Learning Objec5ves. A Very Brief History. The Implementa5on Gap. The Implementa5on Gap. Then a miracle occurs...

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1 Learning Objec5ves Advancing Systems ª Enhancing the Workforce ª Improving Outcomes In this session, par4cipants will learn Informa4on related to recruitment, staff selec4on, workforce development, and reten4on of a wraparound workforce Latest innova4ons in training coaching and supervision of wraparound facilitators and parent peer support partners Techniques to enhance local strategies related to recruitment, staff selec4on, workforce development, and reten4on of a wraparound workforce Hiring, Inspiring, and Never Tiring: Recrui5ng, Developing, and Retaining a Quality Wraparound Workforce Emily Bradshaw, MSW. (ebradshaw@ssw.umaryland.edu ) Joe Anne Hust (hust@ssw.umaryland.edu) Marlene Matarese, PhD (mmatarese@ssw.umaryland.edu) University of Maryland Institute for Innovation and Implementation Technical Assistance Network For Children s Behavioral Health National Wraparound Implementation Center Georgetown Training Ins4tutes Washington, DC July 17, 2014 A Very Brief History " During the 70s and 80s, wraparound emerged from efforts to do whatever it takes to keep children successfully in the community " Provide comprehensive community supports rather than ins4tu4onaliza4on " Help family and child get their unique needs met " In 1998, concerns that wraparound was not well specified led to original statement of 10 principles/value base " List of principles, no informa4on about how to turn that into prac4ce " 2003 expert stakeholders convene define principles and prac4ce model " This group becomes the Na4onal Wraparound Ini4a4ve The Implementa5on Gap Focus on Knowledge: How Does Wraparound Work? Wraparound Principles: Family voice and choice Team-based Culturally competent Natural supports Collaboration Community-based Individualized Strengths based Persistence Outcome-based Positive Outcomes! Then a miracle occurs... The Implementa5on Gap " There are not clear pathways to implementation " What is adopted often is not used with fidelity and good effect " What is implemented disappears over time and with staff turnover Blase, 2008 Bertram, Blasé, & Fixsen,

2 Implementa5on Drivers State Support Program Evalua4on Performance Management Local System Readiness Organiza4onal Supports Supervision and Coaching Staff Selec4on Training Child and Family Benefits Implementa5on Drivers Competency Selec5on Training Performance Assessment (Fidelity) Coaching Systems Interven5on Adap5ve Integrated & Compensatory Technical Organiza5on Facilita5ve Administra5on Decision Support Data System Leadership From Fixsen et al (2005) Fixsen & Blase, 2008 Recrui5ng for Wraparound " Values and skills of great prac44oners Care Coordinators & Family Partners " Posi4on Pos4ngs " Selec4ng & determining most qualified candidates " Wraparound Interviewing techniques What are the values and skills of great Care Coordinators and Family Partners? Looking for Values Care Coordinators and Family Partners " The worst home is becer than the best placements " EVERYONE has strengths that get them through the hard 4mes " All families are doing the best they can with the resources available to them " All bad behavior is a result of an unmet need Skills of a Quality Care Coordinators " Empathic " Ability to maintain a strengths orienta4on " Ability to read the social cues of others " Ability to communicate in a respecful manner " Ability to adapt based on new informa4on " Ability to collabora4ve and work with others " Able to manage conflict as well as various personali4es and agendas effec4vely " Is well organized and can mul4task successfully " Comfortable not having all of the answers " Blend or integrate mul4ple perspec4ves " Able to track and monitor successes (adapted from Henkin & Dee, 1998 & Meyers, 2008) 2

3 .. Skills of a Quality Family Partners Ability to: " Use structured self- disclosure to support another parent " Support parents and the Wraparound process " Build partnerships with professionals " Introduce concept of tomorrow by building hope " Recognize and build on strengths " Provide non- adversarial advocacy " Prac4ce and teach self- care " Maintain a stance of acceptance " Build connec4ons and provide linkages " Preserve a respecful and non- judgmental altude Staff Selec5on Pre- interview Care Coordinators: " Starts with the posi4on pos4ng " Where you adver4se " Job descrip4on " Reviewing Resumes " Know what to look for " Work with people, system experience, crea4vity and/or excitement in a cover lecer, goals/ objec4ves, living abroad or experience with diverse cultures, organiza4onal skills, wri4ng abili4es, some4mes the unusual on a resume Staff Selec5on Pre- interview Family Partners: " Post posi4on- word of mouth most effec4ve " Need to access parents with lived experience " Best resource is families being served " Role descrip4on and clear expecta4ons explained Resume helpful but conversa4on and role play becer " Looking for: " Parent of a child with emo4onal or behavioral challenges " Systems experience " Ability to empathize with others " Communica4on and listening skills " Culturally competent Sample Job Pos5ng Care Coordinator I believe all families have strengths and deserve access to high quality services and supports. I am empathe4c, crea4ve, resourceful, flexible and commiced to doing what it takes to support children with behavioral challenges and their families. If you read this and thinking That s Me! then this wraparound facilitator posi4on may be the perfect job for you. Apply your understanding of children's behavioral health and your cultural sensi4vity to work collabora4vely with families, their supports, other professionals, and community partners to develop individualized, family determined, strength- based plans of care. Please click here for the full job descrip4on. Sample Job Pos5ng Family Partner I am the parent of a child with emo4onal or behavioral challenges and have learned to navigate the system with my own child. I am able to use my own lived experience to support another parent and provide hope and guidance to other families through similar challenging circumstances. I stand commiced to ensuring that other parents have a voice in their child s care and are ac4ve par4cipants in the healing process. Having experienced the s4gma and isola4on that raising a child with mental health challenges brings, I am able to connect other parents to resources and supports that build on their strengths and interest. This job is a full 4me posi4on with benefits. Interviewing Techniques How do you assess for the specific values and skills of quality Wraparound prac44oners during the interview process? 3

4 Interviewing Techniques " Assessing the values and skills of applicants: " Use behavioral examples and situa4ons " Keep the interview ac4on- oriented and prac4ce focused. " Organize group interviews with mul4ple applicants " Involve real families and young people in the interview process. " Incorporate fellow Care Coordinators & Family Partners. Staff Selec5on- The Interview Examples of Interviewing Techniques: " Mock CFTM with instruc4ons (group interview) " Wri4ng sample (based on this example take 5 minutes and write a progress note) " Role Plays " Mini- training or presenta4on " Wai4ng room observa4on " Meet with other care coordinators and family partners (an honest day in the life ) " Interview with a parent or youth Staff Selec5on The Interview Who Do you Hire? How do you choose the BEST applicant for the job? " Do answers to behavioral ques4ons align with the values of the Wraparound process and those of your organiza4on? " Is this applicant able to demonstrate the basic skills necessary for the posi4on and can they be taught to integrate new skills? " Will this applicant be the best fit for the team they will be working with? " For care coordinators, you can teach the wraparound process, you may not be able to teach values and perspec5ves " For family partners, remember you are looking for lived experience - You can teach the wraparound process, you may not be able to teach values and perspec5ves Advancing Systems ª Enhancing the Workforce ª Improving Outcomes Building Staff Competence Workforce Development How do you build upon these values and skills to develop a high quality and fidelity Wraparound prac55oner? 4

5 Workforce Development is a Core Component in Implementa5on Workforce development in a High-Quality Wraparound Practice Model should build practitioners: " Knowledge of the history, theory, philosophy, and rationale for Wraparound as a practice model " Understanding of the components of wraparound and demonstration of the practice elements " Behavior rehearsal to practice the skills and receive feedback on the practice Developing the Model for Training and Coaching " Training, combined with coaching, create condi4ons in which quality implementa4on happens. They are important components to achieve posi4ve outcomes (Joyce & Showers, 2002). " Opera4onalizing the Values Focus on Skill Development in the Model " Transla4ng values to ac4ons/skills (Blase et al., 1984; Joyce & Showers, 2002; Kealey, Peterson, Gaul, & Dinh, 2000) (Fixsen, Naoom, Blase, Friedman, & Wallace, 2005) The NWI and the Workgroups " The Na4onal Wraparound Ini4a4ve " NWI founded 2003 " Bring experts together to build formal consensus around key aspects of wraparound " Disseminate useful informa4on to the field " Workgroups " Focus developing consensus on specific topics nwi.pdx.edu The Process Goals: Demand from the field to protect prac4ce Set expecta4ons that are feasible and consistent with high quality prac4ce Drav created: Survey on exis4ng expecta4ons: non- nego4ables Work group edits Final version: Several rounds of feedback from NWI core group and membership Published June

6 Knowledge, Skill and Ability Development Process Components of Effec5ve Training Identifying skills and competencies to transfer in the training and coaching process Refinement Integra5on Enhanced skills, knowledge and abili5es Innova5on Telling Showing Prac4cing Feedback Perfunctory & Rou5ne Use Orientation & New Knowledge Understanding the capacity of practitioners (Gingiss, 1992; Blase,) Components of Effec5ve Coaching Overall Training Approach (con5nued) Individualized Reflec5ve Accessible Flexible Based on Prac5ce Model Suppor5ve " Training adheres to wraparound principles " Maintain respecful wraparound stance toward families and children/youth, " Training is strengths based, individualized, data informed " Trainers/coaches collaborate with trainees " Training plan and progress are clearly documented " Which elements of training has trainee received " What is the quality of prac4ce Orienta5on: Before Working with Families " Exposure to key topics " Overview: history, model defini4on, expected outcomes, theory of change " Introduc4on to skills/competencies " Intensive review and prac4ce of ac4vi4es (tell, show, prac4ce) Appren5ceship " Trainee is paired with an experienced coach " Expert peer or outside expert with training/ cer4fica4on in coaching " Transi4on observer - > observee " Reliable feedback, structured process for feedback " Appren4ceship ends when " at least three observa4ons complete " benchmark scores are met " knowledge test passed 6

7 Ongoing Coaching and Supervision " Periodic observa4on and document review " Opportunity to collaborate with other expert peers is helpful Workforce Development Building Staff Competency When Developing a Training Model Ask " Do you have a vision and can you plan for it? " Who is your audience? Care Coordinators, Family Partners, Administrators? " Will you provide Cer4fica4on? " Do you have clear expecta4ons and objec4ves? " Can you develop a training model based on a theory base and logic model? " How will you provide linkages to the training model e.g., coaching/evalua4on/fidelity? The Na5onal Wraparound Implementa5on Center " Partnership between PSU, UW and UMD " The Na4onal Wraparound Implementa4on Center (NWIC) supports states, communi4es, and organiza4ons to implement Wraparound effec4vely. " NWIC uses innova4ve approaches grounded in implementa4on science and incorpora4ng culng- edge strategies to support Wraparound implementa4on. " NWIC provides support that is intensive yet affordable. The work is focused on building sustainable local capacity to provide high- quality, high- fidelity Wraparound, thereby increasing posi4ve outcomes for children, youth and their families. Na4onal Wraparound Implementa4on Center Aligns with NWI Training Guidelines Focus on three main areas of support: " Systems Level Support " Workforce Development " Evalua4on and Quality Assurance Implementing High Fidelity AND High Quality Wraparound Practice with Children, Youth and Their Families. Systems Level Support " System structures (governance, management, quality assurance, and prac4ce level, including care management, health home) " Sustainable financing of high quality, high fidelity Wraparound, including the use of Medicaid and other federal financing mechanisms; " Developing centers of excellence for ongoing implementa4on, quality assurance, policy, financing, and evalua4on support; " Building, enhancing, and/or implemen4ng workforce development ini4a4ves outside of the Wraparound prac4ce model, including shiving providers from residen4al services to quality home- and- community- based services; and, " Implementa4on of Wraparound in the context of other systems of care efforts, including developing and implemen4ng other evidence- based and promising prac4ces. Workforce Development " Core Trainings " Coaching " Train the Trainer Cer4fica4on " Prac4ce Improvement Tools " Virtual Coaching Plaform " Virtual Wraparound Coaching Collabora4ve 7

8 Evalua5on and QA RETENTION " Effec4veness and Quality of Training and Coaching " Impact of Training and Coaching on Staff Skills " Evalua4on of wraparound adherence and community/state support using tools of the Wraparound Fidelity Assessment System Level of Community, Organiza4on, State, and System Support " Outcomes for Youth and Families " The External Review of Implementa4on, Fidelity, and Capacity (WrapSTAR), an external review of a state or site s wraparound implementa4on. Through WrapSTAR, the NWIC accountability team will collect data on (1) prac4ce- level fidelity and quality; (2) program- level supports; and (3) system level supports. " TMS WrapLogic Electronic Behavioral Health Record specific to care management using wraparound What it would take for you to stay in your job even if you won a million dollars and no longer needed to work? Organiza5onal Culture What impacts staff reten4on? " Organiza4onal values align with prac4ce. " Staff have the necessary tools, training and support to do their jobs. " Staff are encouraged to contribute their ideas. " Staff are recognized and rewarded for their contribu4ons. " Staff have a passion for the vision/mission of the organiza4on and feel like they play a role in achieving it. Organiza5onal Culture Ques4ons to Assess Organiza4onal Culture? 1. What are 5 words you would use to describe your organiza4on? 2. When visitors come to your offices, what do they no4ce at first sight? 3. What values are reflected in your organiza4on s vision and mission statements? 4. What kinds of behaviors get rewarded in your organiza4on? 5. What does the leadership in your organiza4ons pay the most acen4on to? Organiza5onal Culture How do we go about building organiza4onal cultures reflec4ve of Wraparound? " Embed the Principles, Values and Access, Voice and Ownership into all levels of the organiza4on Orienta4on & Job Descrip4ons, Training, Paperwork, Policies & Procedures, Staff Mee4ngs, Social Media, Internal Communica4on, Evalua4ons, Ou4ngs & Retreats 8

9 Effec5ve Organiza5onal Supervisory Structures Care Coordina5on Agency " Agency Director " Clinical Director " Finance/Business Manager " IT (contracted or internal) " Community Resource Specialist/ Provider Network " Supervisor staffing should include 5-7 care coordinators who each work with 8-10 families " Regular weekly mee4ngs that follow a structured process " Regular access to supervisors Family Support Organiza5on " Agency or Program Director " Finance/HR Manager " IT (contracted or internal) " Supervisor staffing should include 5-7 Parent Partners who each work with 8-10 families " Structured supervision, group supervision, clinical oversight (if billing Medicaid) " Supervisor is accessible and visible " Accommoda4on/accountability " Self Care component Administra5ve Supports How do you u4lize your administra4ve supports? " U5lizing administra5ve staff effec5vely " Answer and direct phone calls, agency website, social media network, calendar and scheduling, space, supplies " Mailing POCs or other documents " Documenta4on, quarterly reports, etc " Training and support for administra5ve staff " Included in training- agency mission, values base " Proficient in youth- guided and family- driven values and know when to escalate access to help " Remember they are oven one of the first contacts with families Climate, Culture and Values " Improve the climate and culture " Support, support, support " Connectedness and Collabora4on " Valuing staff " Fun & Celebra4ons " Being part of decision- making around agency policies " Implement staff sugges4ons " Fostering posi4vity, encouragement, openness, honesty, trust and flexibility " Maintain a Values Orienta5on " What are your organiza4onal deal breakers No- tolerance policy " Family driven, culturally and linguis4cally competent, community- based Good Supervisors Create Environments Where Staff Know " Know what is expected of them " Have supplies and equipment to do their job effec4vely " Receive recogni4on each week for work well done " Have a supervisor who cares and pays acen4on " Receives encouragement to contribute and advance " Can iden4fy a person at work who is a support " Feel the mission of the organiza4on makes them feel like their jobs are important and they are making a difference " See others around them as commiced and doing a good job " Feel they are learning new things and gelng becer " Have the opportunity to do their job well. Adapted from the book First, Break All the Rules: What the World's Greatest Managers Do Differently So what are you going to do now? Resources and Websites " The National Wraparound Implementation Center " The National Wraparound Initiative " The Institute for Innovation and Implementation " Portal to " The Resource Guide to Wraparound " Website of the National Wraparound Initiative (NWI) " Wraparound Evaluation and Research Team (WERT) wraparound fidelity tools " Other wraparound resources: " " WraparoundMilwaukee7851.htm " 9