emq familiesfirst tampa 2012 outcomes on eight wrap programs emqff

Child and Adolescent Characteristics,

Outcomes, and Wraparound Fidelity:Results from Eight California Programs

Abram Rosenblatt,

Michelle Coufal, Kate Cordell, Elisha Heruty, Catherine Aspiras, Mary Ann Wong

EMQ FamiliesFirst

2

Presentation Overview

• Youth Profile and Core Outcomes

• Child and Adolescent Needs and Strengths (CANS) Outcomes

• Wraparound Fidelity Index (WFI-4) Profile and Outcomes

• Longitudinal Outcomes

4

Number of Youth Served in CY11

Total Number of Youth Served in

Wraparound in CY11: 1,158

28%

19%

6%

24%

24%

Bay Area Capital

Central Inland Empire

Los Angeles

6

Youth’s Profile in CY11• Average Age at Admission: 14 years

• 60% Male; 40% Female

• Youth’s EthnicityNative

American

1%Other

1%

African

American

17% Asian

American/

Pacific

Islander

2%

Latin American

46%

Caucasian

34%

8

Primary Diagnosis at Admission for Youths Served in CY11

9%

39%44%

1%7%

0%

20%

40%

60%

80%

100%

Adjustment Mood

Disorder

Disruptive

Behavior

Psychotic Other

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Living Situation at Admission for Youths Served in CY11

60%

23%

0% 2%

15%

0.3% 0.3%0%

20%

40%

60%

80%

100%

HomeFoster Family

Hospital

Justice

Residential

Shelter/Homeless

Other

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Outcomes for Discharged Youth

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Profile of Youth Discharged in CY11

• Number of Youth Discharged from Wraparound:

607

• Average Length of Stay: 11 months

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Core Outcomes for Youth Discharged in CY11

81% 83% 84%

0%

20%

40%

60%

80%

100%

In Home In School Out of Trouble

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Longitudinal Core Outcomes

77%85%

76%

0%

20%

40%

60%

80%

100%


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Why the CANS?

• Item Level Tool

• Items translate immediately into action levels

• It is about the youth, not about the service

• Cultural and developmental contexts are considered

before establishing action levels

• It is about the ‘what’, not about the ‘why’

• 30 day window for rating unless otherwise specified

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CANS Overall Reliable Change Index (RCI)

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CANS Overall RCI by Program

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CANS Life Domain Functioning Domain RCI by

Program

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CANS Child Strengths Domain RCI by Program

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CANS Caregiver Strengths and Needs Domain

RCI by Program

25

CANS Child Behavior and Emotional Needs

Domain RCI by Program

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CANS Child Risk Behaviors Domain RCI by

Program

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What is the WFI-4?

• Measures implementation of wraparound process

• Set of interviews – Facilitator, Caregiver, and Youth

– 40 items for Facilitator and Caregiver

– 32 items for Youth

• Confidential interviews w/multiple respondents unique

perspectives

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Interview Detail:

• 671 facilitators interviewed

– 40.3 minutes average time

• 522 caregivers interviewed


• 305 youth interviewed


Summary of Respondents

Administration Time Frame: January 2008 – January 2012

1,498 interviews from 671 families

8 traditional wraparound

programs in 7 counties:

•Santa Clara

•Sacramento

•Nevada

•Yolo

•Fresno

•San Bernardino

•Los Angeles

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Demographics of WFI Youth

• Average Age at Admission: 13.5 years

• 57% Male; 43% Female

• Youth’s Ethnicity

Caucasian

38%

Latin American

41%Asian American/

Pacific Islander

3%

African American

17%

Other

1%Native American

1%

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Primary Diagnosis at Admission for WFI Youth

10%

45%39%

1%6%

0%

20%

40%

60%

80%

100%

Adjustment Mood

Disorder

Disruptive

Behavior

Psychotic Other

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Living Situation at Admission for WFI Youth

54%

19%

0% 1%

24%

0.3% 0.3%0%

20%

40%

60%

80%

100%

HomeFoster Family

Hospital

Justice

Residential

Shelter/Homeless

Other

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EMQ FF vs National Data: Overall Fidelity

83%77%

87%83% 80%

75% 78%73%

0%

20%

40%

60%

80%

100%

Combined Facilitator Caregiver Youth

EMQ FF National Mean

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EMQ FF vs National Data : Fidelity Scores by Phase

82%76%

86%

76%

88%81%

76%69%

0%

20%

40%

60%

80%

100%

Engagement Plan Development Implementation Transition

EMQ FF National Mean

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EMQFF Phase Scores by Program

81%86%

89%

78% 80%

87%90%

78%

84%85%87%

76%

85%83%87%

76%81%

89%90%

75%78%

87%92%

80%84%

87%87%

75%

81%78%

83%

70%

0%

20%

40%

60%

80%

100%

Program 1 Program 2 Program 3 Program 4 Program 5 Program 6 Program 7 Program 8

Engagement PlanningImplementation Transition

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EMQFF Principle Scores by Program

91%

70%70%

94%89%

94%

72%73%

95%

82%

92%

80%

67%

92%

79%

90%

78%

65%

92%

79%

94%

72%72%

96%

82%

90%

76%

82%

93%

87%91%

76%

67%

92%

82%

91%

72%

64%

89%

69%

0%

20%

40%

60%

80%

100%


Family Voice and Choice Team-Based

Natural Supports Collaboration

Community-Based

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EMQFF Principle Scores by Program continued

97%

78%

91%

82%79%

97%

78%

90%

81%83%

95%

78%

91%

85%

72%

96%

74%

86%84%

76%

98%

80%

89%

82%83%

95%

78%

89%86%

76%

96%

76%

90%85%

76%

92%

70%

81%86%

66%

0%

20%

40%

60%

80%

100%


Cultural Competence IndividualizedStrength-Based PersistenceOutcome- Based

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Average Total WFI Scores By Program

EMQ Wraparound Program Average Total WFI Score

Program 1 84%

Program 2 85%

Program 3 83%

Program 4 82%

Program 5 85%

Program 6 85%

Program 7 83%

Program 8 78%

40

Core Outcomes for Discharged WFI Youth

80%84%

90%

0%

20%

40%

60%

80%

100%


41

Longitudinal Core Outcomes for WFI Youth

85% 88%83%

0%

20%

40%

60%

80%

100%


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WFI and CANS Outcomes

• Is our fidelity associated with our outcomes?

• Which fidelity elements are more strongly

associated with which outcomes?

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WFI & CANS Outcomes

• 324 clients with two CANS Outcomes at least 6 months apart

and a WFI at 6 months of service

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WFI & Life Domain Functioning CANS

• Improved or Declined CANS groups determined by Reliable Change Index (RCI)

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WFI & Child Strengths CANS


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WFI & Caregiver Strengths/Needs CANS


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WFI & Child Behav. & Emo. Needs CANS


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WFI & Child Risk Behaviors CANS


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• Which source of fidelity scores are more

strongly associated with improved

outcomes?

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WFI-Facilitator Source & CANS

• Facilitator fidelity scores are strongly associated with CANS outcomes scores.

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WFI-Caregiver Source & CANS

• Caregiver fidelity scores are lower than facilitator fidelity scores.

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WFI-Youth Source & CANS

• Youth fidelity scores are lower than facilitator scores and exhibit reversal of

pattern in some elements for association between fidelity and outcomes.

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• How is fidelity at different phases of the

program associated with CANS outcome?

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WFI by Phase & CANSThe group of clients who only

declined in CANS domains had

significantly lower fidelity scores at

the:

• Planning (p=0.04),

• Implementation (p=0.005)

• Transition (p=0.001)

phases of the Wraparound program

as compared to the group of clients

who improved in at least one CANS

domain.

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• Focused Quality Improvement:

– In what fidelity elements should we focus our energies in order to

maximize improvement in Child Behavioral and Emotional Needs

outcomes?

• Measurable Quality Improvement

– How much improvement (i.e., what increased percentage of kids

would have reliable improvement) would we expect to see if we

brought all of these elements in our programs up to ‘high fidelity’

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Improving Fidelity

and CANS Outcomes

• There were 317 clients with a

CANS Child Behavioral and

Emotional Needs score which

could be reliably improved from

Time 1 (GTE RCI of 2.2).

• Overall, 45.1% of clients improved

between Time 1 and Time 2.

• Programs with higher fidelity in

certain elements resulted in better

outcomes.

Order of elements determined by classification and

regression tree (CART).

45.1 %

40.1 %

14.8 %

High fidelity (>=85%) for Element 5 (Community Based) = YES

47.2 %

38.1 %

14.8 %

High fidelity (>=85%) for Element 6 (Culturally Competent) = YES

48.8 %

36.9 %

14.3 %

High fidelity (>=85%) for Element 9 (Persistent) = YES

52.3 %

36.7 %

11.0 %

High fidelity (>=85%) for Element 10 (Outcomes Based) = YES

56.5 %

37.0 %

6.5 %

Child Behavior and

Emotional Needs176

Improved

No Change

Declined

Child Behavior and

Emotional Needs168

Improved

No Change

Declined

Child Behavior and

Emotional Needs109

Improved

No Change

Declined

Child Behavior and

Emotional Needs46

Improved

No Change

Declined

Improved

No Change

Declined

Child Behavior and

Emotional Needs317

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WFI and CANS Outcomes Summary

• Our fidelity scores are associated with our CANS

outcomes

• Facilitator fidelity scores are more strongly associated

with CANS outcomes

• The data suggests that focused quality improvement in

fidelity will result in a measurable improvement in CANS

outcomes

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Future Directions

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Future Directions

• Build on Initial Analyses

• Translate to Clinical Staff

• Consider Fidelity Intervention Options

• Ongoing WRAP Fidelity Feedback (Bruns)

• Build Ongoing Reporting Mechanisms

• Link to Quality of Care and Key Performance Indicators

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Q & A

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References

• Bruns, E. (nd). Wraparound Fidelity Assessment System. Retrieved from Wrap Info website: http://depts.washington.edu/wrapeval/WFI.html

• Lyons, J. Child and Adolescent Needs and Strengths. Retrieved from Praed Foundation website: http://www.praedfoundation.org/About%20the%20CANS.html

• Wraparound Evaluation & Research Team. The Wraparound Process. Retrieved from http://depts.washington.edu/wrapeval/approach.html

http://depts.washington.edu/wrapeval/WFI.html

http://www.praedfoundation.org/About%20the%20CANS.html

http://depts.washington.edu/wrapeval/approach.html

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Contact Information

Abram Rosenblatt

[email protected] (408) 364-4016

mailto:[email protected]

emq familiesfirst tampa 2012 outcomes on eight wrap programs emqff

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