-gration of knowledge about individuals, families and groups of people into specific standards, policies, practices and attitudes used in appropriate cultural settings to increase the quality of services, thereby producing better outcomes. Becoming cultur-ally competent means that you should be able to talk about the following:

• I acknowledge my personal values, biases, assumptions, and stereotypes in the workplace and private life.

• I am aware of my own cultural identities and recognize how culture has impacted my personal interactions.

• I can appreciate how diversity has benefited and en-riched my life’s experiences.

• I recognize my own privileges and am able to articulate areas of disadvantages.

• I am aware of my own developmental stage and am constantly working towards improvement.

• I have knowledge of my personal diversity issues and am able to resist “getting hooked” by inflammatory state-ments or behavior.

• I am comfortable being with members of groups differ-ent from my own.

• I am able to recognize different points of view, behaviors, values, and goals both with consumers and co-workers.

• I am comfortable communicating about diversity.• I am able to be flexible, nonjudgmental, and tolerant of

ambiguity, both with consumers and co-workers.

Until recently, most children living with serious emotional dis-turbance have not received culturally competent clinical and/or social care. By being culturally competent we can help the child, youth and family - no matter how difficult their behavioral health issues - access quality services within the context of their home and community.

Family-Driven Care

Family-driven means families have a primary decision-making role in the care of their own children as well as the policies and procedures governing care for all children in their community, state, Tribe, territory and nation. This includes choosing sup-

ports, services, and providers; setting goals; designing and implementing programs; monitoring outcomes; partnering in funding decisions; and determining the effectiveness of all efforts to promote the mental health and well-being of children, youth, and young adults.

Characteristics of Family-Driven Care• Family and youth experiences, their visions and goals,

and their perceptions of strengths and needs guide decision-making about all aspects of service and system design, operation, and evaluation.

• Family-run organizations receive resources and funds to support and sustain the infrastructure that is essential to ensure an independent family voice in their communi-ties, states, Tribes, territories, and the nation.

• Meetings and service provision happen in culturally and linguistically competent environments where family and youth voices are heard and valued, everyone is respect-ed and trusted, and it is safe for everyone to speak honestly.

• Administrators and providers actively demonstrate their partnerships with all families and youth by sharing pow-er, resources, authority, responsibility, and control with them.

• Families and youth have access to useful, usable, and understandable information and data, as well as sound professional expertise so they have good information to make decisions.

• Funding mechanisms allow families and youth to have choices.

• All children, youth, and families have a biological, adop-tive, foster, or surrogate family voice advocating on their behalf.

Three Levels of Family Involvement

1. Child and Family Team Level InvolvementThe family is in full participation and making choic-es, determining options, and prioritizing the needs of their family.

2. Community Level InvolvementFamilies are involved in their parent/family group meetings and are actively participating in a local community family group.

3. State Level InvolvementFamilies hold voting/designee Family Member po-sitions representing communities on the Oklahoma State Advisory Team and participate in the local and state evaluations


Youth and Young Adult-Guided Care

Youth and young adult-guided means youth and young adults have a decision-making role in their own care as well as the policies and procedures governing care for all youth and young adults in their community, state, Tribe, territory and nation. This includes choosing supports, services, and providers; setting goals; designing and implementing programs; monitoring outcomes; partnering in funding decisions; and determining the effectiveness of all efforts to promote the mental health and well-being of children, youth and young adults.

Characteristics of Youth and Young Adult-Guided Care

• Youths’ and young adults’ experiences, their visions and goals, and their perceptions of strengths and needs, guide decision-making about all aspects of service and system design, operation, and evaluation.

• Meetings and service provision happen in culturally and linguistically competent environments where youth and young adult voices are heard and valued, everyone is re-spected and trusted, and it is safe for everyone to speak honestly.

• Administrators and providers actively demonstrate their partnerships with youth and young adults by sharing power, resources, authority, responsibility, and control with them.

• Youth and young adults have access to useful, usable, and understandable information and data, as well as sound professional expertise so they have good informa-tion to make decisions.

• All youth and young adults have a biological, adoptive, foster, or surrogate youth/young adult voice advocating on their behalf.

Three Levels of Youth and Young Adult Involvement

1. Youth/Young Adult and/or Family Team Level Involve-ment

Youth and young adults are in full participation and making choices, determining options, and prioritiz-ing their needs.

2. Community Level InvolvementYouth and young adults are involved in their family/youth/young adult group meetings and are actively participating in a local community youth/young adult group.

3. State Level InvolvementYouth/Young Adults hold voting/designee Youth/Young Adult Member positions representing com-munities on the Oklahoma State Advisory Team and participate in the local and state evaluations.


Engagement Phase

Family meets Coordinator and Family Support Provider. Together they explore the family’s strengths, needs, and culture. They talk about what has worked in the past and what to expect from Wraparound.

Planning Phase

Team members learn about the family’s strengths, needs, and vision for the future. Team decides what to work on, how to get the work accomplished, and who is responsible for what. A plan is develpoed to manage crisis that may occur.

Implementation Phase

Family and team members meet regularly. Team reviews accomplishments and progress toward goals, and makes adjustments. Family and team members work together to implement plan.

Transition Phase

As the team nears its goals, preparations are made for the family to transition out of formal Wraparound. Family and team decide how the family will continue to get support when needed and how Wraparound can be “re-started” if necessary.

Wraparound Road Map


EngagementDuring this phase, the groundwork for trust and shared vision among the family and Care Coordinator and Family Support Providers is established 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 teamwork and team interactions that are consistent with Wraparound principles.

The activities of this phase should be completed relatively quickly so that the team can begin meeting and establish ownership of the process as quickly as possible. Two relevant definitions of “engagement” are: “contact by fitting together” and "the meshing of gears.” The gears of a clock function well only in perfect partnership. If they do not fit precisely, the clock will not keep accurate time or will not operate at all. A Wraparound facilitator’s successful engagement with a child and family requires care if there is to be a successful partnership that leads to desired outcomes.

Walker, J. S., Bruns, E. J., & The National Wraparound Initiative Advisory Group (2008)

ImplementationDuring this phase, the initial Wraparound Plan is implemented, progress and successes are continually reviewed, changes are made to the plan, and then implemented, all while maintaining or building team cohesiveness and mutual respect. The activities of this phase are repeated until the team’s mission is achieved and formal wraparound is no longer needed.

TransitionDuring this phase, plans are made for a purposeful transition out of formal wrap-around to a mix of formal and natural supports in the community (and, if appropri-ate, to services and supports in the adult system). The focus on transition is continual during the wraparound process, and the preparation for transition is apparent even during the initial engagement activities.

PlanningDuring this phase, team trust and mutual respect are built while the team creates an initial Wrap-around Plan using a high-quality planning process that reflects Wraparound principles. In particular, youth and family should feel, during this phase, 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, a rapid time frame intended to promote team cohesion and shared responsibility toward achieving the team’s mission or overarching goal.

Wrapround Phases


FORMS

My Take Aways

14WRAPAROUND | 201 Training Manual

201 training manual | wraparound

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