The Wraparound Process as a Tier 3 Component of School wide Systems of Positive Behavior Supports

(1)

The

Wraparound

Process

as

a

“Tier

3”

Component

of

School

‐

wide

Systems

of

Positive

Behavior

Supports

Eric

Bruns,

PhD

University

of

Washington

School

of

Medicine

Closing

the

Opportunity

Gap

Conference

Tacoma,

WA

June

28,

2013

(2)

www.nwi.pdx.edu

(3)

(4)

(5)

Main

Messages

• Problem behavior remains among the most challenging

barriers to effective education

• School‐wide PBS (with all three tiers) is proving to be both

practical and effective at building the positive social cultures

that support educational gains.

• Addressing the behavior support needs of those students

with the most intense needs is part of school‐wide PBS.

• Wraparound is a key “Tier 3” strategy within PBS that

emphasizes a collaborative, team based approach to solving

behavior problems

• Wraparound requires not just effective process, but

(6)

Primary Prevention: School-/Classroom-Wide Systems for

All Students, Staff, & Settings

Secondary Prevention: Specialized Group Systems for Students with At-Risk Behavior

Tertiary Prevention: Specialized Individualized

Systems for Students with High-Risk Behavior

~80% of Students ~15% ~5% SCHOOL-WIDE POSITIVE BEHAVIOR SUPPORT



(7)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Major Office Discipline Referrals (05-06)

0-1 '2-5 '6+ 3% 8% 89% 10% 16% 74% 11% 18% 71% K=6 (N = 1010) 6-9 (N = 312) 9-12 (N = 104)

Mean Proportion of Students

ODR rates vary by level A few kids get many ODRs

(8)

School

‐

wide

PBS

Universal Systems of Support Secondary/ Tertiary Systems

• Define behavioral expectations

• Teach behavioral expectations

• Reward/acknowledge

appropriate behavior

• Continuum of consequences

for problem behavior

• Collection and use of data for

decision‐making

• Early intervention

• Increased daily structure

• Increased adult feedback

• Functional Behavioral Assessment

• Person‐centered planning

• ___________________ • Family support • Medical support • Academic support • Social support • Behavioral support

(9)

Tier 1/Universal

School-Wide Assessment School-Wide Prevention Systems

SIMEO Tools:

HSC-T, RD-T, EI-T

Check-in/ Check-out

Individualized Check-In/Check-Out, Groups & Mentoring (ex. CnC)

Brief Functional Behavioral Assessment/ Behavior Intervention Planning (FBA/BIP) Complex FBA/BIP Wraparound ODRs, Attendance, Tardies, Grades, DIBELS, etc. Daily Progress Report (DPR) (Behavior and Academic Goals) Competing Behavior Pathway, Functional Assessment Interview, Scatter Plots, etc.

Social/Academic Instructional Groups

Positive Behavior Interventions & Supports: A Response to Intervention (RtI) Model

Illinois PBIS Network, Revised Aug.,2009 Adapted from T. Scott, 2004

Tier 2/

Secondary

Tier 3/ Tertiary

(10)

(11)

What is the Wraparound Process?

 Wraparound is a family-driven, team-based process for planning and implementing services and supports.

 Through the Wraparound process, teams create plans that are geared toward meeting the unique and holistic needs of these youth and their caregivers and families.

 The Wraparound team members meet regularly to implement and monitor the plan to ensure its success.

 Team members include individuals relevant to the success of the

identified youth, including his or her parents/caregivers, other family members and community members, mental health professionals,

educators, system representatives, and others

(12)

Other uses of the term “Wraparound”

 “Wraparound services”

 Different types of services that might be useful for an individual seeking help, but that are not traditionally available or reimbursable

 E.g., Transportation, recreation, child care

 _{“Wraparound approach” or “philosophy”}

 Applying the principles of wraparound to any type of service or context, or to the work of any type of helper

 I.e., to be most effective, services should be family- and

youth-driven, individualized, culturally competent, and emphasize maintenance of the youth in the community wherever possible.

(13)

Why Wraparound?



Working with youths with complex needs and

multiple system involvement is challenging

and outcomes are poor

 _{Child and family needs are complex}

 Youths with serious EBD typically have multiple and

overlapping problem areas that need attention

 Families often have unmet basic needs

 Families are rarely fully engaged in services

 They don’t feel that the system is working for them  Leads to treatment dropouts and missed opportunities

(14)

Why Wraparound?

(continued)

 _{Systems are in “siloes”}

 Special education, mental health, primary health care,

juvenile justice, child welfare each are intended to support youth with special needs

 However, the systems also have different philosophies, structures, funding streams, eligibility criteria, and

mandates

 These systems don’t work together well for

individual families unless there is a way to bring them together

 Youth get passed from one system to another as problems get worse

 Families relinquish custody to get help

(15)

Why Wraparound?



From the family perspective



From the system perspective

(16)

16

The Evans Family

 Crystal, 34  Tyler, 36  David, 14  _{Kyle, 12}  Kaia, 12 Major Problems:

 Crystal has depression and suicide ideation  Tyler is an alcoholic and can not keep a job

 David has been arrested multiple times for increasing levels of theft, vandalism, drug and alcohol use and assault

 David is in juvenile detention and due to lack of progress may be moving to higher level of care

 David is two years behind in school and does not seem to care

 The twins were abused by their dad and are in specialized foster case

 The twins have been diagnosed with bipolar disorders and are often very aggressive

 The twins are very disruptive at school and are not working to grade level

(17)

17

26 Helpers and 13 Plans

Helpers:

 School (5)

 Technical School (2)

 _{Bailey Center (2)}  Child Welfare (1)

 _{Specialized Foster Care (2)}  Juvenile Justice (1)

 Children’s Mental Health (6)

 _{Adult Mental Health (3)}  Employment Services (2)

 _{AA (1)}

 Housing Department (1)

Plans:

 2 IEPs (Kyle and Kaia)

 Tech Center Plan

 Bailey Center Plan

 _{Permanency Plan}

 _{Specialized Foster Care Plan}  Probation Plan  3 Children’s MH Tx Plans  2 Adult MH Tx Plans  _{Employment Services}  35 Treatment Goals or Objectives

(18)

18

Monthly Appointments for the Evans Family

Child Welfare Worker 1 Probation Officer 2 Crystal’s Psychologist 2 Crystal’s Psychiatrist 1 Dave’s therapist 4 Dave’s restitution services 4 Appointments with Probation and School 2 Family Based 4 Twins’ Therapists 4 Group Rehabilitation 8 Tyler’s anger management 4 Children’s Psychiatrist 1 Other misc. meetings:, Housing, Medical 5

TOTAL 42

Also: 16 AA meetings Tyler goes to each month to preserve his sobriety, daily schedule (School, tech center, and vocational training) and the dozen or more calls from the schools and other providers each month.

(19)

19

Comments from the Files:

 Parents don’t respond to school’s calls

 Family is dysfunctional

 Parents are resistant to treatment

 Home is chaotic

 David does not respect authority

 Twins are at risk due to parental attitude

 Mother is non-compliant with her psychiatrist

 She does not take her meds

 Father is unemployable due to attitude

 Numerous missed therapy sessions

 Attendance at family therapy not consistent

(20)

Traditional services rely on professionals

and can result in multiple plans

Behavioral

Health Juvenile _Justice Education

Child welfare

YOUTH FAMILY

Plan 1 _{Plan 2}

Plan 3 Plan 4

(21)

In wraparound, a facilitator coordinates the work of system

partners and other natural helpers so there is one coordinated plan

Behavioral Health Juvenile Justice Education Child welfare Facilitator (+ Parent/youth partner) YOUTH FAMILY “Natural Supports” •Extended family •Neighbors •Friends “Community Supports” •Neighborhood •Civic •Faith-based

ONE PLAN

Laura Burger Lucas, ohana coaching, 2009

(22)

Wraparound

and

Schools

• Wraparound can be integrated into school‐based planning for

students with special needs, regardless of special education label or

agency involvement.

• The wraparound approach is a critical part of the SW‐PBS system as

it offers a means for schools to succeed with the 1–2% of students

whose needs have become so complex that starting with an

FBA/BIP process for one selected problem behavior is not enough

• Full implementation of SW‐PBS at the universal level provides a

solid base of lower‐level interventions (e.g., primary and secondary)

to build on and more effective and supportive environments in

which to implement wraparound plans.

• Within a three‐tier system of behavioral support, students who

need tertiary‐level supports also have access to and can benefit

from universal and secondary supports. Each level of support in SW‐

PBS is “in addition to” the previous level. In other words, no student

(23)

Wraparound

and

Schools

• Although on the surface wraparound can be seen as similar

to the typical special education or mental health treatment

planning process, it actually goes much further as it

dedicates considerable effort on building constructive

relationships and support networks among the youth and

his or her family (Burchard, Bruns, & Burchard, 2002; Eber,

2005).

• This is accomplished by establishing a unique team with

each student and the student’s family that is invested in

achieving agreed‐on quality‐of‐life indicators. Following a

response to intervention (RTI) model in which problem‐

solving methods become more refined for smaller numbers

of students, more intensive techniques for engagement and

team development are used to ensure that a cohesive

(24)

What’s

Different

in

Wraparound?

• An integrated plan is designed by a team of people important

to the family

• The plan is driven by and “owned” by the family and youth

• The plan focuses on the priority needs as identified by the

family

• Strategies in the plan include supports and interventions

across multiple life domains and settings (i.e., behavior

support plans, school interventions, basic living supports,

family supports, help from friends and relatives, etc)

• Strategies include supports for adults, siblings, and family

members as well as the “identified youth”

(25)

Unique Fit

Wraparound plans should be uniquely

designed to fit individual students’

needs as opposed to making a student

fit into existing services or a

(26)

Life Domain Areas to Consider

• Physical Needs/Living Situation • Family/Attachment • Safety • Socialization • Cultural/Spiritual • Emotional/ Psychological • Health • Educational/ Vocational • Legal

(27)

• 6th grade student

• Behavior difficulties and academic failure

• GPA 1.25 (2

nd

quarter)

• 6 ODRs (1

st

two quarters)

• 15 Out-of-School Suspensions (safety)

• Family support needs –history of mobility

with plan to move at the end current

school year. Student moved nine times

since first grade

(28)

Why move to Phase I wraparound instead of an FBA around one problem behavior?

– Discussing problem behaviors would not have motivated family to participate on team.

– Probably not the first time schools have

approached family in this manner (“let’s talk about behavior”)

– Bigger needs to work on to improve quality of life for youth and family

– Open-ended conversation and use of wrap data tools helped engage family

(29)

The team developed a

mission statement

:

“Andy will be happy and confident in school”

(30)

Using Data to Keep the Team Moving “Celebrate Success of current plan”

(31)

A practice model:

The

Four

Phases

of

Wraparound

Time

Engagement and Support Team Preparation

Initial Plan Development Implementation Transition Phase 1A Phase 1B Phase 2 Phase 3 Phase 4 31

(32)

Four Phases of Wraparound

Implementation

I. Team Development

- Get people ready to be a team

- Complete strengths/needs chats (baseline data)

II. Initial Plan Development

- Hold initial planning meetings (integrate data)

- Develop a team “culture” (use data to establish voice)

III. Plan Implementation & Refinement

- Hold team meetings to review plans (ongoing data collection and use)

- Modify, adapt & adjust team plan (based on data)

IV. Plan Completion & Transition

- Define good enough (Data-based decision-making)

(33)

Phase I: Team Development

Initiating the Wraparound Process

• Prepare for wraparound meetings through

individual conversations with core team

members is a critical first step.

• The first contact/s with the family should feel

different than being invited to a meeting.

• Gather information for a rich strength profile

(this will be a valuable tool for action planning).

(34)

Team Composition:

Roles are the focus (not job titles)

• Parents/caretakers and youth

• Person/s the family turns to for support (extended family, friend of parent or child, neighbor, medical/professionals)

• Person representing strengths/interests (coach, specific teacher)

• Agencies Involved: mental health, DCFS, Juvenile Justice, Early Intervention, etc. • Spiritual Supports

• Facilitator • Mentor

(35)

Examples of Natural Supports

Found on Wraparound Teams

• Co-workers

• Relatives: extended family • Friends • Classmates • Clergy • Storeowners/merchants • Postal Workers • Crossing Guards • Taxi Drivers • Neighbors • Coaches • School custodians • Previous “helpers” P.Miles, 2004

(36)

Points to Remember about

Engaging Families

• Apply RtI to Family Engagement: don’t keep doing what hasn’t worked up

• If engagement didn’t happen, how would you change your approach to effectively engage? • professionals don’t get to choose or judge how

families raise their kids.

• Always start with a conversation ( not a meeting) with the family, getting their trust and permission before talking with others.

(37)

Phase I: Team Development

Wraparound Facilitator:

– Meets with family & stakeholders

– Gathers perspectives on strengths & needs – Assess for safety & rest

– Provides or arranges stabilization response if safety is compromised

– Explains the wraparound process

– Identifies, invites & orients Child & Family Team members

– Completes strengths summaries & inventories – Arranges initial wraparound planning

(38)

Establish Family Voice & Ownership

• Communicate differently…

No blaming, no shaming

Start with strengths

Family’s needs are priority

Listen to their story before the meeting

(39)

Checking for Family

Voice & Ownership

• Family

chooses

team members

• Team meets when & where family is

comfortable

• Family (including the youth) feels like it

is

their meeting

and

their plan

instead of

feeling like they are attending a meeting

the school or agency is having about

(40)

Phase

1:

Creating

an

alliance

• From

emphasizing

problems

to

emphasizing

competence

•

• From

the

role

of

expert

to

the

role

of

accountable

ally

• _•

_From

_working

_on

_professional

_turf

_to

working

on

family

turf

•

• From

teaching

to

learning

with

Laura Burger Lucas, ohana coaching, 2009; From William Madsen, PhD, “Collaborative Therapies for Multi-Stressed Families” 40

(41)

Needs-based

• Assumptions & Values

– Difficult behaviors result from unmet needs

– Difficult behaviors tell us important things about a person’s life

– Needs are not services

– Allow family/youth to voice their needs rather than assessing needs for them

– Team measures family experience of “met need” rather than service provided

(42)

Needs & Wraparound

• Focus on the “why” of a need not the “how”

– Needs to feel competent with academic tasks rather than he needs to complete his assignments

• Use descriptive terms

– To learn, To know, To experience, To feel, To see, To have, To be

• Deal with the “big” stuff

– Families/youth deserve to know their teams are dealing with their larger challenges

• More than one way to meet it

– Unlike a goal (John will come to school every day)

• Improves quality of life (as defined by family, youth) Adapted from P.Miles,2004

(43)

Examples of Needs Statements:

• The student needs to feel adults and peers

respect him.

• The student needs to feel happy about

being at school.

• The parent needs to know her son is

getting a fair shake at school.

• The student needs to be reassured that he

can complete the work.

(44)

Phase II Wraparound:

Plan Development

Facilitator:

• Holds an initial (or 2) wraparound plan development meeting • Introduces process & team members

• Presents strengths & distributes strength summary

• Solicits additional strength information from gathered group • Leads team in creating a mission statement

• Introduces needs statements & solicits additional perspectives on needs from team

• Facilitates team prioritizing needs

• Leads the team in generating strategies to meet needs

• Identifies person/s responsible for follow-through with action plan items

(45)

Phase

2:

From

listing

strengths

to

identifying

and

leveraging

functional

strengths

• “David likes football”

• “David likes to watch football with his uncle on

Sundays”

• “David enjoys hanging out with his uncle; David does

well in social situations in which he feels like he can

contribute to the conversations; Watching football is

one activity in which David doesn’t feel anxious or

worry.”

(46)

Phase III of Wraparound:

Plan Implementation & Refinement

• Facilitator

– Sponsors & holds regular team meetings

– Facilitates team feedback on accomplishments

– Leads team members in progress-monitoring

• Plan implementation • Plan effectiveness

– Creates an opportunity for modification

• Maintain, modify or transition interventions

– Documents & distributes team

(47)

Steps for Developing a Wraparound Action

Plan (Phase II-III)

1) Clarify Agenda, logistics, & team rules 2) Introduce by Roles and Goals

3) Develop/Review a Mission Statement (Big Needs) 4) Start Meeting w/Strengths; Celebrate Successes 5) Identify Needs across Domains

6) Prioritize Needs 7) Develop Actions

8) Follow-up: Assign Tasks, Solicit Commitments, Set Next Meeting Date

(48)

Wraparound Phase III

• Develop strategies to meet “big needs” using strengths

• After implementing strategies to improve quality of life (strength-based strategies addressing big needs),

• The team will probably need to zero in on specific behaviors that need function based interventions

(49)

Sample Meeting Norms

• We will listen actively to all ideas

• Everyone is expected to share his or her ideas

• Let each person finish (No interrupting) • Confidentiality

• Respect differences

• Supportive rather than judgmental • Keep discussion "strengths based". • Time Limit (30 mins = ideal, 60 mins =

(50)

Phase IV of Wraparound:

Plan Completion & Transition

• Purposeful transition out of ‘formal’ wraparound process with goal of maintaining positive outcomes

• Strategies become more based on natural supports (ex. friendship, sports…)

• Focus on transition is continual (starts in phase I)

• Transition students from more intensive to less intensive supports

• Universal & Secondary strategies

(51)

Phase

4:

From

professional

services

to

informal/community

supports

Professional (Covered)

Services/Interventions, i.e.,

FORMAL SUPPORTS

Community‐based and

natural supports and services,

i.e., INFORMAL SUPPORTS

Time

(52)

What

does

all

of

this

accomplish?

Research indicates two main pathways to outcomes

Services and supports work better, individually and as a “package” Ten Principles Phases and activities Effective, values-based teamwork High quality, high fidelity wraparound process Participation in wraparound builds family capacities Positive child/youth and family outcomes

Theory of change: Outline

(53)

Core

components

of

the

wraparound

theory

of

change

• Services and supports work better:

– Focusing on priority needs as identified by the family

– Creating an integrated plan

– Greater engagement and motivation to participate on the

part of the family

• The process builds family capacities:

– Increasing self‐efficacy (i.e., confidence and optimism that

they can make a difference in their own lives)

– Increasing social support

(54)

Wraparound Skill Sets

1. Identifying “big” needs (quality of life indicators)

• “Student needs to feel others respect him”

2. Establish voice/ownership 3. Reframe blame

4. Recognize/prevent teams’ becoming immobilized by “setting events”

5. Getting to interventions that actually work 6. Integrate data-based decision-making into

complex process (home-school-community)

(55)

55

Does

wraparound

work?

Evidence from Nine Published Controlled Studies is Positive

Study Target population Control Group Design N

1. Hyde et al. (1996)* Mental health Non‐equivalent comparison 69

2. Clark et al. (1998)* Child welfare Randomized control 132

3. Evans et al. (1998)* Mental health Randomized control 42

4. Bickman et al. (2003)* Mental health Non‐equivalent comparison 111

5. Carney et al. (2003)* Juvenile justice Randomized control 141

6. Pullman et al. (2006)* Juvenile justice Historical comparison 204