NHCBH Workforce Development Network

Foundational Competencies in Children’s Behavioral Health:

Introduction to Systems of Care and Wraparound in New Hampshire

Foundational Competency Modules

• These modules are designed to support the implementation of core competencies in Children’s Mental Health.

• The competencies are formulated at foundational, intermediate and advanced levels.

• The following modules provide introduction to the core competencies and are supported by the Professional Development Workgroup of the NHCBH Workforce Development Network.

Mission

• The mission of the NH Children’s Behavioral Health Workforce Development Network is to build a sustainable infrastructure for the professional development of the children’s behavioral health workforce based upon the core competencies and infused with the system of care core values and guiding principles.

Wraparound NH:

What It Is, What It Is Not: Family Teams and Systems Level

Supports

New Hampshire Children’s Behavioral Health Collaborative

Workforce Development Network

Wraparound Workgroup

Spring 2015

The Context: Systems of Care

“A spectrum of effective, community-based

supports, that is organized into a coordinated network, builds meaningful

partnerships with families and youth, and addresses their cultural and linguistic needs, in

order to help them to succeed at home, in school, in the community, and throughout life”

(Stroul & Friedman, 2010)

System of Care Values

1. Family driven and youth

guided 2. Community based 3. Culturally and linguistically

competent

2010, Beth A. Stroul, M.Ed. Gary M. Blau, Ph.D. Robert M. Friedman, Ph.D. Updating the System of Care Concept and Philosophy

Family and Youth Driven

The strengths and needs of the child and family determine the types of services and supports

provided.

,

Community Based

The locus of services as well as system management rest within a supportive,

adaptive infrastructure and relationships at the community level.

Culturally and Linguistically Competent

Agencies, programs, and services reflect the cultural, racial, ethnic, and linguistic differences of the populations they serve to facilitate access to and utilization of

appropriate services and supports and to eliminate disparities in care.

Positive Outcomes of System of Care Development and Implementation

• Increased positive social, academic, and behavioral outcomes and community connectedness for children, youth, and families

• Decreased out of home, school, and community placements (and duration of such)

• Increased caregiver capacity, decreased caregiver strain

• Programs and supports that are uniquely tailored to each child and family’s culture, strengths, and dreams

(Suter & Bruns, 2009; Bruns & Suter, 2010)

History

• 1960s – Brownsdale programs developed needs based, individualized, unconditional services for children with emotional disturbance.

• Jane Knitzer monograph Unclaimed Children

• 1980s – National Institute on Mental Health provided funding for child-centered service systems (beginning of “standing wraparound teams” regionally in NH)

History (cont.)

• Stroul and Friedman Monograph, 1986- updated 2010, “A System of Care for Children and Adolescents with Severe Emotional Disturbances”

• 1990s – Federal Center for Mental Health Services supported development of Systems of Care- 2000 NH receives first System of Care grant- CARE NH..

History (cont.)

• Wraparound (1980’s, 2000’s)- Child Welfare: Karl Dennis at Kaleidoscope Chicago, Vandenberg in Alaska, Wrap Milwaukee, Eber in Illinois (move toward school based Wraparound)

• Similar developments in other fields: – Developmental Disabilities: “Person-Centered

Planning,” “Personal Futures Planning”

– Child Welfare: “Family Group Decision Making”

The Wraparound Process: Evolution

The National Wraparound Initiative (NWI) defines Wraparound as “an intensive holistic

method of engaging with individuals with complex needs (most typically children, youth and their families) so that they can live in their

homes and communities and realize their hopes and dreams.”

The Wraparound NH Model

Wraparound brings families together with supportive teams to plan and deliver supports

and services that build on family-identified strengths and needs, to help families live together safely and productively in the

community.

What is Wraparound?

• Wraparound is highly-structured family-driven planning process.

• Wraparound is based in a clear set of values and principles.

• Wraparound teams have dynamic rather than static membership.

• Wraparound is a process that begins with the strengths of individual youth and families.

• Wraparound is not a service or set of services.

• Wraparound is highly individualized.

What is Wraparound?

• Wraparound is a solution-focused process that is family and youth driven.

• Wraparound connects families to supports and services in their communities, and always includes a mix of public, private, and natural supports.

• Wraparound includes access to family/youth peer support.

• Wraparound is a process that respects families’ culture and values.

• Wraparound is led by a trained facilitator.

Wraparound Is Not:

• A specific set of services offered

• A typical team meeting

• Any meeting held without family or youth

• An immediate or quick solution

• A crisis intervention or response

• A standing interagency team

NH Wraparound Framework

Framework • Hello: Initial contacts of

welcoming and setting the stage for “engaged enough”

• Help: Agreeing on, providing and delivering a range of interventions, services & supports

• Healing: Modifying initial helping activities to produce family report of healing

• Hope: Future oriented activities designed to sustain family experience of hope

4 Phases of Wraparound

June 14 patmiles@patmiles.com

Hello

Help

Healing

Hope

Phase 1: “Hello”

• Involves a sense of being welcomed which sets the stage for enduring equal partnership-

• Hello conveys the experience of being greeted and appreciated that families deserve to feel as they enter Wraparound.

• Provides comfort while quickly gathering enough information to assemble a helping response on the foundation of the initial greeting.

Activities and Tools at Hello

• Listen for understanding

• Family Timeline- Family Culture Map

• Strengths Discovery and Strengths Summary

• Identify and prioritize needs- Needs Egg

• Identify any immediate safety threats and respond- Risk Assessment Matrix

• Connections and Supports Map

• Create the family’s vision

Phase 2: “Help”

• Families are usually more interested in getting help than in a completed plan.

• Build a team, identify team member strengths and roles, decide what to work on, develop strategies.

• A Child and Family Team is not the intervention but is the way that decisions get made about the range of interventions.

Activities and Tools at Help

• Blend multiple perspectives • Plan of Care • Benchmarking, evaluating, and monitoring

progress • Continuous Engagement Activities • Brainstorming- at least 10 ways to meet each

prioritized need • Empower to action • Establish and adjust safety plan • Review progress towards the family’s vision

Phase 3: “Healing”

• Healing is the restoration of the family's sense of health and wholeness, as they take charge of identifying, accessing, and utilizing the supports and services they need.

Activities at Healing

• Check commitments and follow through

• Assess information about benchmarks

• Rate progress towards family’s vision

• Establish wellness plan

• Identify new strategies

• Review and adjust safety plan

Phase 4: “Hope”

• Hope begins to happen when the family’s underlying needs are being met and the family’s vision is realized.

• When the right supports are in place, transition planning and commencement happen.

Activities at Hope

• Identify contingency plans, ways to “come back”

• Create a transition portfolio

• Define hopes and dreams for life “after Wrap”

• Identify supports and resources beyond Wraparound Planning Process tenure

• “What if” drills

Weaving the Phases Together

“Just as hello isn’t something that only happens at the outset of the arc of care, hope isn’t confined to the closing moments. Hello should kindle and nurture hope throughout the course of the process. Help should be delivered in the context of a powerful optimism designed to increase expectancy on the part of all team members as well as families. Healing should be recognized throughout the entire process of Wraparound as a way to acknowledge and celebrate gains and set the stage for a future of possibilities” –Pat Miles, 2014

Wraparound in Simplest Terms

• Work until it works.

• When barriers arise--- People haven’t failed- the plan needs to be reworked.

• Strengths + Needs= Actions

• Voice and choice.

• If it doesn’t feel like help, it probably isn’t.

• No shame, no blame

FAST Forward NH Project

• 4-year System of Care project funded by the federal Substance Abuse and Mental Health Services Administration (SAMHSA)

• Goals:

– Establish family/youth-driven wraparound in NH

– Establish a funding, policy, and systems administration to support System of Care and wraparound development in NH

FAST Forward NH Project Roles:

Wraparound NH Coordinators in the Fast Forward Project (2012-2016): • Works with families to establish wraparound

teams, hold initial meetings with families, facilitates wraparound meetings and performs care coordination, facilitates referrals to other supports and services, develop crisis plans, facilitates the development of the family’s vision and plan of care, collaborates with Family and Community Support Specialists, collects data and completes required documentation.

Roles (cont.) Family and Community Support

Specialists- • Member of the individual and family team; supports

and coaches the family in the wraparound process; assists family to identify, prioritize, and articulate their goals and needs.

• Ensure that the family’s culture is respected; provide peer to peer support that will include helping the family learn how to navigate and advocate within the system; and work with the family to gain insight of the other team members perspective.

• Provide families with information about and connect them with natural supports and resources.

For NH’s Top-Tiered Children in Need of Mental Health Services

Breaking Down Silos

DCYF Service

NH’s SOC Service Array

CMHC Services

The braiding of services and funding sources will result in children being

served more effectively in their home communities, with enhanced

services from both systems.

FAST Forward- System of Care Service Array

• Enhance and expand traditional service array

• Develop new, non-traditional supports

• Natural, unpaid, community based supports

• All team members commit to developing natural community supports and connections

NH System of Care Individuals in FAST Forward have access to a full service array

• Assessment and diagnostic evaluation

• Care coordination/wrap facilitation

• Outpatient therapy: Office based, individual, group and family therapies

• Participation in wraparound meetings: Stipends for team members

• Medication management

• Psychiatric/medication consultation

• Mobile Crisis intervention

• Community Youth Mentor/behavioral aide service

• School based behavioral health services

• Substance Use intensive outpatient treatment

• Substance use disorder support services

• Therapeutic Day Treatment: after school programs

• ISO in home supports

• Home Based Therapeutic Support

• Child Health Support/Parent Aide

• Crisis Stabilization: out of home

• Respite Services

• Therapeutic Foster Care: ISO foster care

• Residential Treatment

• *Family Support, Leadership and Education

• *Youth Peer Support, Leadership and Education

• Flexible Funds

Care Management Entity (CME)

The NH Division of Children, Youth and Families as the CME

Family/Youth Level: Referrals, eligibility and payment process

• Accepts referrals (Erica Ungarelli and Adele Gallant)

• Screening for eligibility of family, self or school direct referrals when one has not yet been done (using NH CANS) (Erica & Adele)

• Works with referent on Crisis Plan when necessary (Erica & Adele)

• Medicaid payment processing (pa’s entered into MMIS): (DCYF Provider Relations)

Care Management Entity (cont.)

DCYF as CME System Level:

• Develops provider network to provide SOC service array with Managed Care Organizations (MCOs) – utilizing current DCYF/Bureau of Behavioral Health (BBH) providers (Adele and Erica, DCYF provider Relations and BBH)

• Works at developing private insurance network (DCYF Fiscal Specialists)

• Develops/joins regional teams to assess capacity and barriers and community partnership –(Adele/Family Organizations)

• Service utilization management, Quality improvement, Information technology-web based system. (Adele, Erica and DCYF’s data and evaluation groups)

• Manages the contracts and supervises with Fast Forward Coordinators

SUPPORT

• 1:1 Time Limited • Support Group-

Community • Facebook page • Message Board

EDUCATION • PMC Family Education

Program • Webinars • Annual Conference

LEADERSHIP TRAINING • PMC Teacher • Support Group Facilitator • “Life Interrupted” -Speaker • “It’s Your Move”-Advocacy

“Family to Family” Support, Education and Leadership Training

F.A.S.T. Forward Expand “Family to Family”

Support, Education and Leadership Training

+ 1:1 Support-Wraparound + PMC Family Education Program

+ Family Leadership Training

Identify, recruit and provide on-going technical assistance to family leaders serving on a wide range of activities on

the local, state and national levels.

Individual Level: Training and Support

System Level: Training and Support

Leadership

Training for youth to drive their own planning

Youth Move Orientation, Focus Groups

Youth Voice and Perspective to Systems Change Efforts

Group Forums for Individual Support and Connections (YM and RENEW Facebook)

“Strategic Sharing” “What Helps What Harms”- YM National Social Marketing Initiative

Conference Planning and Co-Hosting: Youth Track Development

Development of 1:1 Youth Peer Support Model

Training and Recruitment of Youth for Action in Systems Change

Support and technical assistance to emerging youth leaders across systems

Youth Leadership and Development of Youth Peer Support Granite State Federation of Families for Children’s Mental

Health

Organization of Workforce Development Activities (6/2014)

NHCBH Workforce Development Network-

Leadership Team

Evidence-based Practice Workgroup

YouthMOVE Peer to Peer Training

Children's MHC Directors

Workgroup

Institutions of Higher Education (IHE) Workgroup

In-service Workgroup

Web-Based Learning

Infrastructure Web-Based Content

Wraparound Workgroup

Youth Mental Health First Aid

Multi-tiered System of Support

School-based

Note. SAMHSA = Substance Abuse and Mental Health Services Administration; CBHC = New Hampshire’s Children’s Behavioral Health Collaborative; DHHS = Department of Health and Human Services; DCYF=Division of Children, Youth, and Families; IOD = University of New Hampshire’s Institute on Disability; NAMI NH = New Hampshire chapter of the National Alliance for the Mentally Ill; GSFFCMH = Granite State Federation for Children’s Mental Health; AUNE = Antioch University New England.

FAST Forward Youth/Family focused logic model

Note. SAMHSA = Substance Abuse and Mental Health Services Administration; CBHC = New Hampshire’s Children’s Behavioral Health Collaborative; DCYF = Department of Children, Youth, and Families; NAMI NH = New Hampshire chapter of the National Alliance for the Mentally Ill; GSFFCMH = Granite State Federation for Children’s Mental Health; AUNE = Antioch University New England

FAST Forward Eligibility and Referral

• Eligibility:

– Child or youth, ages 8 to adult transition age

– Meets state eligibility criteria for Serious Emotional Disturbance (SED)- multiagency-category

– At risk for out of home placement

– Enrolled in NH Medicaid program

Contact: Adele Gallant, 603-271-4371

“Training on the phases should explore ways in which families experience their participation with helpers during each of the phases. Through engagement families should feel a sense of being heard and understood, through planning a sense of having caring people joining with them to make a difference in their lives, Through implementation an improved ability to cope with challenges in their lives, and through transition a sense of self-efficacy and optimism for the future.” Pat Miles

Contacts

For more information on Fast Forward or to refer a family: Adele Gallant, MS FAST Forward Program Manager DCYF/ Bureau of Well-Being Thayer Building 129 Pleasant Street Concord, NH 03301 P: (603) 271-4371 F: (603) 271-4677 adele.c.gallant@dhhs.state.nh.us