Wraparound Tools for System Leadership*

Child and Adolescent Needs and Strengths (CANS)
Founded in 1998, the Praed Foundation seeks to support transformational activities in human services, with a special emphasis on improving the lives of children and families. The Foundation has a variety of projects that supports its mission including managing flexible funding for youth with mental health needs in the juvenile justice system. The primary work of the Foundation is in support of a mass collaboration of individuals who seek to use evidence-based assessments as an approach to working together to maintain the focus of human service enterprise on the people they serve. As such, the Praed Foundation maintains the copyrights on the Child & Adolescent Needs and Strengths, the Family Advocacy and Support Tool, the Crisis Assessment Tool, and the Adult Needs and Strengths Assessment to ensure that they remain free for anyone to use who shares this commitment.

Adult Needs and Strengths Assessment –Transition:
The Adult Needs and Strengths Assessment (ANSA) is a multi-purpose tool developed for adult’s behavioral health services to support decision making, including level of care and service planning, to facilitate quality improvement initiatives, and to allow for the monitoring of outcomes of services. The ANSA is currently used in a number of states and Canada in applications hospitals, emergency departments, psychosocial rehabilitation programs, and ACT programs. The CANS was developed from a communication perspective so as to facilitate the linkage between the assessment process and the design of individualized service plans including the application of evidence-based practices.


Effective Financing Strategies
The Research and Training Center for Children’s Mental Health (RTC) at the University of South Florida conducted several five-year studies to identify critical implementation factors that support states, communities, tribes, and territories in their efforts to build effective systems of care to serve children and adolescents with or at risk for serious emotional disturbances and their families. One of these studies examined financing strategies used by states, communities, and tribes to support the infrastructure, services, and supports that comprise systems of care. The study of effective financing practices for systems of care was initiated in October 2004 and was conducted jointly by the RTC, the Human Service Collaborative of Washington, DC, the National Technical Assistance Center for Children’s Mental Health at Georgetown University, and Family Support Systems, Inc. of Arizona. The study was supported with federal funding from the National Institute on Disability and Rehabilitation Research of the Department of Education and the Substance Abuse and Mental Health Services Administration (SAMHSA).

Tiered Care Coordination Expert Convening Meeting Summary
Care coordination is a component of service delivery that has experienced tremendous growth and adaptation in recent years, driven in part by the Patient Protection and Affordable Care Act of 2010 (ACA) and supported by large-scale initiatives from Centers for Medicare and Medicaid Services (CMS), Substance Abuse and Mental Health Services Administration (SAMHSA), and other federal and private partners. Definitions of care coordination vary across implementation settings, and after review of almost forty unique characterizations of care coordination, the Agency for Health Care Research and Quality settled on the following description: “Care coordination is the deliberate organization of patient care activities between two or more participants (including the patient) involved in a patient’s care to facilitate the appropriate delivery of health care services. Organizing care involves the marshalling of personnel and other resources needed to carry out all required patient care activities, and is often managed by the exchange of information among participants responsible for different aspects of care.”1

Financing 2008-09_NIRN_paper[1]
The implementation of an evidence-based program or practice is a complex process rather than a discrete event, and there are several important components involved in the implementation of evidenced based programs and practices. To successfully implement an EBP and provide benefits to consumers, three critical components require financing: (1) start-up activities to explore the need, feasibility, and installation of a program or practice, (2) the direct service provided to consumers by the EBP, and (3) the infrastructure needed to successfully implement and then sustain the quality of the EBP. The following section will review these three components and, describe the role that each plays in successful implementation efforts as well as the implications for financing.

Clinical Decision Making Approaches for Child and Adolescent Behavioral Health Care
Over nearly a decade, beginning in 995, the Health Care Reform Tracking Project (HCRTP) tracked publicly financed managed care initiatives, principally Medicaid managed care, and their impact on children with mental health and substance abuse (i.e. behavioral health) disorders and their families. The HCRTP was co-funded by the National Institute on Disability and Rehabilitation Research in the U.S. Department of Education and the Substance Abuse and Mental Health Services Administration in the U.S. Department of Health and Human Services. Supplemental funding was provided by the Administration for Children and Families of the U.S. Department of Health and Human Services, the David and Lucile Packard Foundation and the Center for Health Care Strategies, Inc. to incorporate a special analysis related to children involved in the child welfare system. The HCRTP was conducted jointly by the Research and Training Center for Children’s Mental Health at the University of South Florida, the Human Service Collaborative of Washington, D.C. and the National Technical Assistance Center for Children’s Mental Health at Georgetown University.

ENGAGE Resource Materials
Additional Resources Relating to the ENGAGE Initiative Ohio Department of Mental Health and Addiction Services (OhioMHAS)

Transition-Age Youth
Transition-age youth are adolescents and young adults (ages 14-25) who have a diagnosable mental illness that has led to impaired functioning in one or more life domains. Examples of life domains include housing, education and employment, quality of life and functioning and life skills Developmentally, transition-age youth are interdependent, seeking their own identity and independence while still partially dependent on the support of family members, caregivers and service providers. Best practices for serving transition-age youth incorporate the principles of recovery, resiliency and cultural competence. In addition, the overall care must be youth-guided and family-driven.

Does Team-Based Planning ‘Work’ for Adolescents? | Studies of Wraparound
This article focuses on wraparound as an example of a team planning process, and uses data from several sources to reflect on questions about whether-and under what conditions-collaborative teams are successful in engaging young people-and their caregivers-in planning. We used data collected in three studies to address our research questions. The first data set comes from a study on wraparound service planning in Nevada. We examined data collected from 23 matched pairs of caregivers and youth at 6 months after wraparound planning began. Our second data set came from a national study of 41 local wraparound programs throughout the United States.

Phases and Activities of the Wraparound Process
“Phases and Activities of the Wraparound Process” focuses on what needs to happen in wraparound; however, how the work is accomplished is equally important. Merely accomplishing the tasks is insufficient unless this work is done in a manner consistent with the 10 principles of wraparound. In addition, future work from the National Wraparound Initiative will provide more detailed information about team member skills that are necessary for the wraparound process, as well as descriptions of specific procedures, templates, and other tools that can be used to complete the activities described.

Promoting Successful Transitions for Youth with Serious Mental Health Conditions
This webinar was presented on October 8, 2014 by Mary Wagner, Ph.D and Lynn Newman, Ed.D, sponsored by the Transitions Research and Training Center at the University of Massachusetts Medical School, Worcester, MA. It provides a national picture of youth who received special education services in high school in the category of emotional disturbance regarding: Post-high school employment; participation in post-secondary education; factors related to an increased likelihood of employment and post-secondary education up to eight years after high school; longitudinal patterns of productive engagement in employment and/or post-secondary education up to four years post-high school and predictors of engagement and disengagement.

The Center for Health Care Strategies, Inc.
A nonprofit policy center dedicated to improving the health of low-income Americans. Since 1995, the Center for Health Care Strategies (CHCS) has partnered with nearly every state in the country to promote innovations in publicly financed health care, especially for individuals with complex, high-cost needs. Its work brings together state and federal agencies, health plans, providers, and consumer groups to advance models of organizing, financing, and delivering health care services. In so doing, it has developed both a birds-eye view and a ground-level feel for the nation’s health care delivery system for low-income Americans and a unique perspective on how to generate systems-level change within Medicaid and across public and private payers.

Wraparound Evaluation & Research Team
The Wraparound Evaluation and Research Team seeks to improve the lives of children and their families through research on the implementation and outcomes of the Wraparound process. Through development, refinement and dissemination of the Wraparound Fidelity Assessment System, our team aims to assist implementation of the Wraparound process, evaluate effectiveness, identify the need for technical assistance and training, and promote communication within the service delivery and research and evaluation fields. Wraparound is a research-based care coordination process for youth with complex needs. It is an intensive, individualized care planning and management process and holistic way 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.

National Wraparound Initiative
The NWI envisions a future in which all children and youth, regardless of the complexity of their needs, are connected to caring adults and have access to appropriate services and supports so they can be healthy, experience positive development, and live and thrive in their homes and communities. Since 2004, the National Wraparound Initiative has worked to promote understanding about the components and benefits of care coordination using the Wraparound practice model, and to provide the field with resources and guidance that facilitate high quality and consistent Wraparound implementation. In 2014, the NWI launched the National Wraparound Implementation Center (NWIC). NWIC supports states, communities, and organizations to implement Wraparound effectively through training and workforce development, organizational- and system-level technical assistance, and evaluation support.

National Wraparound Implementation Center (NWIC)
The National Wraparound Implementation Center (NWIC) supports states, communities, and organizations to implement Wraparound effectively. NWIC uses innovative approaches grounded in implementation science and incorporating cutting-edge strategies to support Wraparound implementation. NWIC provides support that is intensive yet affordable. The work is focused on building sustainable local capacity to provide model-adherent, high fidelity Wraparound, thereby increasing positive outcomes for children, youth, and their families.

Building Systems of Care Primer
Building systems of care is inherently a strategic process. Webster’s Dictionary defines strategic planning as “the science and art of mobilizing all forces—political, economic, financial, psychological—to obtain goals and objectives.” This terminology comes out of warfare! It assumes that there is clarity about goals and objectives. Creating that clarity and mobilizing “all forces” are key roles that system builders play. This document provides a strategic framework to support system builders in these roles by: Reviewing the history, values, principles, and operational characteristics of systems of care to create a context for system building: Exploring many of the functions that require structure in systems of care; Discussing examples and the pros and cons of various structural arrangements to promote improved outcomes for children, youth, and families involved, or at risk for involvement, in multiple systems; and • Describing and providing examples of effective system-building processes.

Crisis Text Line
The Ohio Department of Mental Health and Addiction Services (OhioMHAS) has entered in to a contract with the national Crisis Text Line to provide Ohioans with a state-specific keyword to access its free, confidential service available 24/7 via text on mobile devices. This new resource is intended to broaden the options available through current community crisis hotlines. Throughout Ohio, individuals can text the keyword “4hope” to 741 741 to be connected to a Crisis Counselor. This keyword was originally chosen by the Stark County Mental Health and Addiction Recovery Board and will now be available statewide through this partnership.

Strengthening Family Support for Young People with Mental Health Needs in the Transition to Adulthood: A Tip Sheet for Service Provider
To strengthen family support in the transition to adulthood,service providers need to be able to: Consider the experiences reported by many families during the transition years: A shared sense of losing control with the natural pulling apart of adult family members and youth as youth become more independent; Initially parents may feel confident, although worried, but feel less adequate when service providers undermine their expertise and judgment by questioning and marginalizing them; The treatment system often forces young adults and families to disconnect; Families care for youth in a context ofinadequate resources, and little support in the community; Systems do not necessarily support collaboration with families. Service providers need to be familiar with federal, state, and local legal and policy issues; Individual and family developmental changes happen gradually but institutional transitions occur abruptly according to bureaucratic and legal rules; There are different definitions of serious emotional disturbance in special education versus mental health in the adult system; Youth with mental health disabilities have entitlements in the education system but when they have reached the age of adulthood there is only eligibility for adult services, no entitlement;