Category: Wraparound Innovations

Lessons from the Field: A Prisoner’s Voice and Choice

I met Ralph, age 38, after he volunteered to be part of a group of prisoners at the State penitentiary who were participating in wraparound. Ralph taught me a lot about listening. After 11 years of incarceration, he was heading home. He had entered prison at age 18 years old, and been in and out of prisons several times prior to his last conviction. He typically lasted just a few months on the outside before committing the crimes which would bring him back to prison. The state where Ralph lives had pioneered the use of the wraparound process as a way to reduce recidivism, and had excellent outcomes. In prison wraparound, inmates self-select into wraparound and have support from prison Wraparound Facilitators, most of whom were former guards. Six months prior to release, the prisoners are engaged, the strengths, needs and culture discovery is done, including all the steps of typical wraparound.

In previous releases, Ralph was always given a discharge plan written by a prison case manager, but it wasn’t his plan and he had no commitment to it. This time, it would be his plan. The prison wraparound staff were concerned about housing, finding a job and ongoing mental health treatment. When Ralph prioritized his needs for the first team meeting, he said he wanted to focus on how to keep his 15 year old daughter in high school. She was going to drop out on her upcoming 16th birthday when she could legally leave high school.  He felt that she was following his old path and he feared she would end up right where he did. Although the first meeting was not easy, the team Ralph had chosen brainstormed options which ended up working. When his daughter knew that this was her Dad’s biggest worry, she took his request seriously and with support from relatives, ended up not dropping out.  As Ralph worked with his team to achieve his vision he came to understand he would need to be there to support his daughter. The terms of his probation required him to have a steady job. He added this as a goal, not because the probation officer told him to but because he knew he had to do it to support his daughter He also added goals to help him be a better father.   At 34 months after release from prison, Ralph was still in his community, he was crime-free, and his daughter had graduated high school.  I learned from Ralph that even someone who had been in prison for most of his adult life had strengths, hopes, and dreams and that focusing on what was important to him could lead to success.

Why did wraparound work for him? A big part of it was that first meeting, and that skilled wraparound staff who took his lead from Ralph’s voice and choice about what he needed. When Ralph came home, he came home to a daughter who knew he cared. He came home with a plan to heal some of the wounds caused by his criminal behavior. It was his plan, he prioritized his needs, and the staff and team listened.

Lessons from the Field: How Family Support Partners Changed Us All

When we started developing our wraparound and system of care effort in Southeast Kansas, we formed a loosely held advisory group of community leaders and family members to do the planning.  This group would decide how we wanted to organize and what services were needed.  Virginia was a parent who was taking some leadership in maintaining a parent support group at our mental health center on a voluntary basis.  Up to now, Virginia had lived a very hard life.  Both of her children had been in child welfare custody for brief periods of time, both had dropped out of school and her son had been involved with juvenile justice multiple times and was now in adult prison, with a long sentence.  Virginia could not afford routine health or dental care and was missing most of her teeth.  However, she had hope that wraparound and systems of care could offer better futures for other families and volunteered for most of the planning, assessment and organizational activities that led to our site being funded for a SAMHSA system of care grant.  She became the first family support partner in our county.  Virginia and the family support partners who worked across our region taught me the absolute necessity of the position for success in wraparound. Three short stories about Virginia proved this to me.

The first story is about Virginia’s first time going with a parent to one of our local schools.  I was sitting in my office when I received an emergency call from the superintendent of schools. Steam and profanity rose out of the phone.  “There is a Virginia here at the school trying to attend one of our IEP meetings and she says she works for you.  You know she is the parent to one of the worst students we have ever encountered.  She got into a lot of trouble and her kids were h*** on wheels.  You are more stupid than I thought hiring someone like her.”  I said I would be right over, and sat through that first IEP meeting with Virginia and the mom.  I explained the idea of a family support partner to the incredulous superintendent, and talked about all the positive things Virginia had done in the past few years.  He was not impressed, but agreed to let us continue.  Just over a year later, Virginia was receiving more referrals from the schools than any other program at the mental health center. The families she advocated for became involved in their kid’s school process in a positive manner and the kids showed a lot of improvement.  Virginia and I talked a lot about what it takes to be a successful advocate and we learned together that her experience and passion were important, but the skills she learned to be a good family support partner were just as important.  Her grit, determination, and passion were the essential elements that made Virginia real, and the training, new skills, and polish she received as a FSP made her effective.

The second story happened shortly after we moved to a bigger space to support our growing program.  We lived in an old railroad town that was in decline, and there was an empty grocery store downtown that could be had cheaply. The freezer space made excellent secure storage for our records, and the rest of the building was one big open space.  We put up a few concrete block walls (they were inexpensive), and I decided to put all of my wraparound staff in one big office, each with his/her own desk but no partitions (I thought this would encourage them to be a team).  We had three “quiet rooms” for meeting with parents or taking confidential calls.  We primarily served school age children, so most of our work was done from 11 a.m. until about 7 p.m.  Most of the staff showed up at 10 or so to get ready for the day and do paperwork.  The unfortunate part about the concrete walls was they did little to sound proof the rooms. My office was immediately next to the big wraparound office, so I could hear all of their conversations.  I remember the early days when there was a lot of talk about family dysfunction and shaming and blaming of families as the Wraparound Facilitators vented their frustration about families and how complex wraparound really is.  We did training to counter this, but the effect was slow.  But, an interesting thing began to happen during these discussions.  Someone would start blaming and Virginia would reframe the issue from the parent’s point of view.  There would be discussion of this and then the wraparound staff brainstormed alternative strategies for engaging these families. It started to work.  Within three months, I no longer heard any blaming and shaming.  Virginia helped to change our agency culture. Over time, as we hired more family support partners, I saw similar changes in our other mental health programs.

The third story happened one day when this woman came to my door and very timidly asked to see Virginia.  I showed her into the wraparound office, where Virginia was working alone.  The women sat with her head bowed and in a very quiet voice told Virginia that she had just come from the court building which was a block from the mental health center.  Her son had set a barn on fire over the weekend and because he was already on probation, he was going to be sentenced to the most secure juvenile facility for two years.  She said the probation officer told her if she could get him into wraparound that day, they would give that a chance.  Virginia said, “Honey, the worst days of my life were when I had to see my son’s probation officer.”  The women looked up: “Your son had a probation officer?” Virginia answered that it was worse than that, not only had he had a probation officer but now was in a maximum security adult prison.  She told the woman that she was doing her current job because she wanted to help other parents avoid what had happened to her.  She told the woman some general stories (without using names) of youth whose lives had been turned around. The woman was totally engaged with Virginia, but it was more than that.  I remember later monitoring a wraparound meeting for this family. The mom was upset about something the school was doing with her son and she began to shame and blame the school in the meeting.  Virginia asked for a short time out.  They walked outside and Virginia sympathized, but also talked to her about the impact of the negative approach she was using in the meeting and suggested some better ways to advocate for her son.  As a psychologist, I could have done that. But I don’t think the mother would have listened to me. Because of the engagement she had with Virginia, she came back into the meeting and tried a different and better approach. The school was able to respect and partner with her.

How Individual Wrap Staff can Enhance the System of Care

The stronger your community system of care, the better outcomes you can expect to see for your families. Most agencies want to work with other agencies to meet the needs of children and families and to provide access to needed services and supports for these families.

Developing an integrated system of care requires multiple strategies at multiple levels.  Agency and community leadership partner with representative youths and families to do community assessment and development.  Supervisors work across agencies to support integrated policies and practice.  Wraparound staff build on the above activities to create integrated plans and process one youth, family and team at a time.

Wraparound staff are in a unique position to support system of care development and to identify barriers to challenges with the system.  Since wrap staff interact with so many facets of the system of care for their families each and every day, they are uniquely situated to notice problems, resource miss-allotments, and other challenges to providing superior care.

If wrap staff help identify them, these barriers and challenges within the system of care can be addressed by agency supervisors and managers. They will also have the chance to positively influence families, community members, mental health professionals, and others towards the wraparound process. Each new team member who has a successful experience with wraparound will add more support for wraparound and the system of care, and these team members will share their support with peers.

Just as wrap staff use the Theory of Change (TOC) to help guide the wraparound process for individual families, they can also use the TOC to identify system challenges. When they hit a point that makes following the TOC more difficult, they know you have identified a system problem worth passing along to their supervisor.

A Simple Solution to Reaching and Maintaining Fidelity in Wraparound

Providing high quality wraparound can be hard, but it is much easier when every agency (or group of small programs) has their own Wraparound Process Mentor(s) (WPM). Here are our top seven reasons why:

1. Wraparound Programs are always changing – Staff leave or programs expand, and there is an ongoing need to train and coach new staff. These include wraparound facilitators, family and youth support partners, and supervisors. WPMs can provide this training. In addition, management and agency leadership change and the WPM can provide stability and advocacy to maintain the progress of the wraparound program.

2. Your Agency and Community needs are always changing – Your agency and community isn’t static. Program expansion of changes in funding may mean serving different populations of youth and families. Funding changes may change the way wraparound fits into your system of care. The way you do community outreach, the kinds of people you need to hire, even the services you provide will change over time. A WPM is not just an expert – he or she is your expert: an expert in wraparound AND your agency, community, and history.

3. National Experts and Consultants are expensive – When you are having trouble with high turnover, low training transfer, or stagnant family outcomes, you might need extra help. When you need to meet new challenges, it can be more than the wraparound staff and supervisors can handle. A problem shooter who has been there before can save time and money in the long run. But national consultants don’t come cheap, nor do they understand the unique needs of your community and program. WPMs are linked with other WPMs across the country and can easily access and share collegial ideas. Having a WPM on staff gives you expert attention from someone who understands local context and lets you save your consultant money for when you really need it.

4. You can do all your own training and certifications in house – Training can get really expensive really quickly if you have to hire outside trainers. Having certified coaches lets you train and certify all your own facilitators and support partners in house. Having a WPM lets you train and certify all your own coaches and supervisors in house. A WPM can also do the advanced training to address ongoing challenges and new initiatives.

5. Troubleshoot challenges as they arise; not as you find funding to fix them – You want to try and reach a different segment of the community. Your family outcomes are dropping, and you aren’t sure why. You are losing staff quicker than normal. Challenges and opportunities tend to be met best when they can be met right away. A WPM can start researching your specific issue as soon as you (or they) identify it. No special funding required. Instead of addressing your need with current information or taking your challenge or a vague idea to your funding sources to request more money, you can have a well-researched problem with a few carefully selected possible solutions.

6. Learning Communities don’t build themselves – We all know that learning communities, like professional development plans, can have far reaching benefits for everyone involved. A wraparound learning organization is an agency or program that is committed to continual learning and innovation that uses organizational learning mechanisms to create and support a climate of team learning that results in better fidelity and outcomes, better satisfied staff with lower burnout and turnover, and the ability to quickly respond to new challenges. WPMs provide in-house expertise and motivation to build and sustain these learning communities.

7. Good coaches create good facilitators. Good WPM’s create good coaches. – Your agency can not be any better than the wraparound its wraparound professionals provide. You need good facilitators and support partners providing consistent, high fidelity wraparound to realize the many benefits of wraparound. The best, easiest, and most reliable way to cultivate a strong wrap-force is to have good coaches and supervisors. But good coaches and supervisors don’t create themselves. You might be lucky enough to have a few just walk in already wise in the ways of wraparound coaching and supervising. A WMP takes the luck out of the equation. They can help all of your coaches and supervisors to be stronger.

8. Wraparound is always changing – Our knowledge base about wraparound gets bigger every year. We learn how to do things better, how to help families achieve more, and how to do it all more efficiently. To offer the best wraparound possible, you have to be current. WPM’s are wraparound experts who are constantly seeking to learn more, who are linked with experts and other WPMs across the county. Having a WPM on staff means having at least one person whose job it is to stay on top of it all.

Want to learn more about WPMS? Read more here and here. Interested in becoming a WPM? We have a workshop coming up in July. There is still a little more time to register.

Creating Organizational Change: Staff Engagement

Change is hard. As we covered last week, we cannot just make program changes – we have to change the processes and procedures as well. None of those changes will make any difference if our staff don’t see the value of the new way of doing things.

You can, in some limited ways over a specific period of time, make someone do something. However, you will spend a lot of time monitoring them and enforcing change, and the quality of their work will suffer dramatically. In this scenario, everyone works harder for an inferior output. Plus, everyone feels put out at the end of the day.

It is much more efficient in the short term and the long term (and more in the spirit of wraparound) to spend a little extra time getting everyone on board with the change. Our staff don’t go into social work and mental health for the glory or the riches – they do it because they genuinely care about kids and families. If you can show them that your proposed change increases outcomes (ideally while decreasing some part of their own work over time), they will be excited. If you cannot say that the change increases outcomes or efficiency, then why are you doing it?

Engaging staff to a change isn’t just about getting them excited for the new way of doing things – it is also about overcoming their fear of change. What is there to fear? That the new way won’t work, or that they specifically won’t be able to do it. That it is going to be really hard, or require a lot more time. That their families/partnering agencies/whomever won’t want to make the change.

Org Change Barriers

We can deal with each of these, but only if we recognize the source. Fear of failure should be meet with scaffolding, skills building, intensive training, and ongoing support. Give your staff permission to fail sometimes little while they are learning. If possible, take a little pressure off them by reducing their caseload or holding off adding new families until they feel comfortable.

A concern that the new way won’t work is a different issue. Extensive coaching won’t help. What will help is research, specific examples or case studies, testimonies from families and staff who have experienced the new way, and other “proofs” of efficacy.

Regardless of what specifically your staff are worried about, it is a good idea to spend a little time explaining how the new practice will be the same or less work, or how you have reduced their workload to make up for the extra. No one will be excited about a process that requires more work without creating time for it. You should also help them understand what is in it for each of their partnering agencies so that they can get their team on board.

Fear of change can take a lot of forms. Resistance to the change. Checking out mental from meetings about it, or responding angrily. Public acceptance mixed with privately continuing in the old ways. Any of these can severely inhibit your change process – including impacting new staff as they come on board.

Real change can only happen with staff participation. Take the time to get them on board – it will be more than worth it.

Our Youth Support Partner Textbook is Here

Youth Support Partners (YSP) can add an incredible amount of value to a program. They can reach kids who are otherwise unreachable, and create family and youth engagement at unparalleled rates. Youth Support Partners do a lot of things that are similar to what Family Support Partners do, and they also have some overlap with Wraparound Facilitators. However, they have their own discreet set of primary responsibilities.

The Youth Support Partner Textbook is the very first High Fidelity Wraparound textbook specifically tailored to the Youth Support Partner Role. It contains everything a YSP needs to go from a brand new staff member to a certified professional.

YSP Cover

The textbook contains the same integrated Foundations of Wraparound training material as our Wraparound Facilitator and Family Support Partner books – this allows coaches to train everyone together, which creates the best flexibility and team environment. The YSP Textbook also contains YSP specific shadowing and behavioral rehearsal exercises after the appropriate chapters, and a certification manual specific to the YSP role in the appendices. Like all of our books, it is designed to work with a trainer in a small or larger class, or one on one with a coach.

We are so excited to be able to offer this tangible support to communities everywhere who are making this important step towards fidelity. Youth Support Partners are part of the future of wraparound, and this book can help you make them a reality for your program.

Creating Organizational Change: Updating Your Processes

There is a difficult equation at play when you are trying to make major program changes. Change is usually difficult or at least uncomfortable. It is easier to do things the familiar, safe way. Existing processes (such as billing requirements, paperwork, and peer support) were usually created to support the old way of doing things. On top of that, wraparound providers rarely have the luxury of extra time in their schedules. All of this together means that there is a lot of support for the status quo (whatever that is) and very little naturally occurring support for change.

Org Change Barriers

Notice that I didn’t list a lack of training, or a shortage of resources to support the new way. This formula assumes that you have or brought in an expert who can provide high quality training for the new process. That is the minimum requirement, but it is almost never enough by itself.

So what do you need to make a major change – like implementing High Fidelity Wraparound? We have to change some of those variables listed above. Today, we are going to talk about the first variable. We will get into the second and third in the next few weeks.

The first variable is often the one that seems the most difficult to change, but is usually the easiest. Look at your processes: What does your paperwork look like for wraparound staff to fill out after meetings and visits? What counts as a billable hour? What kinds of requirements are in place for meetings, visits, and extras to “count”? Which activities are reported on?

For each piece of paperwork and every requirement, you are placing constraints and priorities on your staff members. When they are busy (like they almost always are), they will do the things they have to do, and the rest will fall by the wayside. Your job, if you want these changes to be successful, is to take each and every process and procedure and ask yourself: Does this actively promote good wraparound?

PandPcategories

Some processes (like requiring a fixed number of natural supports at each team meeting, or making team meetings follow a schedule instead of needs), actively hinder High Fidelity Wraparound. These need to be changed before you can start.

Others (like focusing paperwork on deficits instead of strengths and strength based planning) don’t actively hinder wraparound, but don’t promote it either. Those policies are really supporting something else (like a traditional deficit-services based style of planning). When rubber hits the road, you can bet that most of your facilitators will revert to what they must document. These kinds of policies are just as important to revisit.

You goal is to have all of your processes actively support wraparound the way you want it to be done. This means going beyond paying lip service to services, into actively making changes to support the process. For example, have your SNCD forms mimic the SNCD process you want your facilitators to pursue.

Staff engagement is just as important as family engagement, and for very similar reasons. Next week, we will look at how to get your staff to buy in to the new style of wraparound.

Moving Florida Case Management to Wraparound: A Targeted Workshop

Wraparound and Case Management have a lot of Medicaid codes in common, but are vastly different ways to work. However, many agencies around the country who want to start using the High Fidelity Wraparound Model are best positioned to transfer some of their case workers over (and perhaps not even full time). Other agencies want to practice targeted case management, but using the principles, theory of change, and activities from wraparound.

Knowing this, we have developed a new workshop to help agencies in this situation get started the right way. Receive this training and then be equipped to coach your Case Management staff to utilize High Fidelity Wraparound. This training is designed to prepare Case Managers to facilitate wraparound as well as to prepare supervisors to coach and certify their own local facilitators.

 

The following will be reviewed during the training

  • Innovations in Wraparound
  • Transitioning “broker type” case managers to facilitate high fidelity wraparound
  • Preparing to utilize the Florida Medicaid funded “Wraparound code”
  • Orientation & Introduction – our orientation is planned around a polarity exercise that helps students understand the big picture of wraparound in a very concrete way as a foundation for all the detailed training.
  • Engagement- covers each of the activities of the engagement phases. The training in this section are focused on concrete strategies for successfully helping families do the wraparound process.
  • Planning – these sections cover the planning process in detail, with more functional activities and numerous new strategies to improve family participation, brainstorming, and quality plans and crisis plans.
  • Implementation – this section covers new concepts to support sustained progress by families such as purposeful transition, transition assets, and the culture of support plus the strategies for using motivational interviewing to create better long term engagement of the youth, family, and team.
  • Transition – under the new model, most of transition preparation happens in the preceding phases and is covered in those sections. This section offers new exercises and a focus on long term sustainability.
  • Special Topics –cover topics that are essential to wraparound success, like how to identify, nurture, develop, or create natural supports, and how to build your local system of care.

We would love to see you there. Read more about the training, including how to register, here: Florida Workshop.

Wraparound Needs a Wraparound Structure

Many competing needs and goal went into creating the processes and procedures we follow when providing mental health services in this country. There are a variety of things we do to protect ourselves legally (like mandated reporting practices, forms we have to get signed, and when and how we meet our clients, to name a few). There are other things we do to make our jobs fit within convenient time frames and billable hours.  There are a whole host of things we do to maintain our own privacy, and to reinforce the barrier between practitioner and patient.

When you are trying to make a process work that relies on securing engagement, it quickly becomes obvious that the modern mental health admittance and treatment process wasn’t created with engagement and client comfort in mind.

I have watched so many dedicated professionals struggle to do High Fidelity Wraparound in a system that hasn’t been adapted to support it. From big picture things like securing or adjusting funding to meet the needs of the process (instead of the other way around), to daily items like adjusting paperwork to reflect the process, there are a lot of potentially fidelity ruining barriers that agencies never examine.

Consider this: we went into an agency that, despite their sincere efforts, was unable to maintain fidelity levels over time. They would have big push, everybody would up their efforts and scores, and six months later they were back where they started. We came in to help them figure out the problem. There were a few things happening, but by far and away the biggest change we helped them makes was to align their paperwork with the process. They have maintained a higher level of fidelity ever since.

The truth is that people do what they have to do. When they are busy, up against a deadline, being evaluated, or struggling with a difficult family, they will hunker down and do what they are actively required to do to make it through. If your paperwork checks things like form completion, services offered, or physical people present – but doesn’t reflect the process – then guess what most people will do, and what they will let slid.

Similarly, if someone can bill for family treatment meetings, but not less formal work, then guess what they will end up doing. The problem is that wraparound depends on this less formal work with the family and team. Wraparound depends on the process.

Wraparound is not services as usual. If we want it to work, we have to restructure to allow it to work.

Education and Strengths Based Planning

Bringing strengths based planning into the school system is one of the incredibly impactful things you can do for kids in wraparound. School is absolutely critical to future success, and kids in wraparound often have a lot going against them in terms of access to and readiness for an education. Trauma, stress, change, and trouble at home all make learning more difficult.

Traditional plans look at problems like poor grades or attendance, and apply generic services. Billy is struggling in math – let’s get him a tutor. Susan isn’t reading at grade level – let’s put her in a remedial class.  Worse, traditional planning can be very punitive – Josh is missing a lot of school, he is going to be held back/suspended/cut from the one thing he enjoys about school (basketball).

These options can be helpful in certain circumstances, but they can actually make things worse sometimes. It depends on the child, and why the problem is happening.

Strength based planning, on the other hand, starts with what the child loves or is good at. Take Susan. She isn’t reading at grade level. She also is hungry most nights, has to listen to her parents have loud, violent fights, and has low self-esteem. Putting her in a remedial class won’t help her have a safe space to practice at night, and it won’t make her more confident. It might make her stop trying at all.

Susan loves horses. Her biggest dream is to have one. She also would really like to have at least one friend at her new school, and she is great at drawing. What if, instead of sticking her right into remedial reading, we found another little girl or two who likes horses, and helped them start a reading club?

We tried it. Susan tried extra hard because she was interested in the books, and because she wanted the other girls to like her. Her reading improved. She made friends. She started to look forward to school. Remedial classes might have accomplished the first thing, but not the last two. Strengths based planning made the difference.

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