Summary: Recommendations for High Fidelity Wraparound Services in California

 In the Spring of 2019 the Resource Center for Family-Focused Practice, in partnership with the California Department of Social Services, completed a national review of High-Fidelity Wraparound Service practices across the United States and published results in the document “Recommendation for HF Wraparound Services in California,” reviewing key findings of this project.

This study was conducted as a response to concerns raised by the California Department of Social Services (CDSS) regarding the significant variation of skills and practices evidenced by Wraparound providers across California’s counties and in an effort to better understand how to meet the needs of vulnerable children and families involved in the child welfare system in the state of California.

Within this context, California was addressing mandates to improve outcomes for those children and families served by the child welfare system; the 2011 Katie A. v. Bonita Settlement Agreement and the 2015 A.B. 403 Continuum of Care (CCR) were paving the way for state-wide changes in child welfare to focus on permanency; integrated service delivery to meet needs without placement change, establish short-term use of therapeutic residential treatment, and increased accountability and transparent access to information. Specifically, this project was focused on examining the need for state-wide certification of wraparound providers to increase and ensure the application of high-fidelity processes and provider skills resulting in more reliable positive outcomes and consistency of service delivery.

Wraparound programs are a key component of California’s System of Care for children and families. Wraparound was first implemented, as a named program, in California well over 20 years ago; currently 42 out of 58 counties have approved Wraparound Plans with CDSS to provide Wraparound services. Historically, Wraparound services were sought as an alternative to placing high needs youth in residential congregate placement, an issue more urgent than ever with elimination of group homes in California under CCR.  Wraparound has provided the opportunity for therapeutic intervention and individualized support directly in the family home and community while, also, providing significant savings for counties as well as improved outcomes. The state share of foster care placement funding was realigned to County control in 2011 and which reduced the direct involvement of CDSS in the implementation of Wraparound in counties and may have contributed to increasing variation of practice expectations state-wide.

In 2018 the California Integrated Core Practice Model for Children, Youth and Families (ICPM) was adopted by the CDSS. ICPM is in alignment with Wraparound with emphasis on individualized focus, team-based effort in planning and monitoring, building from a strengths-based perspective, and being guided by the voice and choice of the parent and family members.

A Call to Action

Wraparound as a process has garnered much attention in the research community over the years as an effective promising practice, with likelihood of achieving an evidence-based status when practiced with high fidelity to practice standards. Currently in California, there exists a significant variation in the skills and practices among current Wraparound programs (both counties and service provider organizations). State-wide, we lack evidence of how many of the current Wraparound programs adhere to the standards published in ACIN NO. I-52-15, never mind potential additional high fidelity expectations.

A Summary of Results

Findings illuminated that there are multiple ways to structure and operate Wraparound programs across the United States. Some states reference a system of care that is similar to Wraparound without using this particular nomenclature.  Other states have called out High Fidelity Wraparound in particular with a commitment to evaluation of services and continuous quality improvement. Service systems include partnerships with state and county agencies, regional jurisdictions and community-based organizations with paid staff members and volunteer team members. Additionally, types of curriculum utilized, training, coaching, supervision, evaluation, guidelines and technical assistance can greatly vary between providers.

Where certification of training and system outcome data are robust, there is a comprehensive data collection and analysis infrastructure. These tools provide important and consistent information that appear to lead to successful outcomes for children and families. The data calls out that additional training, coaching and other technical assistance that may also be of benefit to reach these positive outcomes. 

Recommendations for California

Best practices, for consideration in California, include strong commitment from leadership, communication of a clear and consistent vision, workforce development including training, coaching, on the job support and specific college educational background along with coaching certification to best implement High Fidelity Wraparound.

Recommendations have been crafted with the intention to support the infrastructure needed to not only leverage existing resources in California but, also, to successfully expand those resources to develop an even more effective system of care.

Three actions are recommended first:

1. Foremost, develop a specific logic model to establish a baseline of who is being served, identify what providers are providing care, define what services are being implemented, collect data regarding outcomes to determine success, allow access to the data for providers and improving implementation, measurements and training along the way.
2. Seek clarification regarding implementation of the Integrated Core Practice Model (ICPM) that requires consistent establishment of CFTs and family-centered practices for all children who are dependents and wards in foster care. There must be a clear way to differentiate between the larger population of children, youth and families served by child welfare and those whose needs require higher levels of intensity, frequency and coordination of services such as Wraparound. For distinction here, the sub-populations will be referred to as CFT and Wraparound. While the practice model for CFT and Wraparound is the same, the distinction between CFT and Wraparound exists in the definition of the target population and in specific role responsibility. Wraparound requires additional process skills expertise from providers as well as additional resource availability to be successful serving the target children, youth and families facing more complex and intensive needs.
3. Understand the current landscape of Wraparound in California by identifying and analyzing service delivery in the 42 Wraparound counties. This includes a non-punitive evaluation of provider/county compliance with standards in ACIN 1-52-15.

Following these three actions, short term recommendations, to be collaboratively implemented by the California Wraparound community include the following:

1. Collaboratively define a common set of data to be collected by every provider/county (include level of care and designations with an ability to sort target sub populations as needed).
2. Ensure providers have the resources required to meet high-intensity child, youth and family needs, without incentive to transition service delivery before recommendation from the CFT (potentially by linking payment for services directly to the LOC)
3. Require training in engagement and facilitation skills for any staff position that includes care-coordination responsibilities.
4. Seek consultation on foundational, advanced and specialist curriculum and skills development (for both practitioners and supervisors) and consider use of tools that they have developed and would support hi-fidelity implementation of the ICPM (CFT and Wraparound) including in the field skills coaching.