A Handbook For Administrators And Managers

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1 Wraparound Implementation Guide: A Handbook For Administrators And Managers By Patriia Miles, Neil Brown, and The National Wraparound Initiative Implementation Work Group. Prefae by Janet Walker and Eri Bruns.

2 The Wraparound Implementation Guide: A Handbook For Administrators And Managers The ontent of the Implementation Guide was ollaboratively reated and extensively peer reviewed. Authors By Patriia Miles, Neil Brown, and The National Wraparound Initiative Implementation Work Group Prefae by Janet Walker and Eri Bruns, Co-Coordinators of the National Wraparound Initiative Suggested Citation Miles, P., Brown, N., & The National Wraparound Initiative Implementation Work Group. (2011). The Wraparound Implementation Guide: A Handbook For Administrators And Managers. Portland, OR: National Wraparound Initiative.

3 Prefae Dear Reader, Sine first onvening in 2003, the basi mission of the National Wraparound Initiative has been to promote understanding about the wraparound model and its benefits, and to provide the field with guidane that failitates high quality and onsistent wraparound implementation. In its early stages, the NWI served as the onvening point for wraparound experts nationally to develop onsistent definitions of wraparound, inluding desriptions of the priniples of wraparound, basi ativities of the proess, and harateristis of supportive ommunities and systems. More reently, we have ommitted to more atively support high-quality wraparound implementation by developing and disseminating aountability and quality assurane tools, providing hands-on tehnial assistane, and developing a membership-based national ommunity of pratie. A few years ago, a workgroup within the NWI began to explore the idea of developing standards for wraparound implementation. However, after initial disussions, the group reahed a onsensus that it was not advisable to establish hard and fast rules. Instead, the group deided that the NWI should develop resoures that would provide guidane about wraparound implementation while also reognizing that implementation must be undertaken in a way that fits with the loal strengths, needs and resoures of individual ommunities. The workgroup members felt it Wraparound Implementation Guide 3

4 was of partiular importane to develop pratial information that was speifially tailored for managers and administrators who are involved in developing, implementing, managing, funding, or improving ommunity or state wraparound projets. This information would provide guidane not only about what sort of implementation support was needed for wraparound, but also how managers and administrators ould go about building the needed support. Thus the idea for a how-to manual was born. As in the past, the NWI relied on the individual and olletive expertise of its members to provide ontent for this new publiation. Members of the NWI s Standards Workgroup took the lead in generating material for inlusion in the proposed manual. Workgroup members were asked to ontribute material related to eah of the six themes or areas of wraparound implementation: ommunity partnership; ollaborative ation; fisal poliies and sustainability; aess to needed supports and servies; human resoure development and support; and aountability. For eah theme, workgroup members provided information regarding key onsiderations to keep in mind, the most ritial things to aomplish, and the biggest dangers or pitfalls to avoid. One the workgroup members ontributions had been gathered, we approahed two individuals who have extensive experiene in supporting wraparound implementation aross North Ameria and asked them to synthesize the raw material into a pratial guide for supervisors, managers, and administrators. The result is the urrent doument, the Wraparound Implementation Guide: A How- To Guide for Administrators and Managers. The Implementation Guide is designed to provide a road map for those in program and system oversight roles for wraparound, to help keep them foused on the range of important issues in overseeing effetive wraparound pratie. 4 Wraparound Implementation Guide

5 It is important to reognize, however, that supporting wraparound is not a step-bystep proess. As desribed in the introdutory hapter, wraparound implementation is omplex, and work related to one partiular theme is not independent of work related to other themes. Progress in one area an reinfore, allow, or aelerate progress in other areas; and eah ommunity will likely have different priority areas to work on at different juntures. Thus, the Guide is not designed to be read from over to over, but should instead be seen as a working doument that one an go bak to over time. Toward this end, we have built troubleshooting setions and self-assessments into the Guide, so that an administrator or ommunity team an use these tools periodially to hek how well they are doing. One more point is worth making. As Co-Coordinators, we are often asked whether ( when ) the NWI will in fat establish and disseminate hard and fast expetations or standards for wraparound implementation, suh as aseload sizes, mandated training and oahing ativities, neessary staffing patterns, required evaluation measures, and so forth. Indeed, establishing expetations in these areas is important beause we firmly believe that the suess of every wraparound initiative will be based largely on the nature and quality of the system and program support that is involved. We also have researh that baks up this belief. Thus, the NWI wants to be able to atively shape the development of ommunities, systems, and programs so that wraparound initiatives will sueed and hildren and families will thrive. At the same time, we also believe that one of the unique strengths of wraparound is its oneptual adaptability to loal needs and its ability to benefit from loal innovations. We reognize that every ommunity implements wraparound differently based on unique onditions. This means that, while we need to promote systems and organizations that support wraparound aross a defined set of domains, appliation of overly rigid standards runs the risk of onstraining loal individualization, adaptation, and innovation. What s more, with too many rigid standards in plae, many ommunities might deide that adopting the wraparound priniples in pratie is too ostly or not worth the effort, de-railing the movement toward more ollaborative, individualized, family- and youth-driven servie systems. To reflet this reative tension, we have taken guidane from NWI advisors and developed the Wraparound Implementation Guide in a way that is intended to provide diretion on how to ahieve aommodating onditions in the six areas of ommunity support without demanding that there is only one way to get there. In Wraparound Implementation Guide 5

6 fat, the initial draft was onstruted like a traveler s guidebook presenting useful maps, tips, and fats without suggesting there was only one route the traveler had to take in order to have a suessful voyage. Even though we eventually deided to make the Guide more straightforward we think this initial inspiration remains. We hope the flexible guidane provided here an help you and your ommunity, jurisdition, or state stay foused on high-quality wraparound implementation aross this range of speifi, researh-informed areas, while still allowing you to take a route that works best for you, your stakeholders, and, most importantly, your young people and families. Sinerely, Janet Walker Eri Bruns Co-Coordinators National Wraparound Initiative 6 Wraparound Implementation Guide

7 Members of the NWI Implementation / Standards Workgroup Gerry Rodriguez Neil Brown Don Koenig Mary Stone-Smith Mary Jo Meyers Bunny Hentshel Robin Orlando Keith Solomon Janet Walker Eri Bruns Sharon Morrison-Velaso Jon Nibbio Frank Pae Lisa Conlan Doug Crandall Brad Norman Sharon Yarish Connie Burgess Susan Mlaughlin Susan Boehrer Jim Rast Kurt Moore Pat Miles Ceth Ashen Mihael Rauso Wraparound Implementation Guide 7

8 Table Introdution Prefae...1 Members of the NWI Implementation / Standards Workgroup...5 Welome!...And, About This Guide Welome to wraparound... 8 About the proess...8 About this guide...10 Before you get started: Resoures for right now...11 Deiding where to start in the implementation manual A quik list of wraparound terms for managers...16 The Six Themes Theme 1: Community partnership...19 Theme 2: Collaborative ation Wraparound Implementation Guide

9 of Contents The Six Themes (Continued) Theme 3: Fisal poliies and sustainability Theme 4: Aess to needed supports and servies...46 Theme 5: Human resoure development and support Theme 6: Aountability...59 Troubleshooting: FAQ For wraparound supervisors...67 For wraparound managers...71 For administrators For wraparound funders...78 Appendix Appendix A: Community Groundwork for Wraparound Implementation: A Self-Assessment of Strengths and Needs Appendix B: Self-Assessment Tools for the Leaders, Managers, and Planners of Efforts to Implement Wraparound...90 Wraparound Implementation Guide 9

10 Welome To Wraparound Congratulations on your deision to develop, implement, or improve your wraparound projet. Administering a wraparound projet takes a great deal of ommitment, time and energy. We are hopeful that this Implementation Guide an be helpful to you as you seek to improve servies, supports, and outomes for hildren and families. About the Proess Wraparound is a planning proess that follows a series of steps to help hildren and their families realize a life that reflets their hopes and dreams. Wraparound also helps make sure hildren and youth grow up in their homes and ommunities. It is a planning proess that brings people together from different parts of the family s life. With help from one or more failitators, people from the family s life work together, oordinate their ativities, and move loser together in their view of the family s situation. This proess of oming together always inludes the family as a entral partner in building a oordinated view. Sine the term was first oined in the 1980s, wraparound has been defined in different ways. Wraparound has been desribed as a philosophy, an approah, and a servie. Wraparound an feel like a moving target beause it is designed to adapt to the ontexts of different types of ommunities and systems as well as the needs of individual families. 10 Wraparound Implementation Guide

11 In reent years, wraparound has been most ommonly oneived of as an intensive, individualized are planning and management proess. Wraparound is not a treatment per se. The wraparound proess aims to ahieve positive outomes by providing a strutured, reative and individualized team planning proess that, ompared to traditional treatment planning, results in plans that are more effetive and more relevant to the hild and family. Additionally, wraparound plans are more holisti than traditional are plans in that they are designed to meet the identified needs of aregivers and siblings and to address a range of life areas. Through the team-based planning and implementation proess, wraparound also aims to develop the problem-solving skills, oping skills, and self-effiay of the young people and family members. Finally, there is an emphasis on integrating the youth into the ommunity and building the family s soial support network. Wraparound Implementation Guide 11

12 About This Guide This manual is organized into six units whih orrespond to the six neessary onditions for wraparound implementation as defined by the NWI through a onsensus proess. These areas of neessary ommunity support inlude ommunity partnership; ollaborative ation; fisal poliies and sustainability; aess to needed supports and servies; human resoure development and support; and aountability. The Community Partnership unit fouses on key features for establishing olletive ownership of and responsibility for operation of the wraparound effort. Options for developing effetive strutures and proesses that failitate suh partnership and oversight will be overed. The Collaborative Ation unit disusses ways to maintain joint ownership of the wraparound effort. This will inlude ativities that ut aross systems while also addressing vertial ownership from administrative levels to supervisory levels. The Fisal Poliies and Sustainability unit is foused on aligning resoures and reating poliies and proedures that support wraparound implementation. This unit will not disuss in detail the range of funding streams that an be aligned to support wraparound (you an look to the NWI website for many suh examples: instead, it will review proess steps to make sure that enough resoures are available to support quality implementation. Key hallenges and 12 Wraparound Implementation Guide

13 suggestions for ensuring an integration of fisal and program onerns will be addressed. Aess to Needed Supports and Servies is a unit that rosses over to pratie areas as well as poliy and management areas. Effetive administrators and managers must fous on strutural and resoure issues (suh as the nature of the loal servie array) to make sure families served through the wraparound proess have just-intime aess to needed supports and servies or the initiative runs the risk of only planning, without following through. If a range of servie and support responses is not available, hanes are great that the loal projet will fail to realize hoped-for outomes. The Human Resoure Development and Support unit is foused on the people issues assoiated with Wraparound implementation. While there are key apaities any wraparound projet should have, the range of staffing options varies widely from site to site. What is always true is that wraparound staff need support and diretion. The projet should also seek to ensure that partner ageny personnel are aligned with the goals and ativities of the wraparound projet. The Aountability unit is designed to provide an overview of how a wraparound projet is monitored and evaluated. Experiene has taught us that newly implemented wraparound projets should onstrut a lear set of expetations regarding aountability and find ways to use data to improve the projet. Aountability reates an opportunity for wraparound managers and stakeholders to make adjustments to ensure effetive implementation. Before You Get Started: Resoures for Right Now State Level Most of the 50 states have legislation and/or administrative regulations that referene wraparound. This formal referene an range from regulations that desribe the wraparound proess (California) to training efforts (Arkansas) to funding initiatives (Oregon) to an organized statewide network of loal initiatives that implement wraparound (Massahusetts). Even if you are not diretly involved in state-supported wraparound efforts it is often useful to make ontat with the state representatives who are involved with wraparound. This will allow you to identify resoures, rules or regulations that you an use to support your implementation. Wraparound Implementation Guide 13

14 County Level You are likely to find wraparound or wraparound-like ativities housed within ertain ounty organizations. Some will involve loal hild welfare or mental health authorities while others will be found through loal shools or juvenile ourt sponsored ativities. Making ontat with your loal resoures is likely to reate an opportunity for shared understanding, as well as the possibility of sharing resoures one you have ompleted this Implementation Guide. Private Providers A number of private providers have worked diligently to integrate the wraparound philosophy in all of the work they do. If you are aware of who is pratiing in your ommunity, it would be wise to determine whether they are using the wraparound proess, and in whih settings. Some mental health outpatient providers have developed an array of wraparound responses for a wide range of populations from hildren/youth to older adults. Building a network of wraparound friends will allow you to share not only resoures but a range of lessons learned about wraparound pratie and management. Take the time to learn lessons from other providers as you reflet on your own partiipation. Community and Family Organizations Community organizations, espeially family organizations, may also serve as a good opportunity to gather information. Family organizations have long been advoates of quality implementation of wraparound on a national, state and loal sene. Chek out your state or loal Federation of Families website to see if they have feedbak and information about other resoures that ould be aessed as you get started with this Guide. A Note About Definitions One word of aution is around the use of the term wraparound. Wraparound is used in a variety of ways. Some states may have regulations that refer to wraparound servies. This term usually represents a set of flexible, ommunity-based and often billable servies that are used to support people in their homes and ommunities. A seond use of the term is wraparound philosophy or approah, whih generally means that some type of human servie is intended to follow the Ten Priniples as artiulated by the National Wraparound Initiative (see 14 Wraparound Implementation Guide

15 TenPrinWAProess.pdf), and/or other values. Pertinent to this use of the term, it is possible to follow many of the same priniples in other servie setors (linial, eduational, justie, health, et.) and still not implement the full wraparound proess. The wraparound proess is the model that is most diretly disussed in the materials of the National Wraparound Initiative, and refers to a family-determined, individualized, team-based are planning and oordination proess that resembles the desription provided by the NWI. The existene of multiple and overlapping definitions of wraparound an be frustrating and onfusing to leadership. But it is also refletive of the dynami, grassroots, and adaptive nature of the wraparound onept. Understanding and being able to desribe these different refletions of wraparound an serve to deepen your understanding of what the proess should look like as you strive for quality implementation. Deiding Where to Start in the Implementation Manual This setion is designed to provide a basi overview of wraparound implementation, and to introdue you to the types of information and resoures that are offered in the Implementation Support setion of the NWI website (see overall.shtml). 1. What are the main things to plan for in wraparound implementation? Every ommunity implements wraparound differently, based on its own unique loal onditions. However, eah ommunity also needs to aomplish a set of ore implementation tasks in various areas, suh as setting goals, funding the wraparound effort, hiring and training staff, traking outomes, and so on. There are no rules about where a ommunity or initiative must start in terms of building wraparound infrastruture; however, researh and experiene tells us that it is ritially Wraparound Implementation Guide 15

16 important that these supports get put in plae. This Implementation Guide is strutured around six implementation areas or themes that have been identified in researh using the Community Supports for Wraparound Inventory (CSWI). All ommunities or wraparound initiatives implementing a full wraparound proess must attend to these six themes. The six themes are: ommunity partnership; ollaborative ation; fisal poliies and sustainability; aess to needed supports and servies; human resoure development and support; and aountability. Within eah theme, there is a series of neessary onditions that ommunities typially need to have in plae in order to support high quality wraparound. HUMAN RESOURCE DEVELOPMENT COMMUNITY PARTNERSHIP COLLABORATIVE ACTION ACCESS TO NEEDED SUPPORTS AND SERVICES ACCOUNTABILITY FISCAL POLICIES The setions of this Implementation Guide eah relate to one of the six themes. In eah setion, there is a set of frequently asked questions that provide a kind of overview of important areas of work, key onsiderations, and pitfalls to avoid. Additionally, eah setion inludes referenes to resoures that provide a deeper level of detail on key topis within the theme. An online version of this Guide, found at provides ative links to these online resoures. In general, the NWI s Resoure Guide to Wraparound, found at pdx.edu/nwi-book/index.shtml, provides a host of more detailed examples of high quality implementation. 16 Wraparound Implementation Guide

17 2. Where do we begin? Developing ommunity apaity to implement and support wraparound is a developmental proess, and work is typially ongoing in eah of the six areas. Still, every ommunity needs to get started somewhere. A good first step is to review what sort of groundwork your ommunity or system has laid for wraparound thus far, and to identify areas of greatest strength or apaity as well as the areas of greatest need. You an use the Community Groundwork for Wraparound Implementation selfassessment in Appendix A as a tool to help you review your ommunity s strengths and needs. Consider the results of your self-assessment. You may hoose to start by working on areas of strength beause that may give you the most signifiant gain right away, or you may hoose to start by fousing on the area of greatest hallenge so that your wraparound efforts an have a firm foundation aross implementation areas. There is no right order or single right way to address these themes, but some themes are more interrelated than others. For example, while ommunity partnership and ollaborative ation are interrelated, they also represent some unique attributes and ativities. The ommunity partnership theme speaks to formal arrangements and relationships between ommunity stakeholders while ollaborative ation referenes ations that grow out of the partnership. Community partnership is often neessary for reating the range of imaginative and family-entered responses that is identified in the aess to needed servies and supports theme. It ould also be argued that a ommunity or projet won t have a wide range of responses available unless partners take ollaborative ation to develop oherent finaning shemes as artiulated in the fisal poliies and sustainability theme. Finally, all of the themes are not likely to make muh differene unless a well-supported workfore is dediated to the implementation of wraparound in your ommunity. The point is that, while the themes are signifiantly intertwined, eah ommunity has to hoose to start somewhere. After thinking about your ommunity s strengths and needs for improvement, hoose a theme and go to the appropriate setion of this resoure. This represents a starting plae rather than an ending. Wraparound is often referred to an aspirational model; you are not likely to reah perfetion in any of the themes outlined in this Guide. Progress, however, an be made and is required to ensure effetive quality of implementation of wraparound pratie for eah family you support. Wraparound Implementation Guide 17

18 3. What if we need more help? Many times, wraparound projets turn to onsultants, trainers and tehnial assistane providers to provide the level of ustomized and intensive assistane that goes far deeper than even a omprehensive set of stati implementation resoures. Yet, it is sometimes diffiult to loate a onsultant that mathes a partiular projet s needs. The NWI maintains a listing of onsultants that is intended to serve as a resoure to projets as they explore options for onsultation. This information has been submitted by the onsultants themselves, and inludes both NWI advisors and other people not affiliated with the NWI. Consultants appear in no partiular order. We strongly enourage you to read the Resoure Guide artile on Choosing a Consultant to Support Your Wraparound Projet (Chapter 5a.3) before purhasing onsultation, training, or tehnial assistane servies. The NWI may also be able to help a loal or state initiative diretly. One way in whih we an do this is to support the aountability funtion of wraparound implementation. At a ommunity or system level, the NWI has developed the Community Supports for Wraparound Inventory whih provides information on the level of development in the six themes of wraparound support and a proedure for supporting web-based data olletion from loal stakeholders. At a pratie level, the Wraparound Evaluation and Researh Team at the University of Washington disseminates several implementation fidelity measures. (You an go to depts.washington.edu/wrapeval to learn more.) Finally, the NWI has partnered even more atively with a number of loal and state wraparound projets. For some examples, go to our page on the NWI aross the USA. We look forward to ollaborating with you! A Quik List of Wraparound Terms for Managers Wraparound proess: An intensive, team-based, individualized are planning and management proess that follows a series of steps and onsiders a set of unique inputs to help hildren and their families realize a life that reflets their hopes and dreams. Wraparound priniples: A set of 10 statements that defines the wraparound philosophy and guides the ativities of the wraparound proess. Wraparound approah: Informed by the wraparound priniples. When the priniples of wraparound are purposefully applied to servies or supports that are 18 Wraparound Implementation Guide

19 different from the full wraparound are oordination proess (e.g., hild welfare ase work, day treatment, ase management) we often refer to these servies as adopting a wraparound approah. Flexible servies: A term that is often used to desribe flexibly funded or delivered inhome ativities. Any number of ommunitybased servies an be inluded in this definition, ranging from in-home workers, respite are, transportation, mentoring or other reative ommunity-based approahes. Community team: A group of stakeholders from aross interest groups who provide leadership, strategi planning, support, santion, and aountability to your wraparound proess. Members of the ommunity team typially inlude representatives of hildserving systems, provider organizations, family advoay organizations, ommunity and business groups, and representatives of the hildren and families served by the system or wraparound initiative. Wraparound teams: Also known as hild and family teams, these are groups of people hosen with the family and onneted to them through natural, ommunity, and formal support relationships who develop and implement the family s plan, address unmet needs, and work toward a olletive team mission that reflets the family s vision. Flexible funds: Dollars that are available to individual hild and family teams that an be used to provide flexible, reative or unique servies, supports or strategies. Wraparound staff positions: The range of staff assigned to implement the wraparound proess on the hild and family level. Wraparound staffing an range from one position suh as a failitator or are oordinator who is responsible for putting the proess together for eah family to a group of multiple staff persons that might inlude family support partners, youth partners and/or behavioral speialists. Wraparound staffing varies from site to site but all sites must have the apaity to Wraparound Implementation Guide 19

20 have someone take on the primary role for putting the proess together. Failitator: A person who is trained to oordinate the wraparound proess for an individual family. This person may also be alled are oordinator, navigator, wraparound speialist, resoure failitator or some other term. The person in the failitator role may hange over time, depending on what the family thinks is working best. For example, a parent, aregiver, or other team member may take over failitating team meetings after a period of time. Wraparound fidelity: How fully the wraparound proess (whether it is for a family, in an organization, or in a whole system) adheres to the 10 priniples and basi ativities of the wraparound proess. Can be measured using fidelity tools suh as the Wraparound Fidelity Index or Team Observation Measure. Wraparound fidelity should not be onsidered synonymous with wraparound quality; a wraparound team or initiative that sores high on getting the basi wraparound steps done may still need improvements in the quality of its work. Community supports/neessary onditions: Conditions at the system or organizational level that need to be in plae to ensure that the wraparound proess for individual families is likely to be well-implemented and sueed in ahieving positive outomes. Community supports fall into six themes: ommunity partnership; ollaborative ation; fisal poliies and sustainability; aess to needed supports and servies; human resoure development and support; and aountability. 20 Wraparound Implementation Guide

21 Theme 1: Community Partnership Aording to the Community Supports for Wraparound Inventory, ommunity partnership in wraparound is defined as olletive ommunity ownership of and responsibility for wraparound that is built through ollaborations among key stakeholder groups. As oneived by the National Wraparound Initiative, implementation of wraparound requires attention to six types of ommunity supports. One of these areas is ommunity partnership. This setion provides information regarding how stakeholders involved in the wraparound effort do things suh as: hoose a ollaborative struture, manage this struture, use this ollaborative struture effetively, and support stakeholders to partiipate effetively. 1. What kind of ollaborative struture should we use? The ideal platform for wraparound implementation involves some sort of ollaborative struture often known as a ommunity team in whih deisions are made. A ommunity that is interested in building wraparound apaity has hoies in establishing the ollaborative body. These options inlude: Finding an existing ollaborative body. Wraparound projets don t operate in a vauum. Many ommunities may already have ollaborative strutures in plae Wraparound Implementation Guide 21

22 that an be tapped in building ross-ommunity support for the projet. You may find that linking with an existing effort is the most effiient and effetive way to get your projet off the ground while getting it reognized as a valid effort. Creating a new ollaborative body. You may also find that existing ollaborative strutures don t have the right mix of partiipation, deision-making proesses or fous. In this ase, you may elet to reate a ollaborative body that will provide a platform for launhing wraparound efforts. Whether you link up to an existing struture or find you need to reate a new entity, ertain harateristis and apaities are neessary. These inlude: A representative group of stakeholders who are able to olletively take responsibility for task oversight inluding projet design and risk assumption, as well as for projet guidane through obstales and hallenges. Strutures assoiated with quality wraparound implementation always inlude a plae at the table for youth and families who are reeiving servies and/or advoate for the interests of youth and families who are engaged in servies. Like all members of the ollaborative struture, families and young people should be provided with support and training so that they an partiipate fully and omfortably in these roles. Relevant expertise with representatives who are able to partiipate in deision making. Collaborative bodies should inlude a range of representatives from within soial servie irles, but should also inlude representatives with a range of perspetives outside of those irles. Examples inlude representatives of business and ultural organizations and groups, philanthropy, higher eduation and youth and families. Good representation at the ollaborative body level should reflet the diversity of the ommunity. Authority to atually make deisions that are followed in terms of program design and the apaity to ommit finanial, programmati and staff resoures to the implementation of the projet. 2. What are the steps for preparing a wraparound ollaborative partnership? Merely onvening a ommunity ollaborative body is not enough to ensure its suess. Wraparound an be oneived as a proative systems hange proess (see 22 Wraparound Implementation Guide

23 Chapter 5.b by John Franz in the NWI s Resoure Guide to Wraparound) that requires effetive funtioning of the ollaborative body. The following are a few points to keep in mind: Set a lear purpose. You should work with stakeholders to set a lear purpose for the projet inluding defining who will be helped, how they will be helped, and what the results of the help will be. Build effiieny of effort. Keeping the ollaborative body together requires attention to effiieny. You should be mindful of people s time spent in meetings, and the relevane of the issues and deisions onsidered. Deisions put in front of the group should be deisions that group members are authorized to make; otherwise, you will be taking people s time to disuss areas they have no influene over. It is also important to remember that everyone wants to feel useful. The wraparound projet should reate ways for members of the ollaborative body to make a differene. Develop a method to ensure stakeholder representation. Some steps in a wraparound implementation are nonnegotiable. These inlude the partiipation of families, youth and system providers. Other partiipants are ritial but should be tailored to the strengths, needs and ontext of the ommunity. Consider partiipation vertially, inluding identifying what layer of an organization is most effetive for the job at hand, as well as horizontally, by inluding individuals who represent a broad spetrum of partiipation. Get speifi about how you will make sure that partiipation is balaned and broad based while always ensuring that families are learly listened to and represented. Math your strutures to meet your purpose. Effetive wraparound implementation requires a blend of struture and partiipation. Beause wraparound represents hange at the pratie or diret family level while onurrently foring hange at the management and system levels, you will have to make deisions Wraparound Implementation Guide 23

24 about how to implement the right-sized partnership struture. Some ommunities develop very simple strutures in whih mid-managers meet twie monthly for the purposes of ratifying enrollments and onduting open disussion about hallenges. Other ommunities will develop more omplex strutures that entail multiple levels of partiipation (managers, administrators, pratitioners, supervisors, families and staff types) that address the mehanial aspets of wraparound but also form fairly ambitious system hange and improvement ativities. Still other projets will start with a single sponsor who agrees to support and hampion efforts. While the absene of a strutured ommunity body doesn t prelude getting started with wraparound, the presene of suh a body an make implementation more effetive and onsistent. The key point is to start with what you have and ontinue to work towards effetive partnership. For an example of one ommunity s approah to developing a ommunity team, see Chapter 5.f by Andrew Debiki in the Resoure Guide to Wraparound. 3. What ativities should our ommunity ollaborative struture(s) undertake? The ommunity ollaborative struture (often referred to as a ommunity team ) an serve a number of roles. The fous of ommunity teams ranges from setting goals to intake to monitoring the projet for quality. The following items should be onsidered in every wraparound projet: Referral, enrollment and assignment. These ativities are about making sure that families and other stakeholders have a lear pathway to enter wraparound. This inludes setting forth enrollment riteria, setting a proess to ensure that families are gaining aess to wraparound in a timely fashion, and ensuring that families are mathed to individuals or organizations that are likely to provide 24 Wraparound Implementation Guide

25 quality servies. Speifi areas to address inlude: + + Population of fous. Setting the target for who should be helped through the wraparound proess. This should inlude the harateristis and indiators of families who everyone an agree need this type of pratie. + + Gatekeeping. Creating a proess to ensure that the right family situations are making their way to the people who are operating the wraparound projet. This proess will often involve a group of stakeholders reviewing referrals to ensure that youth and families are never rejeted from the proess for being seen as having too muh need or to ensure that families who enter wraparound have adequate levels of need to justify their enrollment in the projet. In some ommunities this may inlude other system proesses suh as assessing medial neessity. + + Assignment. This funtion an be housed within the ommunity team or an be assigned to the organization that is responsible for wraparound implementation. In larger ommunities that have multiple providers, this may entail blind assignments or mathing to the antiipated needs of the family. In smaller ommunities in whih one provider is responsible for wraparound implementation, this will often involve the supervisor or manager assigning a newly enrolled family to the right omplement of staff. Quality management. Managing quality in wraparound is an ongoing part of the proess. The ommunity team should ensure that quality is addressed and is a major fous of ativities. This is done in the following areas: + + Plan review. Some sites will have eah plan of are reviewed by the ommunity team during the initial two years of operation. This is helpful in establishing onsensus about quality. It an also be dangerous if the ommunity team tries to make major hanges to the plan. Though a ommunity team may wish to have this level of oversight, it is important that the wraparound (hild and family) team that is uniquely onstruted for eah family an serve as the deision maker for what is needed. The ommunity team, however, an set quality benhmarks and review plans to make sure that every plan ompleted addresses quality elements. + + Outomes traking. Effetive ommunity partnerships will pay attention to outomes as they our rather than waiting for an end-of-year report. Depend- Wraparound Implementation Guide 25

26 ing on the number of families enrolled in your projet, traking outomes an be a struggle unless you have reated a method for paying attention on an individual level. As disussed in this Guide s setion on aountability, it is helpful to set benhmarks that address living situation, shool attendane and other areas upon ompletion of wraparound. + + Provider network and the array of servies and supports. Good provider networks are broad based and well balaned. The ommunity team will need to be able to oversee the development of a provider network that provides a range of treatment servies, support servies, and ommunity servies, ideally based on data from families, wraparound plans, and failitators about what servie and support options are urrently available and of high quality and what are not. This will undoubtedly be a developmental proess and will our slowly, but it should be atively attended to by the ommunity team (See more in setion on aess to needed supports and servies). + + Fisal oversight and sustainability. Effetive wraparound initiatives are able to manage, blend and braid funds from a variety of soures. When this doesn t happen entrally, wraparound providers often marh to two or more masters in the form of funders. The ommunity team should be well-informed about, oversee the blending or braiding of, and monitor the use of different funding streams to ensure sustainability, flexibility, and that providers are adhering to the wraparound priniples regardless of the different soures of funds that are used to finane the initiative. (See more in setion on fisal poliies and sustainability). 4. How an we support stakeholders to partiipate effetively in the ollaborative proess? Effetive ommunity partnership involves more than having people attend meetings. Strategies for ensuring effetive partiipation inlude: Ensuring that individuals have the right information and orientation to the setting they are in. This inludes ensuring that individuals partiipating in the ommunity struture have a ommon understanding of wraparound as well as verifying that they are santioned to partiipate. + + Develop and distribute written materials to enourage ommon understanding. 26 Wraparound Implementation Guide

27 + + Set aside time to allow people to get to know eah other as individuals. + + Take the time to orient members until you are satisfied there is ommon agreement. Developing a strutured and detailed definition of the rules of engagement. + + Many of the partners who partiipate on the wraparound ommunity team may be used to partiipating in ross system, ommunity or ollaborative meetings, some of whih may not have been designed to be as supportive of systems hange as the wraparound ommunity team. In order to avoid this just being another ollaborative, it is useful to reate detailed desriptions of the role and responsibility of eah team member and the body as a whole. + + Lead the group in identifying their deision making proess before they make deisions. This an be formal or informal, involve voting, majority rule or a variety of other proesses but it is often helpful for individuals to make a deision about deision making before onfronting the gathered group with the deision itself. Developing a proess for managing hanging representation of stakeholders over time. The initial group gathered to support wraparound implementation will hange over time based on ommunity and personal onditions. + + Remember to orient new members with the same are and attention you used with the initial group s development. This inludes reating a written memory as well as identifying buddies or mentors for new members. Doing an orientation individually or in small groups outside of the meeting time an help keep meetings foused and effiient for all members. + + Aknowledge and reflet on hanges from the initial development of this group. It is important for groups to reognize what Wraparound Implementation Guide 27

28 they do now and how it differs from their original ativities. For example, one ommunity team no longer reviews flex fund requests on an individual level. In the early years of implementation, reviewing individual flexible fund requests was helpful for identifying the types of gaps within systems as well as developing onsensus about appropriate expenditure patterns. Over the years this ommunity team disovered that ontinuing to review eah request led to miro-management and, in some ases, detrated from the wraparound value of family voie and hoie by having a group of strangers reviewing eah expenditure. This group now reviews system patterns, inluding a quarterly aggregate finanial report that shows umulative expenditures for all enrolled families by life domain. 5. What are key ommunity partnership autions? Getting too far ahead of your ommunity partnership. Wraparound projets that move forward with implementation on the ground with families without bringing along their olletive ommunity partnership will find their projet at risk of beoming an isolated pilot that has little relevane to the larger system or ommunity ontext. When this ours, the wraparound projet looks like a subulture that partners tend to dismiss. This isn t good for families or staff. Involve your partners at every step of implementation even when you don t want to. Failing to evolve within ommunity partnerships. Creating a apaity for ommunity partnership is developmental. The omposition, fous, ativities and traditions of your ommunity partnership will evolve over time. It should. As your wraparound projet matures, so will the relationships that omprise your ollaborative body. Omitting key players. Good ollaborative bodies should inlude a range of representation. This means that the ollaborative body should be prepared to invite, welome and work losely with a range of individuals from a 28 Wraparound Implementation Guide

29 range of bakgrounds. Avoiding jargon, adapting approahes inluding meeting loations, times and formats and fostering allianes among members an ontribute to the effetiveness of the partnership experiene. Allowing dominating perspetives. The ollaborative body should avoid allowing a single person or organization to be the overpowering fore behind the effort. While it is not unusual for one member to have a different investment in wraparound implementation than another, it is important that the projet be open to a wide range of perspetives. If one system or partner had all of the answers you wouldn t need wraparound. Aepting a false onsensus. Consensus doesn t neessarily mean that everyone agrees with every deision. Effetive ollaborative bodies are able to inorporate onflit in deision making, reate spae for disagreements to emerge and leave time to work through differenes. 6. What is the take-home message? Utilizing ommunity partnership to guide and support your wraparound initiative is a ritial and developmental omponent of effetively managing this kind of effort. Critial deisions inlude who partiipates, where you loate the partnership body, establishing appropriate deision making sope, and maintaining vitality and fous over time for the group that works together. Developmental aspets of this partnership will be refleted in refining and adapting the fous of the partnership as the ommunity and system onditions hange. What the partnership will need to work on in the third year of your projet should be very different than what you need to do in the first year of the effort. This hange will be refleted developmentally in the ontent and sope of the deisions that are onsidered and made, as well as the strutures that represent your wraparound ommunity partnership. Wraparound Implementation Guide 29

30 Theme 2: Collaborative Ation Aording to the Community Supports for Wraparound Inventory, when a wraparound initiative is fully supported in the area of ollaborative ation, stakeholders involved in the wraparound effort take onrete steps to translate the wraparound philosophy into speifi poliies, praties and ahievements. Collaborative ation is tightly tied to ommunity partnership. Collaborative ation reinfores the idea that leadership has a role that goes far beyond making an initial deision to build wraparound apaity. For suessful wraparound implementation to our, poliy makers, in ollaboration with ommunity and system partners as well as pratitioners and families, must work together to take the steps that are needed to ahieve the goals of the wraparound plan. Wraparound is unlikely to survive without a orresponding leader(s) or hampion(s) providing support. Even as the projet develops the apaity to support families using wraparound planning, ollaborative ation needs to our onurrently on the program and system levels. 30 Wraparound Implementation Guide

31 This setion fouses on key issues and strategies to onsider in helping your wraparound stakeholders move ahead in a ollaborative and oordinated way. For more details and ommunity examples, you an also find several artiles in the NWI s Resoure Guide to Wraparound that provide information about the proess of ommunity development and system hange that is typially neessary in order for ommunities to ollaborate in their ativities in support of wraparound, inluding Planning for and Implementing System Change Using the Wraparound Proess (Chapter 5b), and Family Voies Network of Erie County: One Community s Story of Implementing System Reform (Chapter 5b.2). 1. What are some important first steps? Loate ollaborative leaders for your wraparound efforts. Wraparound efforts rarely sueed without hampions. These hampions an be housed in funding agenies, provider agenies and partner agenies. These leaders must have several key harateristis to be suessful wraparound sponsors, inluding having a signifiant understanding of wraparound, larity on what the initiative hopes to aomplish, and knowledge of typial methods used in wraparound to aomplish goals. Further, these ollaborative leaders must be able to see the whole and omponent parts on both vertial and horizontal levels. This means that effetive ollaborative leaders an design poliy initiatives that are oherent and add value to the wraparound initiative at the ground level where the proess serves youths and families. Develop a guiding plan. Managers and leaders assoiated with wraparound implementation should design and struture a plan that is future-oriented, onrete and speifi. Collaborative ation without that guiding plan runs the risk of detrating from the wraparound initiative rather than providing safe haven for it. Key deisions and issues that should be onsidered in reating the guiding plan inlude defining an initial population of fous; managing family entry and enrollment; funding and building apaity for neessary staff roles for wraparound implementation; developing supports and servies as identified in wraparound team plans; setting performane measures inluding outome, wraparound quality, satisfation and fisal indiators; and, finally, having a designated approah for mid-ourse orretion. Fous on oordinated planning at all levels. Leaders, inluding managers and supervisors, must work together to ensure that integration is ourring from the Wraparound Implementation Guide 31

32 hild and family level through the ageny level, and on through the poliy level. This means that leaders must work to ensure that single plans are evident at all levels of the initiative. At the team planning level, this means that all parties agree to work off of a single plan of are. At the ommunity level, this means that leaders should fous on oordinating and/or integrating administrative ativities. Examples inlude reating onsistent ageny poliies and proedures that are ompatible with the wraparound initiative. This might inlude programmati onerns (family as unit of support, working with entire families, partnering with parents and aregivers), personnel onerns (inorporating family voie in reruiting, hiring and evaluating staff) and administrative onerns (opening organizational ulture to family impat). 2. Doesn t the neessary level of ollaboration take time to build up? Yes! Working together to translate wraparound into onrete ations and to build oherene between the values espoused by wraparound and the way the system or host environment operates takes time, ommitment and talent. Often, it takes some initial suess to onvine stakeholders to make a deeper ommitment to ollaboration and to wraparound, and this allows the projet to move forward into more truly ollaborative ativities. Leaders need to be lear-sighted and, often, pragmati when deiding what they an implement in the short run versus what is ideal for wraparound. They may deide that a less formal, less developed and less fully ollaborative option is what is needed in order to get the wraparound projet underway; however, leaders should be aware of hallenges that may arise as a result. For example, some projets hoose to begin operation using failitators that are loaned or bought out part-time from their usual jobs in hild- and family-serving agenies suh as mental health or juvenile justie. Thus, these failitators are not employed exlusively in wraparound, and have not been hired speifially for the wraparound projet. This sort of model may be the most feasible option for some ommunities in early-stage wraparound development; however, experiene has shown that ommunities that rely on this sort of staffing plan have a hard time ensuring that these part-time failitators have suffiient time, skill, and motivation to omplete a high quality wraparound proess. Demands from the home system may take preedene over wraparound duties, sine the home system is the one that typially remains the offiial employer. Additionally, the projet often experienes 32 Wraparound Implementation Guide

33 onfusion about who will supervise these part-time failitators, and the failitators themselves often omplain that the philosophy and values that govern their other duties are inonsistent with wraparound s philosophy and values. This is not to say that this sort of staffing pattern never works out or allows a ommunity to eventually move to a staffing pattern with full time failitators hired speifially for wraparound; however, stakeholders should eduate themselves about the hallenges assoiated with suh a hoie. Of ourse, making too many ompromises an mean that a ommunity implements wraparound so poorly that it doesn t really help families and/or that various stakeholders beome disillusioned and unwilling to ollaborate with the wraparound projet. 3. What are some of the most ommon pitfalls we should avoid? Failing to allow enough time. Building ollaborative ation that reates support for wraparound implementation takes time and ommitment. Managers and leaders must be prepared to stay onneted with the projet through its early implementation, and ontinue to stay involved as the projet matures, expands and adapts. Be prepared to dediate time to understand how the projet is operating, as well as reating mehanisms to ensure that administrators have a signifiant understanding of the hild and family s experiene. Creating a firewall between the wraparound projet and the rest of the system. A wraparound projet should be relevant to the overall system in whih it operates. If not, the projet runs the risk of beoming inreasingly irrelevant over time. Wraparound priniples should be relevant to the rest of the system and wraparound-ompatible language an be refleted in ontrats, agreements, proedures and poliies. In some ases, wraparound managers will identify inonsisteny between system proesses and wraparound proesses. In these ases, Wraparound Implementation Guide 33

34 managers and ommunity teams should work to resolve those inonsistenies for diret servie staff and families. Failing to beome the hange you wish to see. A ommon mistake for many wraparound hampions is to fous hange efforts on the wraparound projet rather than their own organizations. County mental health or hild welfare managers who reate wraparound ontrats so they an have an additional referral option miss the boat when they don t make hanges in their own operations. Likewise, the administrator of a nonprofit organization who thinks he or she an start a wraparound department without identifying proedure and protool hanges ageny-wide is likely to be faed with many hallenges and organizational onflits shortly after implementation. Substituting values speak for real hange. Some leaders and wraparound hampions are able to preah the need for hange around wraparound values. The wraparound values base an be useful in terms of reating a ase for hange as well as way to talk about hange. Realizing the potential of wraparound requires a hange in systems and strutures and wraparound hampions should be prepared to make these hanges. During early days of implementation, this may involve seeking exeptions to situations but as the projet matures wraparound leaders should be prepared to onstrut poliy and proedural hanges that show a formal endorsement for reative, needsbased planning and programming. Omitting young people and families. Young people and families should be part of the ollaborative ation and leadership equation. When joining with young people and families there are two ommon traps that leaders may fae. The first is the trap of guilt. This ours when an in-system ally hears the family s perspetive for the first time and begins to realize what brought them to this situation. This 34 Wraparound Implementation Guide

35 an also our when families raise onerns about wraparound implementation. Guilt an ause paralysis and shame. The seond area is the trap of denial. This ours when a family s perspetive is heard but the reation is to deny the reality. Often, families messages about system operations seem too painful to ontemplate. This sometimes ours with nasent wraparound projets as families make omplaints. Even though wraparound may reflet a ommunity s best hopes for exellent pratie, wraparound is as apable as any other approah of getting it wrong with an individual family. Don t let this possibility deter you from inluding youths and families in leadership and ourse orretion, or from being persistent in your efforts to improve servies and systems through wraparound when a family points out shortomings. 4. What is the take home message? What are the key things we should keep asking ourselves? Here are some key questions to help you remember some lessons learned by others as you move from building partnership to ollaborative ation on your journey: Have we worked to ensure that all partiipants in our effort understand the values that guide us? Have we invested the time to make sure we have a plan for moving ahead, and that the right people know the plan? Have we reated an environment where we are hanging not only the spae between agenies and organizations, but also paying attention to hanging individual ageny/ system life so that it aligns better with our vision and ation plan? Have we laid out a lear plan for our first and next steps? Have we revisited and updated the plan as a way for us to model ollaborative ation at the planning and leadership table? Wraparound Implementation Guide 35

36 Theme 3: Fisal Poliies And Sustainability Aording to the Community Supports for Wraparound Inventory, suess in the area of fisal poliies and sustainability in wraparound is ahieved when the ommunity has developed fisal strategies to meet the needs of hildren partiipating in wraparound, and methods to ollet and use data on expenditures for wraparound-eligible hildren. Suessful wraparound projets require funding and fisal poliies that embrae wraparound values. A key question is whether you an do wraparound planning without funding. The answer to that is it depends. First, it depends on how muh apaity you want to build. If you are looking to establish wraparound in your system as an exeption to basi are and use it sparingly you an probably garner enough staff resoures to follow the proess, but it will probably be inonsistently ahieved. Seond, it depends on the urrent degree of flexibility of your system s resoures. If you are in a system that has maximized flexibility so that every dollar is seen as flexible and is able to follow the hild and family, then you probably don t need 36 Wraparound Implementation Guide

37 additional funding to implement a high-quality wraparound proess. If, however, you are looking to make wraparound regularly available within a typially siloed system, then you probably need to assign initial dollars while working to reate more flexible fisal poliies over time. This setion addresses some of the most important questions that typially arise when ommunities are developing strategies related to fisal poliies and sustainability. 1. How have ommunities used available funding streams to finane and sustain wraparound? The Resoure Guide to Wraparound ontains a number of hapters that fous on this important question. The hapters are found in setion 5d of the Resoure Guide, and inlude: Developing, Finaning, and Sustaining Wraparound: Models for Implementation Private Provider & Wraparound Flexibility The Wraparound Orange County Model Developing, Finaning and Sustaining County-Driven Wraparound in Butler County, Ohio Funding Wraparound is Muh More than Money EMQ Children & Family Servies: Transformation from Residential Servies to Wraparound 2. What are some of the key wraparound apaities that we will need to fund? There are a number of options that states an pursue to support and/or inentivize the development of loal or ounty wraparound efforts. Regardless of whether the funding strategies are implemented at the state or loal level, it is loal leaders who are responsible for reating apaities that are neessary and desired in their wraparound projet. This means that the loal effort should be responsible for ensuring the following apaities are met: Funds are available for the ost of doing wraparound. Certain fun- Wraparound Implementation Guide 37

38 tions and responsibilities are implied in any wraparound projet. These funtions inlude failitation of teams, meetings and plans; are oordination inluding organizing, arranging and modifying servies, supports and interventions; and infrastruture neessary for managing and supervising wraparound. Most projets also inlude provision of peer-to-peer support to families as a key apaity for wraparound implementation. These key apaities are generally budgeted in the personnel line assoiated with a wraparound projet and may take the form of FTEs in eah of the named areas. Communities vary in terms of how the staff roles are strutured and arranged but a loal ontrat manager or program developer should ensure that there are suffiient fisal resoures for staffing roles so that that key wraparound tasks an get done effiiently and effetively. Funds are aessible for needed supports and servies. Contrat managers should reognize that wraparound is not a treatment or speifi type of program. The wraparound proess annot stand alone like other programs and servies that may be funded. As a planning proess, wraparound seeks to oordinate and integrate a range of servies and supports. This means that ontrat managers should think through how to ensure that funding is available to pay for servies, interventions, and supports that are needed to fulfill wraparound plans, inluding supports that are not reimbursable via traditional systems. Funds are flexible enough to implement the strategies that teams hoose for wraparound plans. A key ingredient of wraparound projets is the presene of funds that an be used to support and purhase a range of options for and with the family. Some ommunities manage this by reating a line item within a ontrat that is designated as a flexible fund ategory. Others will find a way to braid servie dollars that are not neessarily flexible to pay for the servies and supports that are needed. This sort of approah is used by Wraparound Milwaukee, 38 Wraparound Implementation Guide

39 whih funtions as the are management entity for hildren in the mental health system in Milwaukee, Wisonsin. In Wraparound Milwaukee, Wraparound teams identify neessary servies and supports. Results from those team meetings are identified in the management information system that allows individual providers to be paid by entral administration. A range of existing funding streams have been pooled, allowing the projet to math a funding soure with the planned expenditure. In addition, the apaity to pay for servies or interventions exists by always having an other ategory. 3. How do we know when to use flexible funds? Wraparound managers are often faed with issues pertaining to adequate and appropriate management of flexible funds. In the early stages of wraparound implementation, it is not unusual for flexible funds expenditures to be onsidered frivolous, and this an lead to a period of tightening down on flexible fund poliies. Wraparound managers will do well to establish a lear logi for expending flexible funds. One example of suh logi is listed below: Does the intervention, planned interation or expenditure Build on family strengths? It s helpful to hek to make sure that the strengths are funtional and real and were identified prior to the deision to pursue the servie/support that requires funds, rather than having strengths filled in to justify a servie, support, or intervention...add value to the stated mission? Does the intervention or planned ation seem as if it will get the team and plan loser to the mission or outome that is being pursued? This would presuppose that the team has developed a mission statement. The mission should be ompatible with the onditions that brought the family to the attention of the system in the first plae. Meet identified hild and family needs? Does the intervention diretly address a need that has been stated as unmet and targeted by the team? The team should be able to identify the ation and state how it will address identified needs. Represent a ulturally ompetent diretion? Does the planned ation or Wraparound Implementation Guide 39

40 intervention fit well with the family? The ation should be relevant to family members sense of their own identity and should fit with how they experiene their own ommunity. Charateristis to onsider inlude ethniity, lass, age, loation, spirituality, nationality and traditions, among others. Interventions should be hosen whih are ompatible with the family s self-definition. Build on ommunity apaities? Does the intervention empower the ommunity and those in it to are for and support the hild and family? For example, has the aseworker ensured that a landlord is given a hane to help out rather than first requesting flexible funds to over a family s housing-related osts? Projets should hek to make sure that system resoures in terms of people, money and expertise are being used to reate ommunity aring. Represent a good deal for the investment? The planned ation should be reviewed to ensure that it represents a good deal for the prie. This is true for flexible fund expenditures, staff investment of time, referrals to ategorial servies and any other endeavor that a staff member ould undertake. When pursuing the right prie, the results of the investment should also be onsidered so that the bid that wins out won t always be the lowest one, but rather the one that yields the best outome for the investment. 4. What are some of the most ommon fisal autions and pitfalls? Over-relying on any one funding stream. Administrators must reognize that wraparound is a planning and organizing proess that seeks to inorporate, integrate and reate a range of supports in order to meet a family s needs. Sine wraparound is an integrative model it stands to reason it requires an integrated funding stream. The question for funders is how muh integration they need in order to onstrut a oherent funding platform. Integrating Mediaid funding to pay for medially neessary servies and supports through a wraparound planning proess while using general fund servies to pay for all or a portion of staff time may be enough integration. Other sites may pool a wider range of funding streams. Suessful wraparound projets find a way to harness multiple funding streams to pay for servies and projet operation. Falling into the Mediaid trap. Mediaid is frequently used within wraparound projets. Some funtions within the wraparound proess itself may indeed be 40 Wraparound Implementation Guide

41 billable to Mediaid. Others are lose but require staff and administrative time to make them fit. Still other wraparound funtions don t line up with Mediaid rules and regulations. Billing Mediaid may seem like a good idea but good managers should identify whether the ost of making the proposed intervention fit within billing definitions outweighs the potential revenue. Likewise, funders should reate opportunities for some staff time to be billed to other revenue soures so that the support ativities of wraparound an be integrated with the linial ativities. Maintaining the right balane between support and linial intervention will ensure that the wraparound projet funtions effetively. Over-managing flexible funds. Heightened sensitivity to publi pereption auses some sites to reate so many rules and requirements that flexible funds fail to be used flexibly. This an often build resentment on the part of staff and families, who feel like rules are applied arbitrarily. Rules are fine but you should onsider how rules an reinfore wraparound pratie and priniples. Under-managing flexible funds. Some sites will under-manage flexible funds by providing no guidelines for their use. When this happens, family aess to flexible funds may be random and projets fae the risk of running out of the resoure. When this happens, flexible funds no longer funtion as a tool but instead beome a barrier that keeps families and those hired to help from having andid, honest onversations. Stopping at flexible funds rather than building flexibility in funding. Flexible fund pools an be a powerful tool in wraparound. These pools are usually somewhat limited when ompared to soures of inflexible funding. Wraparound is as muh a system hange strategy as a proess for supporting hildren and families. Ultimately, wraparound projets should work towards building as muh flexibility in funding throughout the system as possible. This means that projets Wraparound Implementation Guide 41

42 will have to rely less on the wraparound flexible fund pool as the system adapts and beomes more flexible. 5. What are some fisal options for state leaders? Loal wraparound initiatives are orret in reognizing that state-level fisal poliies and supports are often ritial to ensuring loal wraparound sustainability and suess. In many states, state-level leaders have spurred the development of ommunity apaity for wraparound by developing fisal inentives for implementation. Examples of these inentives inlude: Redireting existing funds. One option available on a state level is to reate new opportunities for loal ommunities to support wraparound by using existing funds from existing funding streams. For example, some states have hosen to reate avenues for loal jurisditions to spend what would have been spent on residential are on wraparound infrastruture instead. This typially involves one of two senarios: (1) redireting the state and ounty share of the residential budget, or (2) pursuing some sort of federal waiver that allows for spending ertain federal funding soures more flexibly. Making grants. Some state leaders will provide grant funds to loal jurisditions and providers to build a ore wraparound apaity. In some ases, this grant making will involve funding the entire projet inluding staff osts, program osts, and projeted servie osts and often, flexible funds osts. Building inentives. Many state leaders find they don t have the funds for fully building wraparound apaity, and they also orretly worry that using grants to promote wraparound development may undermine the sustainability of the projets that are reated with temporary funding. As a result, some states have used an approah in whih they provide inentives to loal jurisditions to begin to build wraparound apaity. This frequently involves hiring some initial staff, suh as a loal projet oordinator or wraparound failitators, or reating some seed funds for the development of a flexible fund pool that an be used to seure other loal ommitments. The following table provides more details on the advantages and disadvantages of eah of the above state-level options for funding loal wraparound initiatives. 42 Wraparound Implementation Guide

43 Options for Funding Wraparound Capaity: Strategies for State Leadership Option Desription Advantages Disadvantages Redireting Existing Funding In this option, existing funding streams are redireted to reating wraparound apaity in loal ommunities. This might require a legislative hange that allows ertain budgetary lines to be redireted (as in the ase of HB 1741 or SB 163 in California) or reates rediretion through administrative rule hanges. Loal jurisditions make a hoie to stop something in order to build something else; larifies wraparound as more than just an option Assures sustainable funding streams by redireting existing resoures rather than reating new resoures Often requires formal ation suh as legislative or formal rule hange Can take more time Some ommunities may not ome on board as they an t imagine losing some existing apaity to build this new apaity (table ontinued on next page) Wraparound Implementation Guide 43

44 Options for Funding Wraparound Capaity: Strategies for State Leadership (ontinued) Option Desription Advantages Disadvantages Making Grants This typially involves providing funding for the entire wraparound operation, inluding personnel, programmati and individual family osts. Full-servie funding an allow projets to begin without having to srimp, save and ut orners Relutant or slow implementers may jump on board faster beause of the presene of full funding from grant soures May be diffiult to keep program going after the grant funding expires Redues inentives for loal agenies and partners to work together to build loal apaity, beause funds are provided from an external soure Loal projet may not feel ownership rather, it is owned by the funding soure (table ontinued on next page) 44 Wraparound Implementation Guide

45 Options for Funding Wraparound Capaity: Strategies for State Leadership (ontinued) Option Desription Advantages Disadvantages Building Inentives This strategy involves the state developing some sort of inentive to subsidize wraparound projet development. This limited funding is typially designed to assist with initial outlay of development osts inluding personnel or flexible funding osts. (Examples of this model an be found in states suh as Mihigan and Wisonsin, with their early efforts to reate apaity for flexible, ollaborative, ommunity based programming.) Creates seed money so loal jurisditions an get started Allows states to monitor development losely to ensure the wraparound projet is ompatible with ustomary wraparound expetations Can stimulate ross-site development by bringing seed projets together from time to time May not fully address the issue of how to build adequate apaity for full wraparound implementation Providing irumsribed and limited inentives may ause the projet to get lost in the shuffle of other funding streams and projets, restriting momentum toward fully supported wraparound Wraparound Implementation Guide 45

46 6. What are some examples of state ation to failitate wraparound funding? Some examples of state legislation and other state supports to wraparound in the above areas are provided below. Redireting existing funding. In 1997, wraparound was established in California under Senate Bill (SB) 163 (Chapter 795, Statutes of 1997) whih allows California ounties to develop the Wraparound Model using State and ounty Aid to Families with Dependent Children Foster Care (AFDC-FC) dollars. This legislation permits ounties to use the wraparound funding for planning and servies delivery instead of use for plaements of hildren/youth in high-end group homes (Rate Classifiation Level (RCL) ) For a summary of SB 163, and a link to the bill itself, see ahwnet.gov/fsweb/pg1320.htm. Making grants. In 2007, the Washington Legislature passed Seond Substitute HB 1088, whih delared an intent to substantially improve the delivery of hildren s mental health servies in Washington state, established an Evidene-Based Praties Institute, and provided that eduational servie distrit boards may respond to a request for proposal for operation of a wraparound model site under this at and, if seleted, may ontrat for the provision of servies to oordinate are and failitate the delivery of servies and other supports under a wraparound model. To view a summary of HB 1088 with links to the bill itself, see wa.gov/billinfo/summary.aspx?year=2007&bill=1088. In Massahusetts, The Children s Behavioral Health Initiative (CBHI) is an interageny initiative of the Commonwealth s Exeutive Offie of Health and Human Servies, whose mission is to strengthen, expand and integrate Massahusetts state servies into a omprehensive, ommunity-based system of are, and to ensure that families and their hildren with signifiant behavioral, emotional and mental health needs obtain the servies neessary for suess in home, shool and ommunity. The CBHI provides funds to over 30 loal Community Servie Agenies to implement ore elements of the Initiative, inluding the wraparound proess. 46 Wraparound Implementation Guide

47 Building inentives. In Mihigan, the Division of Community Servies in the Department of Human Servies is involved with the statewide development and implementation of the wraparound proess for hildren and families at risk of plaement. For a summary of the methods through whih the state provides support to loal implementation, see More omplete examples of state fisal models for sustaining wraparound implementation an be found on the NWI website at 7. What is the take-home message? Funding and fisal poliies have to be addressed if wraparound is to be sustained on a signifiant sale in your ommunity. In addition to providing funding and ensuring flexibility, wraparound projets need to have aess to information about how muh is being spent, on what servies/supports, and for whom. Only this kind of information an truly inform you about key faets of your implementation, inluding what is working (what s not) and how it is working (how it isn t). Effetive and hands-on management of fisal resoures will help you reate the needed math between family needs and servies, supports and ativities. Wraparound Implementation Guide 47

48 Theme 4: Aess To Needed Supports And Servies Aording to the Community Supports for Wraparound Inventory, when a wraparound initiative is fully supported in the area of aess to needed servies and supports, the ommunity has developed mehanisms for ensuring aess to the wraparound proess and the servies and supports that wraparound teams need to fully implement their plans. This setion provides an outline of key onsiderations, pitfalls, and strategies related to developing and managing the servies and supports that wraparound teams will need for the plans they reate. 1. What sorts of servies and supports will our families need? As you roll out your initial wraparound effort, it is important to remember that it is based on a set of priniples that are different than those that underlie many programs or projets. Wraparound is a planning proess that is used to oordinate, reate, tailor, and individualize servies and supports to fit the unique needs of the hild and family while also building on 48 Wraparound Implementation Guide

49 their strengths. While many other programs are prediated on a defined program model, wraparound is built on the notion of individualization. In other models, managers and funders may fous on uniformity in an attempt to ensure that families have aess to the program as it is designed. In wraparound, the organizing proess should our with onsisteny but the plans that are produed should vary onsiderably from family to family. This means that the system in whih the wraparound initiative is funtioning must have a wide array of servies and supports available, and that managers attahed to wraparound projets should be prepared to manage for reativity, flexibility and originality. Wraparound is best implemented in the ontext of a ommunity based system of are. This means that those involved must be able to see the entire ommunity as a resoure that an be deployed for families. Wraparound projets are also prediated on the notion that help is more than servies. This means that leaders of the wraparound effort need to ensure that a wide array of supports and interventions are onsidered and developed in building wraparound apaity. Wraparound projets should inlude a blend of servies and supports inluding: Formal servies drawn from the existing system, inluding evidene-based treatments that have been shown to be effetive in ahieving outomes and/or meeting emotional and behavioral needs; Creative interventions that are developed on a one-youth/family-at-a-time basis; and Purposeful support designed to help families get through system proesses. 2. What are some key issues that ommunities need to onsider as they work to ensure aess to needed servies and supports? Creativity. Managers, inluding providers involved in overseeing wraparound, should be prepared to reate strutures that lend themselves to reativity. This might our through the strategi use of flexible funds, deploying flexible staff resoures or working out unique arrangements with other providers from within the system or ommunity. Additionally, managers should be prepared to develop reative arrangements with system monitors, suh as liensing authorities, to ensure as muh flexibility within program strutures as possible. Managers should be prepared to partner with pratitioners to ensure that the wraparound Wraparound Implementation Guide 49

50 program has an ongoing apaity for servie reation for eah hild/youth and family at a time. This ability to individualize through servie reation requires ongoing support from management either through reative arrangements with other organizations, flexible ontrating, or the apaity to reassign staff roles to meet the needs of families. Wide range of options. Not all servies or supports identified in a wraparound plan will need to be reated. Some will be existing servies and supports, while some will losely resemble usual and ustomary servies, though perhaps with some minor readjusting. What is important is that the wraparound projet reates allianes that allow the widest range of servies possible for families. Wraparound projets should avoid assuming that ertain servies will be limited or not needed. In fat, when it works best, wraparound serves to blend and integrate a range of servies from traditional to nontraditional, from tried and true to never before attempted. Good wraparound leadership reates a platform to arrange all of the possible servies and interventions on behalf of hildren and families enrolled in the projet. Ensure open doors. A key feature of neessary servies and supports is that families are able to get to the right servies when neessary and aren t burdened with servies that are not needed. Aess often means that servies an be tailored in terms of time and loation, depending on the needs of the family. Wraparound staff should be expeted to partiipate in reative resoure development. On the other hand, wraparound managers should monitor reative resoure development to ensure that families are getting what they need with the right amount of effort. Ensuring aess frequently plays out in two ways at the team level. The first is the team working with the family in exerising hoie about the provider of servies. Families and teams should be able to leave servie providers who are not working out and gain aess to alternative providers. The seond way is ensuring aess during risis periods. This aess typially fouses on three features inluding developing an individualized on-all apaity, having the ability to respond wherever the risis is ourring, and the apaity to link to other resoures even during after-hours periods. Fous on just-in-time help. Pae and urgeny are ritial onepts within the wraparound proess. While working with hildren, there is not a lot of time to 50 Wraparound Implementation Guide

51 make mistakes as the lok is tiking on the young person s hildhood. Wraparound leadership has to be prepared to onstrut a range of just-in-time resoures designed to assist families enrolled in the projet. Expediting waiting lists, reating short term fill-in apaity, and realigning resoures to fit with demand are all ativities that fit with the notion of timeliness. Another onept attahed to timeliness within wraparound enters around the apaity to shut off interventions as needed. Wraparound is designed to ustomize servie responses aording to unique individual needs. This means that when a servie is no longer needed it an be shut off, even if that shut-off will be temporary. This differentiates wraparound from many other programs in whih young people stay enrolled until a natural alendar break or until the antiipated disharge from servie nears. Being able to shut off servies that are providing less potent results is as important as granting aess to a range of needed supports and servies. 3. What are some strategies that have worked for reating and managing an appropriate range of servies and supports? Wraparound is not a standalone proess. Effetive projet implementation requires that a range of servies, supports and strategies be available between meetings. Leaders involved in implementing wraparound must onsider ways to ensure that those responsible for implementing the wraparound planning proess have a range of interventions that an be deployed through the planning proess. Strategies that have been used in a variety of settings inlude: Creating a servie provider network. This option entails reating and organizing a range of servie providers that is available to individual wraparound teams. This typially involves estimating a range of servies that might be neessary and reating a struture for easy aess by individual teams. Driven by ontrats Wraparound Implementation Guide 51

52 or memoranda of agreement, servies are not aessed until needed, thereby starting with the family rather than the program. Typial provider networks don t guarantee a minimum amount of utilization but instead let the demands of individual wraparound teams drive the response. This approah works well when there is a entralized funding pool to pull from or when the funds available for wraparound implementation are large enough to warrant a struture for purhase of servies. The advantages of this strategy inlude fostering a wide range of partnerships in wraparound rather than fousing on a single wraparound organization, and developing a knowledge base about family needs and servie utilization. Good provider networks bridge ommunity and system onerns. Balaned provider networks will inlude a range of providers from ertified mental health professionals to neighborhood or ommunity organizations or assoiations that an be onneted to help out. Finally, effetive provider networks have the apaity to ertify and enroll individuals or organizations to provide servies or supports for a single hild or family involved in the proess. Managing a resoure diretory. Some sites find that they don t have the politial or fisal will to develop and manage a provider network. These sites find the less formal approah of reating a resoure diretory to be an effetive alternative. This approah reates assoiations and agreements among a range of providers to work together to build flexible responses. Families an even rate their experienes with ertain providers, whih an be reviewed by teams as they develop the servies and strategies for their plan. This approah works well for many things inluding rafting servies and strategies that are tailored to individual situations. It is often more diffiult, however, to get to individualized responses with this informal approah due to system barriers, ontrat limitations or rules and regulations. Contrating for flexibility. Another approah involves onstruting flexible ontrats. This entails developing or funding a ertain amount of flexibility in the basi wraparound projet design. Examples inlude providing funding for a range of flexible staff that an provide immediate and reative responses to families, or providing signifiant amounts of flexible funds for use in purhase or arrangement of flexible servies and supports. One way of ahieving this is by funding well-designed diret support servies. More information about this approah an be found in the Resoure Guide to Wraparound hapter entitled Diret Support Servies in Wraparound (Chapter 4d.1). 52 Wraparound Implementation Guide

53 4. What are some of the most ommon servie array autions and pitfalls? Fousing solely on aess and negleting exit. Many wraparound projets fous on making sure servies are available but fail to reate protools for families to ease servies they don t find helpful. Over-fousing on a partiular type of servie or support. Effetive wraparound projets ensure a balane between linial intervention and ommunity support. Some projets beome so foused on linial interventions that they neglet ommunity partiipation and basi support while other projets will fous on basi support to the exlusion of linial intervention. Leadership should plan and monitor for a balane between these two extremes to ensure that families don t have to sarifie one or the other in order to partiipate in the proess. Failing to individualize. Individualization means that servies, supports and strategies an be onstruted or reated based on individual family needs. In addition to flexible timing and loation of delivery, highly individualized responses an inlude the apaity to imagine and reate a one-family-at-a-time servie that has never been tried before. Some wraparound projets are designed so that while failitation is funded by the projet, it is assumed that all servies and supports will be paid for from existing funding streams. This will often lead to frustration with the lak of flexibility in programming that many of these funding streams represent, and to a lak of individualization, whih negates the point of the wraparound proess. Effetive leadership should antiipate this and reate formal protools to allow for one-time exeptions to poliy in order to ensure that responses are individualized. Fousing on risis planning rather than risis doing. While the wraparound proess identifies lear steps for developing a risis plan, it is important that the Wraparound Implementation Guide 53

54 projet reates the apaity for immediate risis response. This means that families enrolled in wraparound should not have to manage the risis on their own and that wraparound has ensured that a tailored and preferably individualized response is available when needed. Effetive risis programming in wraparound should inlude after-hours overage, up-front stabilization to help families feel supported and omfortable enough to effetively engage in wraparound, and mobile response so that risis overage goes to where the family is rather than foring the family to ome to the projet. 5. What s the take-home message here? Creating and ensuring aess to a variety of individualizable servies and supports requires as muh effort as reating a sound apaity to failitate wraparound planning. Many ommunities will fous on the planning proess, and overlook the fat that interventions that our between team meetings are ritial. Ensuring a range of responses that are individualized, tailored, and flexible in terms of loation and timing should be onsidered early on in wraparound implementation. 54 Wraparound Implementation Guide

55 Theme 5: Human Resoure Development & Support Aording to the Community Supports for Wraparound Inventory, human resoure development and support in wraparound is ahieved when the poliy and funding ontext supports wraparound staff and partner ageny staff to work in a manner that allows full implementation of the Wraparound projets require a thoughtful and deliberate approah to building staff and personnel apaity. Effetive human resoure development requires both organizational alignment and individual aountability to ensure effetive operations. This setion provides information on how stakeholders involved in the wraparound effort an ahieve suh alignment and effetive operations. 1. What represents adequate staffing in a wraparound projet? The first onern that leadership in a wraparound model. wraparound projet should onsider is the alloation of staff resoures. Certain funtions must be arried out within wraparound and it is important that the administrator develop job Wraparound Implementation Guide 55

56 desriptions and program plans that reflet these key funtions. Some of the more ommon funtions for whih human resoure apaity must be developed are listed below. For eah of these staff roles, links to relevant hapters in the Resoure Guide to Wraparound are provided. Wraparound failitator or are oordinator + + See Phases and Ativities of the Wraparound Proess: Building Agreement About a Pratie Model (Chapter 4a.1) and + + The Phases of Wraparound: Real Life & Teams (Chapter 4a.2) Wraparound family support partner + + See Appliation of the Ten Priniples of the Wraparound Proess to the Role of Family Support Partners on Wraparound Teams (Chapter 4b.1) and + + How Family Partners Contribute to the Phases and Ativities in the Wraparound Proess (Chapter 4b.2) and + + Family Partners and the Wraparound Proess (Chapter 4b.3) Youth advoates + + See Youth Engagement, Empowerment, and Partiipation in Wraparound (Chapter 4.1) and + + Youth Advoates: What They Do and Why Your Wraparound Program Should Hire One (Chapter 4.2) and + + Youth Partiipation in Wraparound Team Planning: Why and How (Chapter 4.3) Diret support servies + + See Diret Support Servies in Wraparound (Chapter 4d.1) Wraparound liniians + + See The Role of the Cliniian Employed in a Wraparound Program (Chapter 4d.2) Wraparound supervisors 56 Wraparound Implementation Guide

57 + + See Wraparound Supervision and Management (Chapter 5.6) and + + Supporting Workfore Development: Lessons Learned from Wraparound Milwaukee (Chapter 5.4) 2. What are key areas to onsider in building human resoure development and support? Adequate support to staff. One key funtions have been outlined, projet leaders should predit the neessary staff time to ensure that these key funtions are provided with enough resoures. This means that staff must be afforded enough time for task ompletion and ase load sizes must be appropriate to the job expetations. Simply adding wraparound duties to an existing job desription or staff role is not suffiient. One strategy for ensuring adequate staffing patterns is workload management, in whih supervisors monitor and attend to workload issues to ensure adequate time for key funtions. Another strategy is resoure development, in whih managers ensure that staff have easy aess to neessary tools and proesses to meet the needs of families in a timely fashion. Another way to inrease staff persons apaity to get the work done is to ensure that organizational artifats (job desriptions, hiring proesses and program statements) reflet a ommitment to wraparound priniples and praties. Finally, ompensation to staff in key wraparound roles (e.g., failitators and family partners) must reflet their value and enourage staff retention and ommitment. A omprehensive performane system. Training and supervision should be based on learly defined expetations and foused on performane as it relates to these expetations. Training and supervision should be supported by objetive data gathered routinely throughout wraparound implementation. This information should also be used in professional development efforts that inlude Wraparound Implementation Guide 57

58 individual training plans. The projet should avoid sending people to training as a reation to employee situations, and instead develop a omprehensive and deliberate training strategy with eah employee. This deliberate training strategy should be foused on the goal of reating a ompetent work fore that not only knows what to do and how to do it, but also an artiulate why ertain tasks in wraparound should be ompleted. Though understanding the basi proedures of wraparound is important, espeially for new staff, adopting a know why approah reates a workfore that an individualize the wraparound proess to fit with eah family rather than simply fousing on the steps of wraparound. Knowwhy wraparound pratitioners ome to understand that the family is always more important than the pratie model. Family involvement. Young people and families should be inorporated in human resoure development strategies. This is done by ensuring that families are inorporated in all phases of hiring, training, and supervising for effetiveness. Examples might inlude families sitting in on hiring interviews, families being surveyed regularly to soliit their feedbak on employee performane, employing young people and families as ore trainers for newly hired staff, and reating a youth/family-led staff reognition ommittee that identifies staff for exemplary pratie. 3. What are some of the key human resoure development autions and pitfalls? Human resoure development and support in wraparound is not an easy task. Professionally trained staff often must take some time unlearning one set of onepts in order to relearn some other wraparound priniples. Many projets will hire family members with diret system experiene to inrease the apaity of the projet to onnet with families being served. This may result in a wide range of expetations, skills and perspetives among staff members requiring wraparound leadership to atively manage onflit. While this an be managed on an ad ho basis during early wraparound implementation, leaders should plan for and antiipate the following hallenges as they implement wraparound: Providing unstrutured supervision. Reative supervision (e.g., the risis of the week approah) done in a vauum with little or no data (e.g., about staff persons overall performane, youth and families strengths and needs, and/or wraparound plan development and implementation) often results in reative 58 Wraparound Implementation Guide

59 wraparound responses. This an then lead to staff onfusion as they begin reating rather than planning and organizing with families. Promoting good pratitioners without supporting them to beome good supervisors. Frequently, projets will promote good pratitioners without helping them learn how to supervise. Failitating a wraparound proess is different than supervising people paid to work with families. Projets should be prepared to artiulate their supervisory theory and ensure that newly appointed supervisors get an opportunity to learn management skills. Establishing the supervisor as expert pratitioner. A supervisor that tends to fous on too muh detail will often funtion as an expert pratitioner who makes deisions about real families during private onsultations with their staff. While that supervisor may be quite skilled, it is unfair to both families and staff for the supervisor to funtion in this way. Families won t have the benefit of being able to speak diretly to the person who is making the deisions, and must rely on the staff person as an intermediary. Staff in this situation may have diffiulty learning new skills sine the projet funtions by having staff ome to the supervisor who is seen as the expert who answers questions and solves problems for staff. Getting stuk in the detail trap. The more that is written about wraparound, the more detail is reorded. The power of wraparound is not in its disrete steps but instead it is the onnetion between the steps of phases that makes the differene. As a result, supervisors should be onerned that they do not overly fous on omponent steps, but rather on the deeper ideas of wraparound, suh as always maintaining a strengths perspetive, basing plans on family needs, and providing organized and holisti support to the family. The supervisor should be foused on the oherent whole and making sure the ideas behind wraparound are Wraparound Implementation Guide 59

60 arried out rather than fousing on any one tehnique. Failing to separate values from skills. Employees who are able to artiulate the wraparound values are not neessarily skilled at delivering wraparound. Supervisors should be able to artiulate a minimal skill set that defines and desribes behaviors. Next, supervisors should set up systems that allow them to monitor whether those behaviors are being deployed regularly within the wraparound projet. In some situations with some families, wraparound staff will need to follow an unexpeted ourse. In suh situations, performane monitoring systems should allow staff to demonstrate skills while also adapting their skills to the needs of eah individual family. As desribed above, good wraparound projets reate the ability for staff to operate reliably rather than seeking uniformity of staff pratie. 4. What is the take-home message? Human resoure needs will hange over time as a wraparound projet grows. Initial work in this area involves antiipating neessary programmati funtions, aligning staff roles to ensure delivery of those funtions, reating strutures that allow those funtions to be delivered with high quality and maximum effiieny, and establishing performane baselines to guide expetations and supervision. Over time, suh data an support adjustments in staffing patterns, staff assignments, and methods of training and supervision that are employed in order to ontinually improve wraparound program operations, and the support that is provided to youth and families. 60 Wraparound Implementation Guide

61 Theme 6: Aountability Aording to the Community Supports for Wraparound Inventory, when a wraparound initiative is fully supported in the area of aountability, the ommunity has implemented mehanisms to monitor wraparound fidelity, servie quality, and outomes, and to assess the quality and development of the overall wraparound effort. This setion provides information regarding how stakeholders involved in the wraparound effort take onrete steps to implement mehanisms to monitor wraparound fidelity, servie quality, and outomes, and to assess the quality and development of the overall wraparound effort. More detail on the topis presented here an be found online in the Resoure Guide to Wraparound, in the hapters in setion 5e. 1. What are the key issues to onsider in building aountability for our wraparound projet? Communities implement wraparound for a variety of different reasons. One ommunity may be onerned about Wraparound Implementation Guide 61

62 spending patterns and pereptions of little or no outome for monetary investment. A seond ommunity may be more foused on how the servie providers meet or fail to meet hildren s and families needs. Rather than just appropriating metris that have been used by other projets, or piking evaluation instruments off the shelf, true aountability in wraparound requires asking what the goals of the projet are and how it will be known those goals have been ahieved, and then reating measurement strategies aordingly. To ahieve this kind of aountability, it is important to start early on in the proess of implementation, with wraparound stakeholders working together to establish indiators of suess and failure. Areas to onsider in building aountability inlude: Establishing lear outomes. This area answers the question of whether you are getting the right results for your effort. Stakeholders in the wraparound initiative should have an opportunity to olletively establish what outomes are most important to them. If you don t know the desired result then you run the risk of pratiing for proess sake rather than pratiing with a purpose to get a desired outome. You also won t be able to answer questions about whether your effort has sueeded. Setting defining proess elements. This area answers the question of whether you are following the right implementation proedures in your wraparound projet. Similar to establishing outomes, a hallenge for any new projet is identifying what key proess elements must be reliably ahieved for partiipating youth/families. This means that your wraparound projet has to first deide what praties you want staff and managers to follow and then monitor to make sure those praties are followed. There is no single best way to measure the proess of wraparound implementation. Some sites will use researh tools suh as the Wraparound Fidelity Assessment System (WFAS) to get information about whether the ativities and priniples of wraparound are being followed. As an 62 Wraparound Implementation Guide

63 alternative or in addition to WFAS or other researh tools, sites may use supervisory and program heklists that identify how the proess is being implemented at the youth and family level. Gathering satisfation and other data diretly from youths and families. This area answers the question of whether individual youth and families are satisfied with your implementation of wraparound. Simply following the proess or steps of wraparound implementation does not guarantee that youth and families will be satisfied with the proess or that they will be getting their needs met. This area of building aountability requires diret feedbak from youth and families who are most affeted by the projet. Suh information may fous on their satisfation with the wraparound proess, satisfation with servies that are being reeived, and pereptions of whether needs are being met, whether progress is being made, and what barriers are getting in the way. Suh information an be gathered through written surveys or diret interviews and should our regularly from the onset of the projet. Some sites will ontrat with family organizations or train family members to gather this information. Monitoring osts. This area answers the question of whether your investment of time, money, personnel, spae and other resoures is worth it. There is no national standard for priing wraparound; wide regional varianes exist throughout the ountry. Costs related to wraparound inlude are oordination osts assoiated with arranging and organizing the proess, and osts assoiated with the neessary servies, supports and strategies that are outlined in a wraparound plan of are. The four dimensions above ome together to answer a omplex question: Are you realizing the right results for doing the right things beause you ve made the right investments that satisfy the young people and families you are serving and suessfully meet their needs? At the same time, there are omplex issues that may failitate or hinder suess and that are diffiult to measure with a simple evaluation tool. For example, the host environment in whih your projet operates is vitally important to the suess of wraparound. Organizational oherene an have a positive impat on staff morale and projet osts as well as family outome. If you are not realizing the types of results you were hoping for within eah of these areas, you may find that the issue is lak of oherene with the host environment. This means that wraparound is not likely to thrive in an organization or system that doesn t align Wraparound Implementation Guide 63

64 with wraparound priniples. In addition to the above issues, it is important to be aware of the degree to whih there is a fit between the organization, the system, and the goals and priniples of the wraparound projet. 2. What are the implementation steps we should undertake to build aountability? Before making deisions about speifi instruments or measurement strategies, building aountability for a wraparound initiative requires adherene to several ore onsiderations. Determine how you will use your information before you begin to ollet it. The point of data olletion is not just to ollet data but to atually use it. It often helps to ome up with a simple answer to the key question, What information do we need and how will we use it or gain from it? One that is established you an then identify what information you need that will get you where you need to go, and what the best soure(s) of data will be. Be ritial in your methods. Some projets will ollet information beause it s onvenient rather than olleting data that an stand up to srutiny. Examples of this inlude surveying only those individuals who are easily reahed, forming onlusions based on low response rates, or using methods to ollet information that would lead one to question validity, suh as relying solely on the provider of a servie for data olletion (some ould argue this approah would result in a biased response). Set reasonable goals for data olletion. Wraparound projets should be disiplined in terms of establishing what they want to measure and then ensuring that adequate resoures are dediated to reliable and valid data olletion, aggregation, and reporting. Projets should be disiplined about gathering only information they need to know and avoid drifting to things they might like to know, espeially if it is not a lear need as identified by projet stakeholders. Stay on the ollaborative ourse. In building a set of data measures it is important to ontinue to inlude other stakeholders and perspetives, inluding youth and families. Different people an get foused on single indiators that they take as a plaeholder for quality or suess. Reahing onsensus about definitions of quality and suess and revisiting these definitions regularly is one strategy for ensuring that key wraparound sponsors have a shared vision of quality and 64 Wraparound Implementation Guide

65 suess. It an also help these stakeholders stay together throughout implementation. Fous on the meaning of the proess, not just the steps of the proess. As more is written and studied about wraparound, more detail emerges. This detail an lead to a redutionist ourse in whih lots of disrete steps are evaluated but the overall purpose or goal of wraparound is lost. A fous on individual steps poses its own set of problems. Even though you an tehnially deliver eah of the steps, this does not neessarily mean that you are providing quality wraparound. Like ballroom daners, wraparound staff persons need to be able to put the steps together in a fluid pattern that ommuniates are, onern and ompassion for and on behalf of a family. Additionally, measuring more steps adds omplexity, and means having to fous on deiding whih step(s) is/are most important. Though measuring proess is important, remember to not lose fous on the meaning of the wraparound proess and the overall goals of your projet. 3. What types of data do we gather to assess whether or not we are doing high quality wraparound? As desribed above, measuring the proess of wraparound implementation an take many forms. Data olletion and feedbak an be ritial in the proess of supervising and oahing staff, as desribed in a hapter in the Resoure Guide to Wraparound on Wraparound Supervision and Management (Chapter 5.6). Others may fous more on using wraparound fidelity evaluation tools, whih an be used in supervising wraparound staff, but are more frequently used in aggregate form to provide feedbak to the site and its stakeholders about how implementation is going overall. Wraparound projets need to make these deisions for themselves. In general, however, measures of the proess of wraparound tend to provide: Data on the quality of the wraparound proess provided, olleted by live observation, plan review, and feedbak from youth and families. The methods used to assess the proess and its quality should be grounded in the priniples of wraparound and used as the basis for ongoing quality assurane/ improvement. Monitoring and analysis of the types of servies and supports inluded in wraparound plans, whether or not planned servies and supports are provided, and whether or not the goals and needs that appear on wraparound plans are met. Wraparound Implementation Guide 65

66 Data that an be used in an ongoing proess to trak satisfation and buyin among stakeholder groups, inluding youth and families and representatives of partner agenies and organizations. Information that feeds asystemati proess for identifying and addressing barriers that prevent wraparound teams from doing their work and/or fully implementing their plans. 4. What types of outomes do ommunities typially measure? As desribed above, wraparound projets may define suess in many ways, so it is ritial to onvene a ollaborative proess to define what represents suess in terms of ultimate outomes. Information on outomes should be relevant to funding deisions, poliy disussions, and strategi planning. Outomes that are hosen should be important to stakeholders as well as to families and reflet the values of wraparound; for example: Enabling hildren and youth to be at home, in shool, and out of trouble Inreasing hild and family assets and strengths and redution of needs Improving aregiver well-being Inreasing family and youth empowerment Short-, intermediate-, and long-term outomes that are theoretially important in wraparound are outlined in the Resoure Guide artile How, and Why, Does Wraparound Work: A Theory of Change (Chapter 3.1). Outomes that have been used in previous researh are desribed in A Narrative Review of Wraparound Outome Studies (Chapter 3.3) and The Evidene Base and Wraparound (Chapter 3.2). 5. What types of Management Information Systems (MIS) are needed to support aountability? Similar to deiding outomes and proess measures, deiding how to manage information olleted in support of a wraparound projet will neessarily be driven by loal needs and resoures. However, well-established wraparound initiatives tend to have MIS systems that an maintain information that serves a range of funtions, inluding maintaining information on youth and families who are enrolled, authorizing servies and making payments, and traking youth and family outomes. The 66 Wraparound Implementation Guide

67 artile Supporting Workfore Development: Lessons Learned from Wraparound Milwaukee (Chapter 5.4) in the Resoure Guide to Wraparound inludes a detailed desription of how Wraparound Milwaukee has built and integrated its MIS systems over time. 6. What are ore steps to take to ensure aountability? Aountability is more than just a researh design of your wraparound effort. Some sites have relatively large resoure pools to aess in building and exeuting a researh and data olletion design. Other sites have minimal resoures and are struggling just to get things aligned for implementation (rather than fousing on evaluation omponents). Whatever ategory your projet fits into, the following steps an be helpful in ensuring adequate aountability: Define what you want to know: Do you want to ensure a minimum level of pratie? Do you want to ensure the right fisal expenditures? What outomes do you hope to ahieve? How will family perspetives on satisfation and quality of the proess align with the other three questions? What deisions will this information inform? Define your data soure(s): Define an existing data soure that would meet your information need Outline question(s) for whih you need additional information Wraparound Implementation Guide 67

68 Fill in the blanks: Define what missing information you would need to answer your unanswered question(s): + + Do you have aess to the information or will you have to reate it? + + Do you have the staff to do that? If not, who will? + + Do you have the resoures to do that? If not, where will you get them? + + Do you have the politial will to do that? Define what your unit of analysis must be: + + Individual families? + + Teams? + + Staff? + + Other? Establish a proess for review: Define how frequently your results and information should be reviewed Define who should be involved in reviewing them Establish your protool for deision making: How will you interpret the data? How will you use it to develop shared meaning among your stakeholders? Use the data to inform ation: Stop doing something Start doing something else Get additional resoures Get more information 68 Wraparound Implementation Guide

69 Trouble-Shooting: Questions For wraparound supervisors: These are individuals who are hired or will be hired to provide handson oversight, diretion and oahing to staff members who work diretly with families by using the wraparound proess. Question: I try to orret my staff but I often hear that sine I ve only supervised wraparound and never done it, I don t understand. What tips do you have? Answer: Some supervisors find that taking responsibility to funtion as the wraparound failitator for a single family an be very helpful. Others plae themselves in a o-failitator role with staff. Still others spend time in the field and get a sense for the pratie in that way. What is important is that you have a sense of the overall wraparound proess, signifiant knowledge of omponent steps of Wraparound Implementation Guide 69

70 wraparound, and knowledge of the way your system operates. The advantage that you bring to the disussion is that you have enough distane to be able to see the entire proess without getting aught up in the detail. Finally, use multiple data soures in providing feedbak to staff, inluding your personal observations, family and team feedbak, and outome and fisal data. Question: Our projet has flexible funds available but we haven t developed any poliies around the use of those funds. For some of our wraparound teams, the main strategy seems to be have our flexible funds pay for whatever is needed. How do I manage this? Answer: It is not unusual for new wraparound projets to beome foused on flexible funds as the solution to hallenges. Effetive flexible fund management should ensure this resoure will be used in a manner that promotes aountability while ensuring that the spirit of flexibility is maintained. Develop simple rules that an be shared with all wraparound team members inluding families, professional partners and ommunity representatives. Make sure your rules reinfore the initial goals for your projet. Question: Wraparound is suh a omplex proess; how do I hold my staff aountable for quality implementation of the wraparound proess? Answer: Beause wraparound happens in ommunities and not offies, supervisors find that they need to spend field time with staff to ensure that the proess is being implemented orretly and with quality. This inludes not only attending team meetings but also aompanying staff to individual meetings with families 70 Wraparound Implementation Guide

71 and other team members during the engagement phase of wraparound. Some supervisors will augment this field work through use of surveys (either telephone, inperson, or written) from family and other team members. Supervisors should also onsider ative monitoring of teams progress toward ahieving team goals or meeting family needs, and use these data in supervision. Finally, these praties should be orrelated with individual outomes for young people and families enrolled in wraparound (e.g., meeting needs, reduing problem behaviors, funtioning better in shool, home, or the ommunity) to ensure that one informs the other. Question: Many of the families we have enrolled in wraparound need more than wraparound meetings failitated by my staff. Yet many of our partners tend to think that let wraparound do it all, is the answer. How do I help them get past this idea that wraparound is the servie? Answer: While supervisors need to be foused on quality implementation of the wraparound proess, you should also fous on the range, mix and type of servies and interventions that are being provided to families between team meetings. It s a good idea to keep trak of these servies and onstrut a report that omprehensively desribes servies used in wraparound. Some sites will organize this desription of servies by life domain while others will sort by servie definition or setting (home, shool, ommunity). Use this report to oah your staff and inform your boss about the mix of servies being used and to provide support for further developing the servie array. Wraparound Implementation Guide 71

72 Question: Our projet has a ommunity team that provides oversight to our work even though my ageny has the ontrat to implement wraparound. That ommunity team often gives me feedbak that I think onflits with the spirit of wraparound. What an I do about this? Answer: What wraparound means within a given ommunity is something that evolves as people gain insight and experiene. Often our ross-system oversight groups are onvened after one workshop about wraparound or less. It is often helpful to get ommunity oversight entities to ommit to deepening their knowledge about wraparound through workshops, researh and in-depth disussions. Members of the group may even be engaged in the proess of interviewing families and staff about their experienes. At the very least, they should be exposed to in-depth desriptions of suh family and staff experienes. Question: In our ommunity, everyone ame together to start wraparound but now that we re up and funded it seems that I m the only person responsible for implementation. What should I do as a supervisor? Answer: It is often helpful for supervisors of wraparound projets to onvene a group of supervisors from other systems to review implementation and ontinue to manage system barriers. Just beause you ve funded wraparound in your ommunity doesn t mean that all poliies are now ompatible with wraparound. Gathering a group of supervisors to monitor and troubleshoot not only wraparound implementation but also ross-system partiipation in wraparound plans an be a very helpful way to keep others engaged. 72 Wraparound Implementation Guide

73 For wraparound managers: These are individuals who provide management oversight to wraparound projets. These might be employees of servie organizations, typially nonprofit, who have a wraparound projet inluded in their department. Wraparound supervisors will typially report to managers diretly, and they in turn report to administrators. Question: If we have limited resoures to ommit to monitoring and aountability where should we start? What are the bare essentials? Answer: How you prioritize your fous in the general area of aountability will vary based on loal onditions. Eah projet should develop apaity to monitor satisfation, outome, fisal and proess indiators. Where you start and what you prioritize, however, is entirely dependent on loal onditions. If you are worried about the quality of wraparound eroding, then start with proess indiators. If you have onerns about your ability to ahieve the original outomes set forth in your wraparound projet, or have a need to demonstrate suh outomes to ensure sustainability, you may start with monitoring outomes like plaement. The point is to work to put all four omponents in plae within a reasonable amount of time. Question: Do we really need players from all setors of our ommunity system at the ommunity partnership group? Answer: A number of ommunities have fostered wraparound with a single-system approah. Some of these projets have been relatively suessful and have reated important alternatives for young people and families. On the other hand, some Wraparound Implementation Guide 73

74 of these single-system wraparound projets have struggled over time. Some of these struggles are the result of a lak of lear understanding about the nature of wraparound. Often, there are multiple-system initiatives that look like wraparound but operate under a different name. In other systems, there are projets that use the name wraparound but don t follow wraparound praties. Establishing ommunity partnership and olletive ownership is an important step in bringing oherene and onsisteny to wraparound within a given ommunity. It an lead to greater sustainability for wraparound projets while also fostering greater ohesiveness among system players. Effetive managers start where they must but ontinue to work for system oherene and integration around wraparound. Question: We have done less formal or small W wraparound as a single provider for years. Now it is time to step up and make it more formal and a bigger deal. Where should we start to be sure we do this stage of our development right? Answer: Many provider organizations or departments find that the wraparound proess feels familiar beause they have tried to do work that is ompatible with the philosophy for a long time. In formalizing your implementation, a good plae to start is by working with other leaders to establish ross-system ownership of your wraparound initiative. This will help lead to a ross-system, ommunity understanding of your newly formalized efforts. In doing this, ensure that your organization is open to input from ommunity partners and that your staff are prepared to learn new tehniques, approahes and assumptions. 74 Wraparound Implementation Guide

75 Question: Flexibility and individualization are important onepts in wraparound and other servies. How do we best manage the liability onerns and risks that ome with developing this type of resoure set in a ommunity system? Answer: All leaders in wraparound should abide by responsible risk taking. That means that you need to ensure that your staff are equipped with a sound approah to introduing issues of risk within wraparound teams and planning for mitigation of those risks. Some managers also reate an oversight proess that allows them to review unusual ations in wraparound plans. This oversight proess may inlude a linial review through a single ageny or a ross-system review that brings a variety of perspetives. If you do elet to reate a review proess, you should establish the rule that this group may not simply hange plans but instead should dialogue with individual teams to make suggestions for effetive risk management. Question: We have a ontrat to provide wraparound failitation but we are also able to bill Mediaid for some of those duties. Shouldn t I try to maximize my Mediaid billing to ensure sustainability? Answer: Many wraparound projets are implemented using a mix of ontrat dollars with billable soures. Using Mediaid to fund your wraparound projet an be a good fisal poliy as long as using those billable definitions doesn t hange your definition of wraparound. Managers should work with their projet to find the right blend of dollars to ensure quality implementation, even if that means that billable rates are somewhat lower. Remember the point is not to bill a lot, but instead to use resoures strategially to ensure quality family servies and supports and ahievement of program goals. Wraparound Implementation Guide 75

76 Question: Can one supervisor effetively supervise staff doing wraparound at the same time that they supervise staff doing another projet? Answer: Some projets are able to reate dediated supervisors for wraparound, while others are just don t have the resoures. There is a learning urve for newly assigned wraparound supervisors, and it is important that you dediate enough time and resoures to allow the supervisor to learn about wraparound. Investing in site visits to other projets, finding training opportunities (either live or via webinars) and identifying networking opportunities are all important investments. For wraparound administrators: These are individuals who take on administrative and exeutive tasks assoiated with the wraparound projet. These ativities may inlude hosting the wraparound implementation staff or administering ontrats that are passed through to implementation groups. These individuals may work for private non-profit or publi setor organizations. Question: Answer: How do administrators help make for getting to out of the box solutions for People often fous on wraparound as a proess sure that families families. There is an emphasis on reating, get what they need molding, or finding just the right resoure for individual families rather than seleting strategies from a presribed menu of servies and from wraparound? resoures. Wraparound administrators learn that the trik seems to be more about getting the right deision made, rather than getting the right servie or ontrat in plae. 76 Wraparound Implementation Guide

77 Individualization is fostered by ensuring that wraparound poliies and proedures lead to wraparound teams aessing what s needed. Administrators should fous on empowering individual teams with the ability to make deisions and giving teams the authority to follow through. Effetive wraparound administrators fous on this team empowerment model rather than reating poliies and proedures foused solely on onsistent repliation of a servie. Question: We are trying to hoose what to measure to inform our implementation effort. Possible areas to measure inlude osts, satisfation of those served, whether the proess we use lives up to our expetations, and whether what we are doing is really hanging lives for families. Do we really need to measure something in all four of these areas to effetively maintain aountability for our effort? Answer: Aountability is about developing strutures and proesses that help you identify your information needs, how you will get the information, how it will be analyzed, who the information will be presented to, and how that information will be used to make deisions about the life of the system of are you are developing. This work often falls into four ategories: Costs Satisfation Proess adherene Impat/outome It is not unusual for ommunities to develop aountability mehanisms for one or two of these areas, work on that for a while, and then move on to add in another fous area. The proess of developing a full set of indiators an take a signifiant amount of time. Working toward a multi-tiered set of aountability measures is important and will require effort and resoure ommitments over time. This investment will support your effort to refine and improve your wraparound projet based on loally developed and managed indiators sets that are relevant to the priorities you have hosen for your implementation. Wraparound Implementation Guide 77

78 Question: Wraparound has several staff roles inluding failitator, parent partner, youth partner, and supervisor. Do these positions always need to be in plae for all projets in order for us to all what we do wraparound? We are operating on a tight budget and are not likely to have all of the funds neessary for all of these positions. Answer: Many sites struggle with ensuring the right mix of staff for implementation of wraparound. Minimally, you must have someone take on the role of failitation of the wraparound proess inluding meeting, team, and plan failitation. Other roles are important and may be added later or an be built in through partnerships with other organizations. For example, some wraparound projets hire failitators and pair eah one with a peer support partner from other, existing, loal initiatives. Question: What is the right balane between osts for doing wraparound, osts for needed support and servies, and really flexible dollars for one-time, onefamily expenses? How do we know if we alloated our resoures orretly to support this work? Answer: The right ratio is largely dependent on loal onditions. If you are in a ommunity that has developed a signifiant and broad-based partnership group, you may find that your need for flexible one-time dollars is less than for other ommunities beause you an aess in-kind options. Staff osts assoiated with the implementation of wraparound are also largely dependent on loal onditions and the workload you ve established for your wraparound staff. If they are expeted 78 Wraparound Implementation Guide

79 to do a great deal of paperwork or various other duties, you will need to spend a relatively larger share of funds for staff. Most projets begin by gathering information from a variety of other pratitioners and starting with some sort of ratio. As the projet matures, try to foster open disussions with partners and providers to try to establish the right amount and blend of funding to effetively implement wraparound. This information an be gathered retrospetively as more families are served and should inform future finanial deisions. Question: What should we do when the partnership feels unequal? For example, one system spends more money on our wraparound effort than the others and they seem to feel like they have a bigger stake and more power in the deisions we make. Is this okay? Answer: Wraparound investment is likely to vary from system to system and from time to time. In some states, wraparound is funded through a rediretion of hild welfare dollars while other states may see primary funding ome from other systems suh as mental health or juvenile justie. Managing this imbalaned investment requires strategi ation. Some ommunities have established methods for deision making that are fair, open and transparent, while others have aknowledged the greater investment by giving those with a bigger stake a bigger vote. Some administrators find it helpful to aknowledge the more subtle investments made by those who don t ome to the table with a big hekbook. Again, as with most things in wraparound implementation you must build on what you have and ontinue to work towards improvement over time, inluding movement toward greater system integration. Wraparound Implementation Guide 79

80 Question: How do we keep wraparound from being just another program in our system? How do we keep it alive as a hange mehanism for the broader system? Answer: Many sites struggle with ensuring the right mix of staff for implementation of wraparound. Minimally, you must have someone take on the role of failitation of the wraparound proess inluding meeting, team, and plan failitation. Other roles are important and may be added later or an be built in through partnerships with other organizations. For example, some wraparound projets hire failitators and pair eah one with a peer support partner from other, existing, loal initiatives. For wraparound funders: These are individuals who make exeutive leadership and fisal deisions related to developing and implementing wraparound within ommunities. Question: What outomes should we trak in our wraparound initiative? whih ones you will prioritize an inlude: Answer: Communities have tried many strategies to sort out this issue. The most important onsideration is how to ensure that there are outomes that you jointly own and trak and report. Methods for piking Reviewing all indiators from all partiipants systems and seleting a subset that all systems trak some information about. Having eah system identify one indiator that they are most onerned about 80 Wraparound Implementation Guide

81 and then treating the omposite group as the starter set of indiators for the projet. Developing a set of unique indiators that reflet the leadership pereption of important things to trak and monitor. The important thing is to start traking, monitoring, and analyzing outome information from early in the projet and to use this information for subsequent improvement efforts. Question: In our effort to build a ollaborative body we have gathered people from different levels in their organizations. It does not always feel right for a diret line supervisor to arry the same weight as an exeutive diretor of one of our funders. What an we do about this without alienating representatives who are invested in improving are for youth and families in our ommunity? Answer: Community partnership and ollaborative bodies sound like ideas rooted in an egalitarian and ooperative tradition. While these ideals are a good thing, we need to be autious about assuming that everyone at the ollaborative table brings the same thing. One option is to think about tiering partiipation in the ommunity ollaborative. This approah would math people from similar levels to work together to identify and resolve hallenges in wraparound implementation that affet their level of the organization. This is a way to garner ideas and solutions from aross the organizational levels while reating a role for multiple levels of input. Strutures within ollaborative bodies an inlude sub groups that are: Task-foused; for example, workfore development, outome management, and others; or Wraparound Implementation Guide 81

82 Role foused; for example, exeutive level, supervisor level, or family representatives. Healthy ollaboratives find ways to use the talents of representatives in a way that is appropriate and respetful to their roles and expertise. Question: How do we enourage providers in our ommunity system to work together rather than ompete for dollars and expertise? Answer: First of all, ompetition among providers an be healthy for system improvement. Competing to be the most flexible and responsive provider in the eyes of families is very different than ompeting to have the biggest budget. Leadership messages and deisions reinfore and shape opinions and pereptions of what is important. Create opportunities for healthy ompetition by inentivizing the things that you value. If working together is one of those, then reating inentives for working together, rewarding it when it happens, and funding joint efforts are all strategies that an be effetive at improving ollaborative ation at the provider level. Question: What is the right mix of formal servies and flexible funds to ensure that we have the right help available to families as we do wraparound? Answer: There is no known formula for figuring out this mix. It will depend on several fators inluding the type and volume of servies urrently available in your system and the depth of need and hallenge faed by families. In order to keep the right balane in mind it is neessary 82 Wraparound Implementation Guide

83 to trak expenditures and servie usage patterns by individual family. This an be done by reating a proess that builds an individual budget by family and wraparound team. This information an then be aggregated at the funding level. Funders should analyze this data, onsider its onnetion to inputs and outomes, and then make informed deisions about where to make fisal ommitments. Monitoring flexible expenditures may point to the need to make other investments. For example, a plethora of flexible expenditures lustered in one type of ativity may lead to a deision to reate a new servie type or ontrat in the ommunity system. This kind of proess and analysis will lead to an improved mix ` of formal and flexible resoures. Question: Lots of wraparound projets seem to pool funds. We will not be doing that in our ommunity. Does this mean we should not do wraparound? Answer: Pooled funds are often a symbol of multiple funders ommitment to wraparound. The lak of ability to pool funds does not mean that you should abandon your wraparound efforts. If you will not be pooling funds, just be sure to pay attention to inreasing your abilities to: Share speifi, aurate, and up-todate budget information; Share dollars aross systems for important investments in flexible responses for families and youth; and Share, publily and repeatedly, your ommitment to ollaboratively manage and improve are for youth and families. These are the underlying funtions that are addressed in pooling funds. Wraparound Implementation Guide 83

84 Question: Starting a new projet means new training for projet staff and ommunity members. How do we make sure we get the best possible training for our ommunity? Answer: There are many plaes to searh for a training resoure that mathes your ommunity s needs. San your environment, find out who is doing wraparound, and find out who trained them. Chek at the state level, the ounty level, and the provider level for organizations that have implemented wraparound. Interview them to asertain their approah to training. A mix of outsider/expert (to get the latest and the best from the broader field) and loal experiened staff and leaders (to get the pratial on the ground piture) reates the most effetive balane. It is also important to develop a plan for ensuring that you reah all of the right audienes with the right information at the right time. Wraparound managers need different information than families enrolled in wraparound. Additionally, training should be seen as an ongoing, iterative proess that adapts over time to loal onditions. This is likely to mean that you will need more than one trainer or training resoure over time. 84 Wraparound Implementation Guide

85 Appendix A: Self-Assessment Of Strengths And Needs Community Groundwork for Wraparound Implementation: A Self-Assessment of Strengths and Needs Theme 1: Community partnership An initial group of stakeholders has ome together and made a firm ommitment to moving forward with wraparound implementation Is this happening? 1=not really 2=some 3=quite a bit This group urrently inludes, or is atively reahing out to... family members and youth and/or young adults who are system experiened inluding any family or youth support/ advoay organizations in the ommunity 1=not really 2=some 3=quite a bit Wraparound Implementation Guide 85

86 Theme 1, ontinued representatives of key funders and key hild- and family-serving organizations ageny and organization leaders who are able to ommit resoures and lead efforts to hange poliies 1=not really 2=some 3=quite a bit 1=not really 2=some 3=quite a bit Theme total (sum of four items): 86 Wraparound Implementation Guide

87 Theme 2: Collaborative ativity Is this happening? The people who are planning for wraparound implementation have a solid understanding of and ommitment to wraparound priniples and pratie are ommitted to making hanges in their own organizations and in the larger system have reahed a deision regarding who will be eligible for wraparound are lear about the desired outomes they hope to ahieve 1=not really 2=some 3=quite a bit 1=not really 2=some 3=quite a bit 1=not really 2=some 3=quite a bit 1=not really 2=some 3=quite a bit Theme total (sum of four items): Wraparound Implementation Guide 87

88 Theme 3: Fisal Poliies and Sustainability Is this happening? The people who are planning wraparound implementation have a basi understanding of what will need to be funded and approximately how muh it will ost to fund the following ore wraparound needs: Key staff roles, inluding failitators, family partners, youth partners, supervisors and administrators Training, oahing and supervision for key staff roles IT or data management systems to trak utilization, administrative data, and wraparound plans, progress and outomes People who are planning wraparound implementation understand the basi models and options for ahieving adequate, stable funding for the wraparound effort 1=not really 2=some 3=quite a bit 1=not really 2=some 3=quite a bit 1=not really 2=some 3=quite a bit 1=not really 2=some 3=quite a bit Theme total (sum of four items): 88 Wraparound Implementation Guide

89 Theme 4. Aess to Needed Servies and Supports Is this happening? The people who are planning for wraparound implementation have knowledge about the array of servies that is typially needed for wraparound programs, inluding non-traditional servies and supports, and are atively strategizing about how to fill gaps in the array understand the role that informal and ommunity supports play in wraparound, and are atively strategizing about how to inrease ommunity apaity to build and use suh supports understand the importane of peer support in wraparound, and are atively strategizing about how to ensure aess to peer support are atively strategizing about how to build ommunity apaity to reate ompletely individualized supports for youth, aregivers, and family members 1=not really 2=some 3=quite a bit 1=not really 2=some 3=quite a bit 1=not really 2=some 3=quite a bit 1=not really 2=some 3=quite a bit Theme total (sum of four items): Wraparound Implementation Guide 89

90 Theme 5. Human Resoure Development and Support Is this happening? The people who are planning for wraparound implementation have a realisti understanding of what it takes to provide adequate training and oahing for key roles (failitators, family/youth partners, supervisors), and are atively strategizing about how to ensure this for the wraparound projet. have a realisti understanding of typial staffing plans (inluding aseload sizes) that allow people in key roles (failitators, family/youth partners, supervisors) suffiient time to provide high quality wraparound, and are atively strategizing about how to ensure this for the wraparound projet. have a realisti understanding of the strutures and proesses that are needed to ensure that people in key roles offer high quality supervision, and are atively strategizing about how to ensure this for the wraparound projet understand the need to get servie providers and ommunity partners on board with wraparound, and are atively strategizing about how to do this 1=not really 2=some 3=quite a bit 1=not really 2=some 3=quite a bit 1=not really 2=some 3=quite a bit 1=not really 2=some 3=quite a bit Theme total (sum of four items): 90 Wraparound Implementation Guide

91 Theme 6. Aountability Is this happening? The people who are planning for wraparound implementation are exploring options for assessing progress and suess in overall implementation of the wraparound projet are exploring options for measuring wraparound quality and other proess outomes are exploring options for measuring utilization, osts and expenditures are exploring options for measuring hild/ youth and family outomes, inluding hild/ youth and family satisfation and other outomes that families and youth are about 1=not really 2=some 3=quite a bit 1=not really 2=some 3=quite a bit 1=not really 2=some 3=quite a bit 1=not really 2=some 3=quite a bit Theme total (sum of four items): Wraparound Implementation Guide 91

92 Appendix B: Self-Assessment Tools For Leaders Self-Assessment Tools for the Leaders, Managers, and Planners of Efforts to Implement Wraparound These self-assessments are designed to help wraparound leaders assess and plan for important aspets of the wraparound development proess. Managers should answer these questions and use their answers to highlight strengths and hallenges in their implementation. The six areas are the same six areas disussed in this Guide. These are also the six areas defined in the Community Supports for Wraparound Inventory, a resoure developed through the National Wraparound Initiative. There is a self-assessment for eah of the six areas: Community Partnership Collaborative Ation Aess to Needed Servies and Supports Fisal Poliies and Sustainability Human Resoure Development and Supports Aountability 92 Wraparound Implementation Guide

93 The self-assessments are designed to help managers pinpoint the essential organizational and system supports they should develop to ensure quality wraparound pratie at the family level. Completing the self-assessments will help these leaders, managers, and planners to: Assess whether they have worked on the right areas to support an effetive initiative Gain a better sense of where to target improvement efforts and resoures in the planning and implementation proess Identify when they may need to gather additional information in order to keep their system development efforts on trak The self-assessments were designed so that Yes answers reflet areas of strength. No answers are seen as refleting an opportunity for improvement and development. As a strategi leader, you should review your answers and identify where you want to invest energy. Fousing on positive answers may help you to strengthen ertain areas before takling the areas of greatest hallenge. On the other hand, as a strategi leader you may find that some No answers require attention for you to move on. You an go through these questions one theme at a time or omplete the entire set of self-assessments in one sitting. The purpose of the self-assessment proess is to help you guide your ommunity effort more effetively and strategially. The self-assessments are a starting point rather than an ending point or destination. You an use these tools multiple times, and you may find that your answers may differ from one rating period to the next. Wraparound evolves and hanges along with ommunity ontext, people,and system development. Wraparound Implementation Guide 93

94 Community Partnerships This area of the self-assessment fouses on three key aspets of ommunity partnership related to the implementation of wraparound. These areas are: Membership: Are the right people partiipating from the right levels of the partner organizations? Struture: Is there a struture that supports and enourages effetive partnerships that translate hope into ation? Proess: Are there proesses in plae that assist us in maintaining effetive relationships, goals, and plans for our ommunity servie system? Area Questions to onsider Yes No Membership Have you inluded a range of representatives from aross the system? Families System Partners Community Representatives Business leaders Cultural Leaders Have you seleted the right level of partiipation? Supervisors Managers Poliy Makers Others Have you onsidered who s missing? Have you planned for how to seure their involvement? 94 Wraparound Implementation Guide

95 Area Questions to onsider Yes No Struture Have you designed a struture from whih the ommunity partnership an operate? Is it mindful of the time, energy, and ommitment of members? Is the sope of deision making learly and openly artiulated? Is this struture ompatible with and tied to other strutures urrently operating within the ommunity? Proess Have you identified the proess by whih deisions get made? Have you identified how to welome, orient and remind members of our proess and mission? Have you established an effetive ommuniation network that will reah the right people and provide the right information? Have you established a way to doument your work and maintain your wraparound memory as membership hanges? Wraparound Implementation Guide 95

96 Collaborative Ation This setion of the self-assessment fouses on the three areas for establishing ollaborative ation among stakeholders: Shared Leadership: Have you worked with others inluding families to build support for your projet? Guiding Plan: Have you established a plan that is future-oriented, strategi and relevant? Organizational Integration: Are you onsidering the entire system in your design? Area Questions to onsider Yes No Shared Leadership Have you identified who your wraparound hampions are, both within and outside the projet? Have you ommitted to identifying families and young people as allies and sponsors of your wraparound projet? Are you putting families and young people forward with support, authority, and resoures? Have you ommitted to sharing deision making and power with them? Are you willing to redistribute resoures (personnel, time, spae, equipment, funds, et.) if family and youth voie leads to hanges in some priorities or poliies? Have you built an inlusive agenda with families and young people rather than for them? 96 Wraparound Implementation Guide

97 Area Questions to onsider Yes No Shared Leadership (ontinued) Have you identified what deisions you an make ollaboratively? And with whom? Guiding Plan Have you established long-range goals for your projet? Have you established mid-range objetives for the projet? Have you worked with others in establishing goals and objetives? Have you published your plan? Have you sought feedbak about your guiding plan from those most impated by it? Organizational Integration Have you identified ageny-, organization-, and system-level poliies that are ompatible with your projet? Have you identified poliies that are not ompatible? Have you reviewed your own operations within the initiative to identify areas of oherene or inoherene inluding: Paperwork? Billing Expetations? Wraparound Implementation Guide 97

98 Area Questions to onsider Yes No Organizational Integration (ontinued) Have you identified staff job desriptions and roles for the projet? Are they ompatible with wraparound values and real job expetations? Have you notified other partners of your ommitment to hange? Have you enlisted their partiipation? Have you reated a means to identify, prioritize and implement hanges that will give you the best leverage for quality wraparound implementation? 98 Wraparound Implementation Guide

99 Fisal Poliies And Sustainability This area of the self-assessment fouses on resoure issues inluding finanial investments and inludes the following areas: Wraparound Projet Funds: Have you invested enough to ensure that you will have the right staff and infrastruture to produe your desired outome? Building Funding Streams for Neessary Servies: Is your projet positioned to wisely distribute funds for both projet implementation and individual family servies/supports? Flexible Funds: Are there lear, fair, quik pathways for flexible fund expenditures? Stewardship: Does your management of flexible funds and resoures reinfore the wraparound values and praties? Area Questions to onsider Yes No Wraparound Projet Funds Have you identified and seured funding for at least a minimum range of staff roles? Will staffing patterns/ase loads allow staff members time to do key tasks well? Have you identified what you will need in terms of supervision? Have you budgeted for overhead osts inluding providing linial onsultation and support? Have you identified and budgeted for the types of supervisory strutures you will need to reate? Wraparound Implementation Guide 99

100 Area Questions to onsider Yes No Wraparound Projet Funds (ontinued) Have you budgeted for after-hours support and aess to aommodate family needs? Have you developed and budgeted for training and staff development strategies so that staff have adequate information? Build Funding Streams for Neessary Servies Have you identified what funding streams an be used in support of individual wraparound plans? Have you ontated other wraparound sites to projet the range of servies and supports that are typially needed? Have you established funding for a front-end apaity so that families who enter wraparound in a high state of destabilization an aess potent servies and support quikly? Have you identified an integrated paper trail to avoid dupliation on the part of diret servie staff, partiularly when multiple funding streams are aessed? Have you identified opportunities to impat funding streams at the poliy level to ensure that flexibility an be enhaned for hildren and families? 100 Wraparound Implementation Guide

101 Area Questions to onsider Yes No Build Flexible Funds Have you identified poliies for management of your flexible funds? Have you reated easy ways to aess ash or heks? Have you established lear definitions about flexible funds and their use? Stewardship Have you set forth poliies for use of flexible funds? Have you sought feedbak from youth and families about those poliies? Have you avoided setting hard and fast rules but instead reated thinking poliies for staff to use openly with families? Have you made sure you are balaning the right ratio of staff roles with the right mix of diret servie and the right mix of flexible funds? Have you reated a transparent poliy to seek exeption to poliies set forth to make sure that outlying situations with families an be onsidered? Wraparound Implementation Guide 101

102 Aess To Needed Servies And Supports This area of the self-assessment fouses on the need to build a range of flexible, responsive and reative servies and support for families enrolled in wraparound. Areas of fous in this area inlude: Creativity: Have you ensured that a range of helping ativities is available to families through this proess? Wide Range of Options: Are you maximizing hoie for families and individual teams in arranging or delivering servies and supports? Ensuring Open Doors: Have you reated simple and straightforward ways for people to aess help? Just-in-Time Help: Have you developed effiient ways for timely response? Area Questions to onsider Yes No Creativity Are you working with urrent providers to tailor interventions? Have you made it possible for as many different types of help to be available to families through as many of your partners as possible? Have you worked to define the differene between getting a servie and getting needs met? Have you arranged resoures (personnel, ontratual, others) to ensure that unique servies and supports an be reated? Can teams build and get support for a reated intervention that is right for just one family? 102 Wraparound Implementation Guide

103 Area Questions to onsider Yes No Wide Range of Options Have you reahed out to and inluded a broad array of providers? Even those who are not usually onsidered? Have you built an understanding that effetive help reahes beyond servie boundaries and definitions? Have you arranged enough flexibility of resoures to support highly individualized supports for families? Ensuring Open Doors Do you have a lear plan for how supports and servies will be aessed and onneted to families? Have you reated apaity to onnet with an off-line provider as an exeption to poliy? Have you reated a risis apaity? For on-all? For mobile response? For aess to ommunity resoures? Just-In-Time Help Have you effetively planned for getting help to families in a timely way throughout this effort? Have you developed a way for servies to ease when they are no longer needed? Have you reated fast-trak agreement proedures so that paperwork will never prohibit servie aess? Wraparound Implementation Guide 103

104 Human Resoure Development and Supports This area of the self-assessment is foused on human resoure issues as they relate to your wraparound implementation. Speifi areas in this setion inlude: Adequay of Staff and Roles: Have you developed a plan to get the right people in the right role with the right tools to do the job? Comprehensive Performane System: Have you reated methods for assessing and supporting ontinual development of staff ompetene? Family Involvement: What have you done to involve families in all aspets of workfore development? Area Questions to onsider Yes No Adequay of Staff and Roles Have you outlined the key roles needed to operate suessfully? Have you developed job desriptions that are aurate and values based? Have you defined what key features you will need in suessful andidates? Do you have a reruitment strategy in plae? What is it and how is it different from reruiting for other positions? Have you built the steps for hiring the right employees for the positions you have planned? Have you developed a training strategy? What are the types of knowledge and skills you will need addressed, and by when? 104 Wraparound Implementation Guide

105 Area Questions to onsider Yes No Adequay of Staff and Roles (ontinued) Do you know how you will orient staff to the goals of the projet on the very first day? Have you developed a proess for monitoring workload issues to ensure adequate staffing patterns? Have you reated internal and external partnerships that will allow your wraparound staff to funtion suessfully? Are there unique roles that will require unusual or nontraditional supervision? How will you aess this support? Comprehensive Performane System Have you established key benhmarks for staff and program performane? Have you established open feedbak loops so staff an reeive positive and orretive feedbak? Have you linked program performane to employee performane? Do you know the mehanism you will use to summarize performane information to employees, funders and internal administrative roles within your organization? Family Involvement Have you involved families in reruitment and interviewing for positions? How will you involve families in providing feedbak for staff around program and personnel performane? Wraparound Implementation Guide 105

106 Aountability This area of the self-assessment fouses on quality assurane improvement proesses. You should use this to determine measures for aountability and how you will get enough information to use in program improvement. Speifi areas in this setion inlude: Key Outomes: Have you identified the key results or impat you are expeting? Management of Key Proess Elements: Have you identified what praties you want staff to follow with individual families? Youth and Family Issues: Have you identified and involved families in determining satisfation measures? Community Proesses: Have you built an awareness of antiipated ommunity, organizational and system hange ativities? Costs: Have you reahed onsensus about the right amount of fisal investment you expet to make to get your desired results through following your prioritized praties? Area Questions to onsider Yes No Key Outomes Have you artiulated what you hope to aomplish for the people you are helping? Do you have a plan for how you will measure it? Have you atalogued the soures of information that are available to you? Are you lear about what your funders are about? Do you have a plan for how you will summarize outome information for staff? 106 Wraparound Implementation Guide

107 Area Questions to onsider Yes No Key Outomes (ontinued) Have you determined the level of outome ahievement you hope to see? What an you settle for? Have you deided what type of postompletion follow-up you will use and how long after servies are over you an hek to determine effetiveness? Key Proess Elements Have you identified whih praties within wraparound you are most about? How will you monitor whether those are happening? Do you have linkages to any researh projets? Do you have a plan for how to use proess information in program improvement? Youth/Family Speifi Issues Have you determined if there is anything unique about your target population that you need to/want to monitor? Do you have a plan for how you will measure the family s experiene of your projet? Community Proesses Have you artiulated what you expet the ommunity impat of the projet to be? Do you have a plan for how you will determine if your system is hanging? For the better? For the worse? Wraparound Implementation Guide 107

108 Area Questions to onsider Yes No Costs Do you have a way to trak urrent and future osts of are? Do you know what soures of funds those osts inlude? Have you examined what is a reasonable expenditure outlay per family? Will you know when it is too muh? When is it too little? Do you have a plan for how to onsider expenditures aross life domains and sort out what that suggests for your system of are in terms of program development? Other Have you planned for how frequently you will need this information for it to be pereived as useful to the projet? 108 Wraparound Implementation Guide

109 join the nwi and gain the benefits of membership Wraparound is an intensive, team based proess for designing and implementing individualized plans of are for hildren and youths with omplex needs and their families. The National Wraparound Initiative provides open aess to resoures and information about implementing wraparound through its main website. In addition, individual members and organizational subsribers reeive further benefits and opportunities, inluding exlusive aess to: A omprehensive, searhable library of resoures shared by members. Everything from assessments to intake forms, job desriptions, MOUs, evaluation reports, and more; The NWI member diretory; Job openings and postings; NWI members-only web pages that allow members to pose questions and get answers, review one another s materials, and join work groups and affinity groups; Online blogs and forums; The NWI s eletroni newsletter, News Alerts and researh updates; and Disounts to NWI onferenes and other events. Our mission is to promote understanding about the omponents and benefits of wraparound, and to provide the field with resoures and guidane to failitate high quality and onsistent wraparound implementation. Perhaps most importantly, memberships help sustain the NWI, so that the NWI an ontinue to provide free aess to materials and resoures that support wraparound everywhere. To aess the many resoures of the National Wraparound Initiative, beome a member, or sign up for future notifiations, go to NWI members also have the opportunity to partiipate in the development of new resoures and onsensus douments for the field, and to preview, pretest, and omment on new NWI materials.

110 More about the National Wraparound Initiative Based on the shared efforts and expertise of advisors and partners, the NWI has reated an open, ollaborative, ommunity of pratie. Using this approah, the NWI has developed materials that desribe the priniples and ativities of wraparound, the theory and researh base, the role of the family partner, and requirements for implementation. The NWI has also produed a 50-artile Resoure Guide to Wraparound; produed the User s Guides for Families; and failitated aountability through dissemination of fidelity measures and implementation blueprints. With investment from members and funding from our federal partners, the NWI is atively working on making the following supports available to the field, inluding: A new Implementation Guide to Wraparound that provides system partners with an overview of what it takes to develop and oversee a wraparound initiative A detailed Implementation Blueprint and Readiness Guide that provides hands-on, step-by-step guidane to setting up systems and organizations to failitate wraparound implementation A desription of the ore skillsets for individuals in key roles for wraparound to guide training, oahing, and supervision of the workfore Tools for evaluating the quality of training and tehnial assistane for wraparound initiatives, with guidane for interpretation An outomes measurement system that is based on wraparound priniples, provides dashboard reports for wraparound teams, and is available on the online data entry and reporting system of the Wraparound Fidelity Assessment System Webinars, onferenes, symposia and more! get onneted to the nwi join today! Go to The NWI is Co-Direted by Janet S. Walker of Portland State University and Eri J. Bruns of the University of Washington. The NWI reeives support from the Child, Adolesent, and Family Branh of the SAMHSA Center for Mental Health Servies. For more information: Contat Sarah Peterson at or all

111

112 This guide overs the Six Themes of Wraparound Implementation and how you an apply them in your program: 1. Community Partnership 2. Collaborative Ation 3. Fisal Poliies And Sustainability 4. Aess To Supports And Servies 5. Human Resoure Development 6. Aountability This publiation is a produt of the National Wraparound Initiative. For information about what we do, look inside this bak over.

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