youth and family training institute: training, coaching...
TRANSCRIPT
Youth and Family Training Institute:
Training, Coaching, Credentialing,
and Monitoring Wraparound
Youth and Family
Training Institute
Welcome and
Introductions
Youth and Family Training Institute:
Shannon Fagan – Director
Monica Walker Payne – Lead Evaluator
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Learning
Objectives
• The importance of stakeholder involvement
• Elements of effective team training
• Utilizing the Coaching Circuit Professional Development Plans and
Rubrics to assure skill development
• The development of Advance Training and Credentialing Renewal
(ATCR)
• The implementation of standardized documentation
• Collection and reporting descriptive, outcomes, satisfaction, and fidelity
data to key stakeholders
• Using the continuous quality improvement process to enhance learning 3
Youth and Family
Training Institute
Vision
“Children and youth with behavioral health challenges and
multi-system needs, and their families will be able to access
High Fidelity Wraparound anywhere in Pennsylvania.”
Mission
“To achieve quality family and youth driven outcomes by
advancing the philosophy, practice and principles of High
Fidelity Wraparound through training, coaching, credentialing
and ensuring fidelity to the process.”
Website: www.yftipa.org
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Who are our
Stakeholders?
• Youth, Family, and System Partners
• Office of Mental Health and Substance Abuse Services (OMHSAS
Children’s Bureau)
• Youth and Family Training Institute Advisory Board
• High Fidelity Wraparound Providers
• County Administrators
• University of Pittsburgh / Western Psychiatric Institute & Clinic
• Community Care Behavioral Health / Other Managed Care Organizations
• Child Adolescent Service System Program Coordinators
• Community Organizations
• PA System of Care Partnership
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• YFTI trains, coaches and credentials High Fidelity
Wraparound workforce members, which consist of: Coaches,
Facilitators, Family Support Partners and Youth Support
Partners.
• YFTI ensures the HFW workforce has the knowledge and
skills to provide HFW consistently, with accountability, and
fidelity to the process.
• YFTI provides technical assistance and helps prepare
counties and system partners interested in implementing
HFW.
• YFTI has been in existence for 7 years
Youth and Family
Training Institute
(YFTI)
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HFW Training
The focus is on learning the High Fidelity Wraparound
Model, more specifically, the Ten Principles, the Four
Phases (activities and skill-sets), Theory of Change
and workforce roles to effectively practice the model.
Our trainings were adapted from the
Vroon VanDenBerg.LLP Model
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Training
Responsibilities
All HFW workforce members must attend:
Five Day HFW Team Training
2 Day Coach Training
Online Transition Training
Chart Form Training
Evaluation Training
Advanced Training and Credentialing Renewal
-Web Based Skill Training and Topics
-Approved Agency required learning
Train the Trainer Program
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HFW Coaching
Coaching is the process of teaching someone to do
HFW by showing them the skills, doing the process
with them, and providing ongoing consultation and
feedback.
Coaching teaches the HFW Facilitators, the Youth
Support Partners and the Family Support Partners
how to do the HFW process with fidelity.
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HFW Coaching
Continued…
A High Fidelity Wraparound (HFW) Coach uses the
Coach Circuit to support the Facilitator, the Family
Support Partner and the Youth Support Partner in role
skills to do their work in the team process.
The Coaching Circuit is a research informed teaching
progression (‘learn, watch, practice, do, teach’) that
builds knowledge and skills creating fidelity to the
process and positive outcomes for youth and families.
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Coaching Circuit
(NRI based model)
Targeted Professional Development Plan
w/Goals
Coaching on Topic/Family Presentation
Modeling
Behavioral Rehearsal
Live Coaching
Peer-to-Peer Coaching
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Credentialing
The credentialing process for High Fidelity Wraparound
refers to the skill attainment each HFW workforce member
must reach in order to become credentialed in their HFW role.
All skills are scored on a tool with scoring rubric. Local
coaches and YFTI coaches achieve inter-rater reliability as a
part of the Coach Credentialing process.
The credentialing process ensures that all HFW workforce
members are receiving the same knowledge and
education. This leads to consistency in the HFW process and
fidelity to the process.
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Theory of Change
for Workforce
• Needs-based coaching utilizing objective data
• Self-efficacy is the goal with credentialing and skill
acquisition
• Natural supports through peer-to-peer (P2P)
• Integrated ‘Professional Development Planning’
(PDP) utilizing the Coaching Circuit
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Team
Training Coach Prepares
Staff for Training
Data,
Coaching
Agreement,
PDP
Coaching
Circuit Credentialing
CQI
Training
Coaching
Sustainability
and Quality Control
Youth and Family Training Institute support is ongoing
Professional
Development
Continuum
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ATCR
Evaluation
Responsibilities
• Evaluation and monitoring functions to continually assess
quality, fidelity, and outcomes.
• Data and continuous quality improvement information
highlighting strengths, challenges, fidelity, outcomes,
services, and costs are reviewed by our Evaluation
Subcommittee that is comprised of youth, family, and
system partner stakeholders across the Commonwealth.
• CQI reports are then shared on a quarterly basis with the
counties, managed care organizations, families, youth, and
the Office of Mental Health and Substance Abuse Services
(OMHSAS) to effect change.
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Data Collection
Data in today’s presentation has been
collected from July 2011 – February 2015
from the:
• Wraparound Fidelity Index – Short Form (WFI-EZ)
• Youth and Family Training Institute Chart Form
Data Pilot
• CMHS National Evaluation - Longitudinal
Outcomes and Satisfaction Study
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• 146 families enrolled in the Wraparound Fidelity Index – Short Form (WFI-EZ)
• 13 Counties
– Allegheny
– Bucks
– Chester
– Crawford
– Delaware
– Erie
– Fayette
– Lehigh
– Montgomery
– Northumberland
– Philadelphia
– Venango
– York
Fidelity
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Youth Caregiver Facilitator Team
Member
Total
Forms
PA 90-Day
(106 families)
71 110 103 264 548
PA Transition
(47 families)
34 47 45 113 239
HFW Team
Perspectives
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Team Member Type PA 90-Day PA Transition
Family Support Partner 92 36
Youth Support Partner 56 27
Therapist/Clinician 31 8
Caseworker 20 9
Teacher / School Staff 2 4
Probation Officer 3 0
Residential Home Staff 1 1
Sibling 11 8
Grandparent 5 2
Live-in partner of parent 1 1
Foster Parent 1 1
Birth/Adoptive Parent 1 0
Adult Friend 8 2
Aunt or Uncle 4 3
Other 28 11
System Partners and
Natural Supports
Mean Total Score
PA 90-Day 72.4%
PA Transition 77.7%
National Mean 74.2%
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
PA Transition
= 47 Families
PA 90-Day
= 106
Families
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Mean Total
Scores
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Key Element
Scores
EffectiveTeamwork
Natural/Community
Supports
Needs-based
Strategies
Outcomes-Based Plan
Strength-and-family-
driven
PA 90-Day 68.9% 66.4% 75.0% 70.1% 82.8%
PA Transition 71.1% 72.9% 77.0% 80.7% 84.6%
National Mean 72.7% 67.0% 68.8% 76.6% 80.6%
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
90-Day =
106
Families
Transition =
47 Families
Standardized HFW
Chart Documentation
Forms were designed to standardize how all
counties/providers document information about the
HFW process.
The process itself will be unique for each family, but the
information that is categorized, recorded, and tracked
during the process will be the same.
The forms will not increase the burden on youth and
families because they are completed by staff.
The forms do not have the expense of interviewers and
participant payments so the data collection is sustainable. 22
Benefits of
Standardized HFW
Chart Documentation
• The forms allow us to show how a family progresses through the four
phases of HFW in greater detail.
• The tracking highlights the specific skills used by the HFW workforce
(each workforce role can be tracked separately) in assisting and teaching
families to plan for their own needs.
• At the same time, we document changes in all of the child-serving
systems (Mental Health, Child Welfare, Juvenile Justice, Drug and
Alcohol, Physical Health, and Education)
• Data is sent/uploaded to the Evaluation Team so that Continuous Quality
Improvement (CQI) Reports can be generated and utilized.
• CQI Reports are tailored to youth, families, HFW workforce members,
and county and state stakeholders. 23
The HFW
Chart Forms
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Engagement Form Referral info
Demographics (including expanded cultural, linguistic, and disability information following new
CLAS standards)
Living Situations
Trauma
Core Family Information
Supports
Community Involvement
Systems (Education, Juvenile Justice, Child Welfare, Physical Health, Drug and Alcohol, Behavioral
Health)
Contact Note
Needs /Goals Form
Team Meeting Cover Sheet /Updates
Transition Cover Sheet /Updates
Post Comparison Form
Hewlett Packard
Teleform Software
We purchased a software package that allows us to scan paper forms or PDF files
directly into our database to cut down on the burden of data entry.
All of our data is de-identified - It is important that providers fill out the ID number
clearly on the teleforms and mark each answer within the circle or square so they
are processed accurately.
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• 47 families enrolled in the Chart Form Pilot
• 5 Counties
– Bucks
– Crawford
– Montgomery
– Northumberland
– Venango
Chart Form Pilot
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49.7%
32.3%
10.1%
3.7% 4.2%
0.0%
20.0%
40.0%
60.0%
Engagement Planning Implementation Transition Missing
Pe
rce
nta
ge o
f C
on
tact
No
tes
Phase
At what phases are the workforce most actively involved with a family?
(n=2054 contact notes)
Chart Form
Pilot Data
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21.0% 22.0%
3.7% 6.0%
33.9%
12.2% 11.1% 8.4%
5.0%
32.9%
0.0%
15.0%
30.0%
45.0%
60.0%
Per
cen
tage
of
No
n-s
ched
ulin
g C
on
tact
s
Domains
What content are the focus of contacts? (n=1473 contact notes)
Chart Form
Pilot Data
31
What skills are most often used by each role?
Facilitators % of Contacts
Provided Support for Family 24.4
Progress update 21.5
Identified new areas of need 20.3
SNCD development/review 17.4
Met with team 16.1
Family Support Partners % of Contacts
Progress update 28.2
Provided Support for Family 27.9
Identified new areas of need 25.8
Met with team 23.8
SNCD development/review 20.8
Youth Support Partners % of Contacts
Provided Support for Youth 54.8
Identified new areas of need 37.3
Provided Support for family 31.3
Identified new strengths 27.8
Brainstormed new ideas for progress 22.2
n = 1473 contact notes
Chart Form
Pilot Data
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Teaching Self-efficacy through the HFW process
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
Engagement Planning Implementation Transition
Per
cen
tage
of
Co
nta
ct N
ote
s b
y P
has
e
Phase
Doing For
Doing With
Cheering On
n = 1473 contact notes
Chart Form
Pilot Data
Statewide Data
Collection
County providers have options for how they can get data to us…
Copies of completed paper forms can be mailed to the Evaluation Team
in large self-addressed postage paid envelopes.
PDF forms that were either completed on paper and scanned or typed
into via Adobe Professional can be uploaded to us securely through the
YFTI Registration Website.
Some counties have built the forms into their electronic medical record
systems and do monthly data dumps.
We are currently building a web interface that allows users to log into their
provider’s portal and complete all of the forms securely online. Forms can
then be saved in PDF format or printed for local agency use.
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Quarterly CQI
Reports
Descriptive – (Ex. Referral source, system involvement, presenting
issues, mental health diagnoses, custody, people involved in the
planning/treatment process, etc.)
Demographic – (Ex. Race, ethnicity, gender identity, sexual orientation,
income, education, language, disability status, etc.)
Coaching – (Ex. Days in each phase, Time spent, Types of Supports,
Primary Purpose of Contact, Content Domains, Skill Utilization, Goal
Progress, etc.)
Outcomes – (Ex. Changes in system involvement, services, functioning,
living situations, natural supports, community involvement, family, etc.)
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CQI Successes
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Examples of using the data in coaching:
• Developed coaching strategies based on data received regarding transition.
• Number of families/youth that leave before transition phase.
• Refined coaching support regarding recognizing when families are ready
for transition, confident in their skills to meet their own needs and facilitate
their own meetings.
• Number of families/youth that left process w/o a plan.
• Refined coaching support to support families/youth in leaving process
regardless of phase with some type of plan on who they can call, strengths
they can use, etc. to meet ongoing needs.
• Workforce Development areas indicated in the Contact Notes:
• Documentation Skill development- providing more detail related to the
skills workforce members are using
• Continued support around engaging natural supports, professional
supports/system partners
• 83 youth/caregivers enrolled in the CMHS National Evaluation –
Longitudinal Outcomes and Satisfaction Study
• 11 Counties
– Chester
– Crawford
– Delaware
– Erie
– Fayette
– Lehigh
– Montgomery
– Northumberland
– Philadelphia
– Venango
– York
Preliminary
Outcomes
37.5%
50.0%
81.3%
62.5%
50.0%
18.8%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Intake 6 Months 12 Months
One Living Arrangement Multiple Living Arrangements
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n = 16
Data reported were collected using the Living Situations Questionnaire (LSQ). This instrument collects data on the status of the child/family in the 6 months prior to the interview.
A Stable Place
to Live
Data reported were collected using the Education Questionnaire–Revision 2 (EQ–R2). This instrument collects data on the status of the child/family in the 6 months prior to the interview.
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Actions Intake 6 Months
Suspended 40.0% 14.3%
Expelled 2.9% 0.0%
Neither Suspended Nor Expelled
57.1% 82.9%
n = 35
Less School
Discipline
• In the past 6 months have you been . . .
Data reported were collected using the Delinquency Survey–Revised (DS–R). This instrument collects data on the status of the youth age 11 years and older in the 6 months prior to the interview. Because participants may have had multiple criminal justice contacts, percentages may sum to more than 100%. 40
Questioned by thePolice
ArrestedTold to Appear in
Court?Convicted of a
Crime?On Probation?
Intake 20.0% 20.0% 33.3% 33.3% 20.0%
6 Months 6.7% 0.0% 20.0% 6.7% 20.0%
12 Months 6.7% 0.0% 0.0% 0.0% 13.3%
0.0%
10.0%
20.0%
30.0%
40.0%
Pe
rce
nta
ge o
f Y
ou
th
n = 15
Less Juvenile
Justice Contact
41 Data collected using the Engagement Form from the YFTI High Fidelity Wraparound Chart Form Pilot.
n = 47
Increased Youth
Natural Supports
Data reported were collected using the Multi-Sector Service Contacts–Revised (MSSC–R) questionnaire. This instrument collects data on the services received by the child/family in the 6 months prior to the interview.
42
8.3%
25.0%
0.0%
20.0%
40.0%
60.0%
80.0%
Intake 6 Months
Per
cen
tage
of
Yo
uth
Invo
lved
Timepoint
Recreational Activities
n = 36
Data collected using the Engagement Form from the YFTI HFW Chart Forms.
n = 47
More Community
Involvement
Percentage of youth who answered "Mostly" or "Always"
Intake 6 Months
I make changes in my life so I can live successfully with my emotional or mental health challenges
43.8% 71.9%
I know how to take care of my mental or emotional health
63.6% 69.7%
When a service or support is not working for me, I take steps to get it changed
42.4% 54.5%
I tell service providers what I think about services I get from them
51.5% 60.6%
Data reported were collected using the Youth Information Questionnaire, Revised.
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n = 33
Increased Youth
Self Efficacy
0.0% 6.3%
0.0% 0.0%
75.0%
81.3% 87.5%
81.3%
25.0%
12.5% 12.5% 18.8%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Objective Strain Subjective
Externalized Strain
Subjective
Internalized Strain
Global Strain
Worsened Remained Stable Improved
The Reliable Change Index (RCI) is a relative measure that compares a caregiver's scores at two different points in time and indicates whether a change in score shows significant improvement, worsening, or stability (i.e., no significant change).
44
n = 16
Improved Caregiver
Strain by 12 months
Data reported were collected using the Multi-Sector Service Contacts–Revised (MSSC–R) questionnaire. This instrument collects data on the services received by the child/family in the 6 months prior to the interview.
45
CaseManagement
Day TreatmentBehavioral orTherapeutic
Aide
ResidentialCamp
InpatientHospitalization
ResidentialTreatment
Center
Intake 63.9% 22.2% 17.1% 14.3% 22.2% 27.8%
6 Months 50.0% 5.6% 0.0% 2.9% 8.3% 27.8%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
Pe
rce
nta
ge o
f Y
ou
th
Support & Inpatient Services n = 36
Less Costly
Services
Intake 6 Months 12 Months
Residential Camp 25.0% 0.0% 0.0%
InpatientHospitalization
33.3% 0.0% 8.3%
Residential TreatmentCenter
50.0% 25.0% 0.0%
Therapeutic Foster Care 8.3% 0.0% 0.0%
0%
40%
80%n = 12
46 [a] Data reported were collected using the Multi-Sector Service Contacts–Revised (MSSC–R) questionnaire. This instrument collects data on the services received by the child/family in the 6 months prior to the interview.
Less Costly
Services
Data reported were collected using the Multi-Sector Service Contacts–Revised (MSSC–R) questionnaire. This instrument collects data on the services received by the child/family in the 6 months prior to the interview.
47
Assessment orEvaluation
CrisisStabilization
MedicationMonitoring
Group TherapyIndividualTherapy
Family Therapy
Intake 82.9% 28.6% 72.2% 48.6% 80.6% 48.6%
6 Months 71.4% 8.6% 63.9% 31.4% 75.0% 42.9%
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
Pe
rce
nta
ge o
f Y
ou
th
Outpatient Services n = 36
More Coordination
of Care
0.0% 9.1%
4.0%
80.0% 72.7%
84.6%
20.0% 18.2% 15.4%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Worry Social Anxiety Physiological Anxiety
Worsened Remained Stable Improved
The Reliable Change Index (RCI) is a relative measure that compares a child's or caregiver's scores at two different points in time and indicates whether a change in score shows significant improvement, worsening, or stability (i.e., no significant change).
48
n = 16
Improved Anxiety
Symptoms
Internalizing Behaviors Externalizing Behaviors
Intake 69.2% 69.2%
6 Months 46.2% 61.5%
12 Months 38.5% 53.8%
69.2% 69.2%
46.2%
61.5%
38.5%
53.8%
0.0%
20.0%
40.0%
60.0%
80.0%
% in
Clin
ical
Ran
ge o
n C
BC
L P
rob
lem
Sco
re
Internalizing and Externalizing Scores n = 13
49 Data reported were collected using the Child Behavioral Checklist 6–18 (CBCL 6–18). This instrument collects data on the status of the child/family in the 6 months prior to the interview. Internalizing and externalizing scores 64 or above are in the clinical range. Scores on the eight narrow band syndrome scale 70 or above are in the clinical range.
Decreased
Problem Behaviors
Contact
Information
Youth and Family Training Institute:
Shannon Fagan, Director:
(412) 856-8785
Monica Walker Payne, Lead Evaluator:
(412) 856-2890
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