Top 12 Lessons Learned of High Fidelity Wraparound
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We have learned hundreds of lessons about successful wraparound training, coaching, and implementation. Here are our “Top Twelve”:
- The first focus must be on outcomes and fidelity. Teaching people about principles, phases and activities and related topics often does not change practice. Focusing on actual interactions with youth and families is critical to move to higher fidelity.
- The greatest enemy of high fidelity wraparound is drift. Even passionate, skilled wrap staff will quickly drift back to case management unless there is ongoing monitoring of fidelity to the NWI Principles and Phases and Activities.
- Wraparound is first about youth and family voice and choice. Consistently, program evaluations find the biggest threat to good outcomes for youth with SED and their families is lack of engagement. These youth and families often drop out of services or do not follow through with recommendations. Wraparound works because it focuses on what is important to the youth and family, not on deficits determined by “professional” staff.
- It is about culture. Of all the wraparound principles, cultural competence may be the most critical to really engage youth and families. If the training and coaching is not culturally competent to the setting wraparound is done in, it is not embraced by the community. If the wraparound plan is not based on the assessed family culture of the wrap family, the family does not recognize the plan as theirs. Unfortunately, few staff have ever been taught to assess community and family culture and use the information in working with the family.
- “Training only” models do not work. Coaching and proof of skill acquisition (credentialing) must accompany innovation. In this proposal, VVDB uses the term credentialing to mean that all skill acquisition must be tested, documented and monitored. We use credentialing as a mechanism for ensuring that wraparound staff know the Principles, the Phases and Activities, and the 96 skills, can do them consistently, and are monitored over time by the local coach. The VVDB expert coaches will train the Mass mentors and local coaches for both ICCS and CPPS who will then carry out credentialing.
- The Family Partner role is a non-negotiable. Often families in wraparound have had “bad” experiences with the system and have trouble partnering with professional staff to truly express their voice and choice. Other parents who have had similar challenges and successfully navigated the system are able to form a stronger empathetic link and can be more successful engaging these families in the process. Wraparound is based on a premise of “support first,” rather than “formal treatment first.” The person who has support in their life looks very different than someone without support. For those who have lost their own supports, Family Partners are crucial to build short term supports while the natural supports of the family are rebuilt.
- Effective supervision is crucial to success. Our experience is that many supervisors are not taught strengths-based supervision, nor taught to be skill coaches of their staff. Adequate supervision of Care Coordinators and Family Partners (CPPS) means that the staff receive regular effective supervision that mirrors the high fidelity wraparound principles.
- Continuous Quality Improvement must occur. We think that monitoring of fidelity and outcomes must be institutionalized within the local system of care (SOC). This monitoring is one of the basic tools in creating a culture of learning and community of practice that strives to support continual learning and improvement.
- Training which is structured correctly helps minimize the coaching needed. VVDB has followed and embraced the work of the educator/learning researcher, Dr. Bruce Joyce. Dr. Joyce says that training which closely approximates the environment which skills will be practiced in is more effective training. VVDB uses the concept of multiple repetitions in multiple learning styles with behavioral rehearsals in training, which are an enhanced form of role play where pairs and small groups approximate the setting of the behaviors and focus on the skills used in those settings.
- Skill sets are crucial. It is important to remember that when training, VVDB presents the skills in sequence, as separate skills. However, experienced wraparound, Care Coordinators and Family Partners are able to blend a cluster of skills into one interaction. The skills are broken down into detailed actions so that a coach or a supervisor can ensure staff possess each vital skill.
- Individualization is crucial. It is also important for staff to remember the skill sets may have to be individualized based on family needs. VVDB teaches the skills in a set sequence that matches the National Wraparound Initiative Phases and Activities, with the understanding that the need for individualization comes first.
- Evidence-Based Practice and Practice-Based Evidence are crucial. Most states now regard high fidelity as evidence-based practice. It is also essential, when formal services are part of a wraparound plan, that those services be based on scientific evidence of effectiveness. For example, standard talk therapy has been shown to have limited outcomes. However, Functional Family Therapy, one of the evidence based practices, can be an essential part of an overall wraparound plan. Practice-based evidence which is based on the norms of a community or family culture is also essential to outcomes. VVDB teaches high fidelity staff to use Evidenced-Based Practices as part of wraparound, and to assess and use Practice-Based Evidence.