(WITHDRAWN) Full-on Fidelity: Using Multiple Methods to Support Best Practices in a Statewide Child Behavioral Health Wraparound System

Wrap-CT, Connecticut’s child behavioral health wraparound system, is a network of care coordinators working within a statewide System of Care. This paper describes a range of fidelity efforts that provide practice feedback and an evolving definition and measurement of program success. Adherence to Wraparound values and principles, measurement of the frequency and nature of team meetings and care plans, and supervision supporting a trauma-informed, relationally-based practice together provide a comprehensive perspective for understanding program process outcomes. The analysis of a separate array of outcome measures, supported through Substance Abuse and Mental Health Services Administration (SAMHSA) funding, provides an evaluation of substantive outcomes. This range of fidelity and outcomes indicators allows for a comprehensive view of project mechanisms and outcomes.

Staff are trained in the values and methods of Wraparound practice, and taught to convene Child and Family Team (CFT) meetings and develop Plans of Care with skills that reflect National Wraparound Institute (NWI) values and methods. Additionally, the CFT data form items allow staff to review feedback about the nature and frequency of their meetings and plans of care. The dataset, unique to Wrap-CT, allows for precise identification of CFT frequency and the type of supports offered a family, and utilizes a ratio mechanism that allows on-going assessment of the extent of informal supports helping each family.

Funding from SAMSHA allows Wrap-CT to collect a full complement of outcome measures, including the Ohio Scales, the Columbia Impairment Scale, a trauma survey and measures of caregiver strain. The analysis of this data presents a beginning picture of the efficacy of wraparound services generally, and when combined with the CFT data provides an understanding of specific components of the program that contribute to positive outcomes. For example, fewer days to convening a first CFT and monthly CFT meetings, each of which reflect NWI standards, were not associated with better outcomes. A greater number of informal supports was associated with better youth outcomes.

Implementation of the CFT data form and use of data analyses in coaching and program development efforts led to identification of a third perspective that was not captured either in the formal program design or in program evaluation efforts. Fifteen Factors for Families is a core practice model that defines and supports trauma-informed and relational aspects of wraparound work, and is used in combination with traditional wraparound fidelity efforts and the CFT data system.

Approaching fidelity and program evaluation from these three perspectives, supported by access to outcomes data, allows the project to consider the unique contribution of 1) the overall relational, strengths-based nature of the model, 2) the frequency of convening CFT meetings, 3) the number of informal supports assisting each family, and 4) the specific nature of supports offered by this extended network.

This paper presentation will discuss the collaborative method used to develop these fidelity frameworks, review selected findings, explore use of the findings in coaching and program development efforts, and consider the implications of the framework for the development of wraparound models and research efforts.