High Fidelity Wraparound Pilot

Service Component of NC System of Care Implementation Grant

NC System of Care Grant• Pilot of high fidelity wraparound• Support and strengthen System of Care Local

Community Collaboratives• Increase access to family and youth voice and

peer support• Increase timely access to an array of evidence

and trauma-informed, community services

High Fidelity Wraparound Pilot in NC

Package of:• Structured family-driven team planning

process• Intensive care coordination • Family and youth peer support• Supervision and coaching

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What is High Fidelity Wraparound?

Structured, Family-Driven Team Planning● intensive, individualized care planning and

management process”● “ structured, creative, and individualized

team planning process….to address a range of life issues”

● “emphasis on integrating the youth into the community and building the family’s social support system”

Source: National Wraparound Initiative

Who will be served in the pilot?1st Year● Youth transitioning from Psychiatric

Residential Treatment Facilities (PRTFs) 2nd-4th Years● Expand to include youth with high use of

crisis services and other levels of residential care

Nationally, youth with the most complex needs are served (1-5%) with high fidelity wraparound.

What else is needed for High Fidelity Wraparound?

Wraparound staff

Accountability

Community

Partnerships and Action

Fiscal Policies

Access to

supports and

services

Foundation of System of Care Values

Staffing: NC Wraparound Team● Intensive care coordination

with low staff to family ratios of 1:10/1:12

● Family and youth peer support offered to every family

● Supervisor/coach

Accountability●High fidelity wraparound requires monitoring

with fidelity tools that can include chart reviews, observation of team meetings, and interviews with families and youth served.

●High fidelity wraparound requires high quality, consistent training and coaching from dedicated and certified coaches.

Community Partnerships and Action● Interagency collaboration and involvement of

natural supports are necessary for high fidelity wraparound.

● System of Care Community Collaboratives can develop protocols to increase collaboration across agencies.

● System of Care Community Collaboratives will be critical in the pilot sites in monitoring the fidelity of their local projects.

Fiscal Policies● There needs to be a case rate or billable

service for intensive care coordinators and/or family/youth peer support to use.

● These rates need to be robust enough to support low ratios and the training/coaching that is critical in high fidelity wraparound.

Access to services and support● Youth transitioning home from PRTFs and their

families need to access a range of community-based services and supports in a timely fashion.

● Some of these supports and services are behavioral health services but some are other kinds of services and supports such as assistance with housing, connecting to pro-social activities related to the young person’s interests and strengths, and helping the young person with legal and school issues.

● This requires support from the Community Collaboratives and it requires that services be individualized.

How is high fidelity wraparound different from NC's current CFTs?

While there have been successes with Child and Family Teams in some of the SAMHSA grant funded System of Care sites, that success has not been scaled up statewide due to lack of systemic support.Families' experience of Child and Family Teams varies by: • Which CFT training the facilitator had (There are 4 DMH/DD/SAS

endorsed versions plus trainings for DSS, DJJ, and school staff).• Whether the facilitator is trained and supported in family driven care.

Funding does not support critical cross agency collaboration and routine access to family and youth peer support. Funding has not supported intensive care coordination for the youth with the most complex needs or coaching in providing this intensive service planning model.

High Fidelity Wraparound Child and Family Teams in NC

• Growing evidenced base• Serves the youth with the

most intense , complex needs and their families.

• Consistent training and coaching of facilitators

• Facilitators are intensive care coordinator with low ratios of 1: 10 or 1:12

• Have access to family and youth partners who are part of the package of high fidelity wraparound

• Demonstrated cost savings

Available to youth in residential treatment and community based services of intensive in-home, Multisystemic Therapy, and day treatment• 4 training options for MH

providers including an online version

• Highly variable access to family and youth peer support

What is the benefit of the high fidelity wraparound pilot for the rest of the state?

Track outcomes to learn if the young people and their families are doing better

Learn how to roll-out and sustain (development of multi-agency support at the state level and the community level, development of fiscal policy, learn how to develop informal supports for both individual youth and also communities)

What else will the SOC Grant do besides NC Wraparound?● Work to strengthen Community Collaboratives:

setting priorities, tracking progress on priorities, identifying and filling service gaps, developing interagency protocols and memorandum of agreement, supporting family/youth voice and support

● Access to family and youth support beyond the family peer support in high fidelity wraparound: LME/MCOs and other agencies can contract for family peer support services for youth and families at all levels of need

● Timely access to an array of services and supports and flexibility providing services

● Commitment to family and youth driven, community-based, and quality care

● Strengthen the current Child and Family Teams

Strengthen Current CFTs● Review the multiple models of CFT training

with DSS and other partners and consider options for improving the training/support in order to improve the families’ experiences of CFTs and their outcomes.

●We will learn from NC Wraparound ideas to

support the Child and Family Team planning process.