NHCBH Workforce Development
Network
Foundational Competencies in
Children’s Behavioral Health:
Introduction to Systems of Care and
Wraparound in New Hampshire
Foundational Competency Modules
• These modules are designed to support the
implementation of core competencies in
Children’s Mental Health.
• The competencies are formulated at
foundational, intermediate and advanced levels.
• The following modules provide introduction to
the core competencies and are supported by the
Professional Development Workgroup of the
NHCBH Workforce Development Network.
Mission
• The mission of the NH Children’s Behavioral
Health Workforce Development Network is to
build a sustainable infrastructure for the
professional development of the children’s
behavioral health workforce based upon the
core competencies and infused with the
system of care core values and guiding
principles.
Wraparound NH:
What It Is, What It Is Not:
Family Teams and Systems Level
Supports
New Hampshire Children’s Behavioral Health Collaborative
Workforce Development Network
Wraparound Workgroup
Spring 2015
The Context: Systems of Care
“A spectrum of effective, community-based
supports, that is organized into a
coordinated network, builds meaningful
partnerships with families and youth, and
addresses their cultural and linguistic needs, in
order to help them to succeed at home, in
school, in the community, and throughout life”
(Stroul & Friedman, 2010)
System of Care Values
1. Family driven and youth
guided
2. Community based
3. Culturally and linguistically
competent
2010, Beth A. Stroul, M.Ed. Gary M. Blau, Ph.D. Robert M. Friedman, Ph.D.
Updating the System of Care Concept and Philosophy
Family and Youth Driven
The strengths and needs of the
child, and family determine the
types of services and supports
provided.
Community Based
The locus of services as well as system
management rest within a supportive,
adaptive infrastructure and
relationships at the community level.
Culturally and Linguistically Competent
Agencies, programs, and services reflect
the cultural, racial, ethnic, and linguistic
differences of the populations they serve
to facilitate access to and utilization of
appropriate services and supports and to
eliminate disparities in care.
Positive Outcomes of System of Care
Development and Implementation
• Increased positive social, academic, and
behavioral outcomes and community
connectedness for children, youth, and families
• Decreased out of home, school, and community
placements (and duration of such)
• Increased caregiver capacity, decreased caregiver
strain
• Programs and supports that are uniquely tailored
to each child and family’s culture, strengths, and
dreams
(Suter & Bruns, 2009; Bruns & Suter, 2010)
History
• 1960s – Brownsdale programs developed needs
based, individualized, unconditional services for
children with emotional disturbance.
• Jane Knitzer monograph Unclaimed Children
• 1980s – National Institute on Mental Health provided
funding for child-centered service systems (beginning
of “standing wraparound teams” regionally in NH)
History (cont.)
• Stroul and Friedman Monograph, 1986updated 2010, “A System of Care for
Children and Adolescents with Severe
Emotional Disturbances”
• 1990s – Federal Center for Mental Health
Services supported development of
Systems of Care- 2000 NH receives first
System of Care grant- CARE NH..
History (cont.)
• Wraparound (1980’s, 2000’s)- Child Welfare:
Karl Dennis at Kaleidoscope Chicago,
Vandenberg in Alaska, Wrap Milwaukee, Eber
in Illinois (move toward school based
Wraparound)
• Similar developments in other fields:
– Developmental Disabilities: “Person-Centered
Planning,” “Personal Futures Planning”
– Child Welfare: “Family Group Decision Making”
The Wraparound Process: Evolution
The National Wraparound Initiative (NWI)
defines Wraparound as “an intensive holistic
method of engaging with individuals with
complex needs (most typically children, youth
and their families) so that they can live in their
homes and communities and realize their hopes
and dreams.”
The Wraparound NH Model
Wraparound brings families together with
supportive teams to plan and deliver supports
and services that build on family-identified
strengths and needs, to help families live
together safely and productively in the
community.
What is Wraparound?
• Wraparound is highly-structured family-driven
planning process.
• Wraparound is based in a clear set of values and
principles.
• Wraparound teams have dynamic rather than static
membership.
• Wraparound is a process that begins with the
strengths of individual youth and families.
• Wraparound is not a service or set of services.
• Wraparound is highly individualized.
What is Wraparound?
• Wraparound is a solution-focused process that is
family and youth driven.
• Wraparound connects families to supports and
services in their communities, and always
includes a mix of public, private, and natural
supports.
• Wraparound includes access to family/youth peer
support.
• Wraparound is a process that respects families’
culture and values.
• Wraparound is led by a trained facilitator.
Wraparound Is Not:
•
•
•
•
•
•
A specific set of services offered
A typical team meeting
Any meeting held without family or youth
An immediate or quick solution
A crisis intervention or response
A standing interagency team
NH Wraparound Framework
4 Phases of Wraparound
Framework
• Hello: Initial contacts of
welcoming and setting the
stage for “engaged enough”
• Help: Agreeing on, providing
and delivering a range of
interventions, services &
supports
• Healing: Modifying initial
helping activities to produce
family report of healing
• Hope: Future oriented
activities designed to sustain
family experience of hope
June 14
patmiles@patmiles.com
Hello
Help
Healing
Hope
Phase 1: “Hello”
• Involves a sense of being welcomed which
sets the stage for enduring equal partnership• Hello conveys the experience of being greeted
and appreciated that families deserve to feel
as they enter Wraparound.
• Provides comfort while quickly gathering
enough information to assemble a helping
response on the foundation of the initial
greeting.
Activities and Tools at Hello
•
•
•
•
•
Listen for understanding
Family Timeline- Family Culture Map
Strengths Discovery and Strengths Summary
Identify and prioritize needs- Needs Egg
Identify any immediate safety threats and
respond- Risk Assessment Matrix
• Connections and Supports Map
• Create the family’s vision
Phase 2: “Help”
• Families are usually more interested in getting
help than in a completed plan.
• Build a team, identify team member strengths
and roles, decide what to work on, develop
strategies.
• A Child and Family Team is not the
intervention but is the way that decisions get
made about the range of interventions.
Activities and Tools at Help
• Blend multiple perspectives
• Plan of Care
• Benchmarking, evaluating, and monitoring
progress
• Continuous Engagement Activities
• Brainstorming- at least 10 ways to meet each
prioritized need
• Empower to action
• Establish and adjust safety plan
• Review progress towards the family’s vision
Phase 3: “Healing”
• Healing is the restoration of the family's sense
of health and wholeness, as they take charge
of identifying, accessing, and utilizing the
supports and services they need.
Activities at Healing
•
•
•
•
•
•
Check commitments and follow through
Assess information about benchmarks
Rate progress towards family’s vision
Establish wellness plan
Identify new strategies
Review and adjust safety plan
Phase 4: “Hope”
• Hope begins to happen when the family’s
underlying needs are being met and the
family’s vision is realized.
• When the right supports are in place,
transition planning and commencement
happen.
Activities at Hope
• Identify contingency plans, ways to “come
back”
• Create a transition portfolio
• Define hopes and dreams for life “after Wrap”
• Identify supports and resources beyond
Wraparound Planning Process tenure
• “What if” drills
Weaving the Phases Together
“Just as hello isn’t something that only happens at the outset
of the arc of care, hope isn’t confined to the closing moments.
Hello should kindle and nurture hope throughout the course
of the process.
Help should be delivered in the context of a powerful
optimism designed to increase expectancy on the part of all
team members as well as families.
Healing should be recognized throughout the entire process of
Wraparound as a way to acknowledge and celebrate gains and
set the stage for a future of possibilities” –Pat Miles, 2014
Wraparound in Simplest Terms
• Work until it works.
• When barriers arise--- People haven’t failed- the plan
needs to be reworked.
• Strengths + Needs= Actions
• Voice and choice.
• If it doesn’t feel like help, it probably isn’t.
• No shame, no blame
FAST Forward NH Project
• 4-year System of Care project funded by the
federal Substance Abuse and Mental Health
Services Administration (SAMHSA)
• Goals:
– Establish family/youth-driven wraparound in NH
– Establish a funding, policy, and systems
administration to support System of Care and
wraparound development in NH
FAST Forward NH Project
Roles:
Wraparound NH Coordinators in the Fast Forward
Project (2012-2016):
• Works with families to establish wraparound
teams, hold initial meetings with families,
facilitates wraparound meetings and performs
care coordination, facilitates referrals to other
supports and services, develop crisis plans,
facilitates the development of the family’s vision
and plan of care, collaborates with Family and
Community Support Specialists, collects data and
completes required documentation.
Roles (cont.)
Family and Community Support
Specialists• Member of the individual and family team; supports
and coaches the family in the wraparound process;
assists family to identify, prioritize, and articulate their
goals and needs.
• Ensure that the family’s culture is respected; provide
peer to peer support that will include helping the
family learn how to navigate and advocate within the
system; and work with the family to gain insight of the
other team members perspective.
• Provide families with information about and connect
them with natural supports and resources.
Breaking Down Silos
For NH’s Top-Tiered Children in Need of Mental Health Services
NH’s SOC
Service Array
CMHC Services
The braiding of services and funding
sources will result in children being
served more effectively in their
home communities, with enhanced
services from both systems.
DCYF Service
FAST Forward- System of Care
Service Array
•
•
•
•
Enhance and expand traditional service array
Develop new, non-traditional supports
Natural, unpaid, community based supports
All team members commit to developing
natural community supports and connections
NH System of Care
Individuals in FAST Forward have access to a full service array
•
•
•
•
•
•
•
•
•
•
•
Assessment and diagnostic evaluation
Care coordination/wrap facilitation
Outpatient therapy: Office based,
individual, group and family therapies
Participation in wraparound meetings:
Stipends for team members
Medication management
Psychiatric/medication consultation
Mobile Crisis intervention
Community Youth Mentor/behavioral aide
service
School based behavioral health services
Substance Use intensive outpatient
treatment
Substance use disorder support services
•
•
•
•
•
•
•
•
•
•
•
Therapeutic Day Treatment: after
school programs
ISO in home supports
Home Based Therapeutic Support
Child Health Support/Parent Aide
Crisis Stabilization: out of home
Respite Services
Therapeutic Foster Care: ISO foster
care
Residential Treatment
*Family Support, Leadership and
Education
*Youth Peer Support, Leadership and
Education
Flexible Funds
Care Management Entity (CME)
The NH Division of Children, Youth and Families as the CME
Family/Youth Level: Referrals, eligibility and payment process
• Accepts referrals (Erica Ungarelli and Adele Gallant)
• Screening for eligibility of family, self or school direct referrals when
one has not yet been done (using NH CANS) (Erica & Adele)
• Works with referent on Crisis Plan when necessary (Erica & Adele)
• Medicaid payment processing (pa’s entered into MMIS): (DCYF
Provider Relations)
Care Management Entity (cont.)
DCYF as CME
System Level:
• Develops provider network to provide SOC service array with Managed
Care Organizations (MCOs) – utilizing current DCYF/Bureau of Behavioral
Health (BBH) providers (Adele and Erica, DCYF provider Relations and BBH)
• Works at developing private insurance network (DCYF Fiscal Specialists)
• Develops/joins regional teams to assess capacity and barriers and
community partnership –(Adele/Family Organizations)
• Service utilization management, Quality improvement, Information
technology-web based system. (Adele, Erica and DCYF’s data and
evaluation groups)
• Manages the contracts and supervises with Fast Forward Coordinators
“Family to Family”
Support, Education and Leadership Training
•
•
•
•
SUPPORT
1:1 Time Limited
Support GroupCommunity
Facebook page
Message Board
EDUCATION
• PMC Family Education
Program
• Webinars
• Annual Conference
•
•
•
•
LEADERSHIP TRAINING
PMC Teacher
Support Group Facilitator
“Life Interrupted” -Speaker
“It’s Your Move”-Advocacy
F.A.S.T. Forward
Expand “Family to Family”
Support, Education and Leadership Training
+ 1:1 Support-Wraparound
+ PMC Family Education Program
+ Family Leadership Training
Identify, recruit and provide on-going technical assistance
to family leaders serving on a wide range of activities on
the local, state and national levels.
Youth Leadership and Development of Youth Peer Support
Granite State Federation of Families for Children’s Mental
Health
Individual Level: Training
and Support
System Level: Training
and Support
Training for youth to drive Youth Move Orientation,
their own planning
Focus Groups
Group Forums for
Individual Support and
Connections (YM and
RENEW Facebook)
Leadership
Youth Voice and
Perspective to Systems
Change Efforts
“Strategic Sharing”
Conference Planning and
“What Helps What
Co-Hosting: Youth Track
Harms”- YM National
Development
Social Marketing Initiative
Development of 1:1 Youth Training and Recruitment
Peer Support Model
of Youth for Action in
Systems Change
Support and technical
assistance to emerging
youth leaders across
systems
Organization of Workforce
Development Activities (6/2014)
NHCBH Workforce
Development NetworkLeadership Team
Evidence-based
Practice Workgroup
Children's MHC
Directors
Workgroup
YouthMOVE Peer to
Peer Training
Institutions of
Higher Education
(IHE) Workgroup
Youth Mental
Health First Aid
Wraparound
Workgroup
Multi-tiered
System of Support
School-based
Web-Based
Learning
Infrastructure
In-service
Workgroup
Web-Based Content
Note. SAMHSA = Substance Abuse and Mental Health Services Administration; CBHC = New Hampshire’s Children’s Behavioral Health
Collaborative; DHHS = Department of Health and Human Services; DCYF=Division of Children, Youth, and Families; IOD = University of New
Hampshire’s Institute on Disability; NAMI NH = New Hampshire chapter of the National Alliance for the Mentally Ill; GSFFCMH = Granite State
Federation for Children’s Mental Health; AUNE = Antioch University New England.
FAST Forward Youth/Family focused logic model
Note. SAMHSA = Substance Abuse and Mental Health Services Administration; CBHC = New Hampshire’s Children’s Behavioral Health
Collaborative; DCYF = Department of Children, Youth, and Families; NAMI NH = New Hampshire chapter of the National Alliance for the Mentally
Ill; GSFFCMH = Granite State Federation for Children’s Mental Health; AUNE = Antioch University New England
FAST Forward Eligibility and Referral
• Eligibility:
– Child or youth, ages 8 to adult transition age
– Meets state eligibility criteria for Serious
Emotional Disturbance (SED)- multiagencycategory
– At risk for out of home placement
– Enrolled in NH Medicaid program
Contact: Adele Gallant, 603-271-4371
“Training on the phases should explore ways in
which families experience their participation
with helpers during each of the phases.
Through engagement families should feel a
sense of being heard and understood,
through planning a sense of having caring
people joining with them to make a difference
in their lives,
Through implementation an improved ability to
cope with challenges in their lives, and
through transition a sense of self-efficacy and
optimism for the future.” Pat Miles
Contacts
For more information on Fast Forward or to refer a
family:
Adele Gallant, MS
FAST Forward Program Manager
DCYF/ Bureau of Well-Being
Thayer Building
129 Pleasant Street
Concord, NH 03301
P: (603) 271-4371
F: (603) 271-4677
adele.c.gallant@dhhs.state.nh.us