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Youth and Family Training Institute: Training, Coaching, Credentialing, and Monitoring Wraparound Youth and Family Training Institute

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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

2

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

4

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

5

• 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)

6

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

7

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

8

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.

9

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.

10

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

11

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.

12

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

13

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

14

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.

15

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

16

• 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

18

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

19

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

20

Mean Total

Scores

21

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 Chart Form

Model

24

The HFW

Chart Forms

25

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.

26

• 47 families enrolled in the Chart Form Pilot

• 5 Counties

– Bucks

– Crawford

– Montgomery

– Northumberland

– Venango

Chart Form Pilot

28

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

29

(n = 2054 contact notes)

Chart Form

Pilot Data

30

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

32

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

Family Report

33

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.

34

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.)

35

CQI Successes

36

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

38

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.

39

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.

43

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:

[email protected]

(412) 856-8785

Monica Walker Payne, Lead Evaluator:

[email protected]

(412) 856-2890

50

Discussion

• Any questions or comments?

• Thank you so much for your attendance and

participation!

Thank you to the PA SOC Partnership for funding and support.

www.pasocpartnership.org 51