Wraparound in Washington State: Coordinating Care and Why it Matters

Wraparound in Washington State: Coordinating Care and Why it Matters

Skagit Results: Dawn Scott and Terrance Ellison

Pilot Site Results: Ericka Wiggins

Skagit Wraparound

Program Status From: July 08 – June 10

Client Demographics

Total of 20 youth and their families One (1) youth was a readmission,

resulting in an actual unduplicated count of 19

Six (6) were non-Medicaid clients

0

2

4

6

8

10

12

14

Num

ber

Avg A

ge

Avg Stay inM

onths

BoysGirls

Racial Demographics

8

1

2

1

7

0 0

1

0

1

2

3

4

5

6

7

8

Boys Girls

WhiteAfrican AmericanLatinoOther

Age Range at Intake

Boys from 6 – 18 Mean: 12 Median: 12

Girls from 7 – 17 Mean: 12 Median: 11

Living Situation at Intake

Two Parents: 6 30% Biological Mother Only 6 30% Biological Father Only 2 10% Home Of Relative 2 10% Foster Care 1 5% Adopted 3 15%

Referral Source

Referral Source N = 20 Percentage

Mental Health Agency 15 75%

School Based Mental Health

3 15%

Psychiatric Hospital 1 5%

Self Referral 1 5%

14 IEP and One (1) 504

Services Six (6) Months Prior to Wraparound

Police Involved

CPS ARIS Residential Treatment

MH Hospital Outpatient MH

Outpatient Substance

Abuse

Inpatient Substance

Abuse

Specialized Education Services

Boys 3 5 2 0 3 11 1 0 10

Girls 0 4 2 0 4 7 1 1 5

Total 3 9 4 0 7 18 2 1 15

% 15% 45% 20% N/A 35% 90% 10% 5% 75%

Two (2) IEP and One (1) 504

New Services After Entering Wraparound

Police Involved

CPS ARIS Residential Treatment

MH Hospital Outpatient MH

Outpatient Substance

Abuse

Inpatient Substance

Abuse

Specialized Education Services

Boys 2 2 N/A 2 4 N/A 1 1 2

Girls 0 1 N/A 1 2 N/A 1 1 1

Total 2 3 N/A 3 6 N/A 2 2 3

% 10% 15% N/A 15% 30% N/A 10% 10% 15%

School Status Intake Six Months 12

MonthsYes No %

Enrolled in School or Child Care

18 2 90%

School Changes or Disruptions

11 9 55%

Suspended (N/A= 3, 3)

6 11 35%

Expelled (N/A= 2, 3)

2 16 11%

Yes No % % CHG

19 1 95% +5%

5 15 25% -30%

3 17 15% -20%

1 19 5% -6%

Yes No % % CHG

16 4 80% -15%

4 16 20% -10%

1 16 6% -9%

0 17 0% -5%

Youth Risk FactorsIntake Six Months 12

MonthsYES NO %

Police Involvement

3 17 15%

Suicidal Gestures (missing=1)

9 10 47%

Strike Another Person

16 4 80%

Damage Property 15 5 75%

Take Property (missing=1

12 8 60%

Run Away 5 15 25%

Act Worried or Fearful

18 2 90%

Problems Due to Drugs

1 19 5%

Receive Outpatient MH Counseling

18 2 90%

Receive Inpatient MH Treatment

7 13 35%

YES NO % % CHG

1 19 5% NC

5 15 25% NC

8 12 40% -5%

5 15 25% -5%

5 15 25% -17%

2 18 10% -5%

8 12 40% -15%

1 19 5% -5%

14 6 70% -10%

2 18 10% -10%

YES NO % % CHG

1 19 5% -10%

5 15 25% -22%

9 11 45% -35%

6 14 30% -45%

8 11 42% -18%

3 17 15% -10%

11 9 55% -35%

2 18 10% +5%

16 4 80% -10%

4 16 20% -15%

Caregiver Risk Factors Intake Six Months

12 Months YES NO %

Under Supported Chronic Physical Illness

3 17 15%

Untreated Mental Illness 4 16 20%

Untreated Substance Abuse (missing=1)

0 19 0%

Psychiatric Hospitalization 0 20 0%

Incarceration 1 19 5%

Domestic Violence 1 19 5%

Victim of Sexual Abuse 3 17 15%

Poverty (missing=2) 7 11 39%

Exposure to Substance Abuse In The Home

2 18 10%

YES NO % % CHG

3 17 15% NC

2 18 10% -10%

0 20 0% NC

0 20 0% NC

0 20 0% -5%

2 18 10% +5%

0 20 0% -15%

7 13 35% -5%

0 20 0% -10%

YES NO % % CHG

1 19 5% -10%

0 20 0% -10%

0 20 0% NC

1 19 5% +5%

0 20 0% NC

1 19 5% -5%

0 20 0% NC

7 13 35% NC

0 20 0% NC

Loss of Personal Time

10

667

244

55

2

5

2

7

4

0

5

10

15

20

Intake Six Months 12 Months

Not at allA LittleSomewhatQuite a BitVery Much

Loss of Personal Time

Not at All

Not at All

2 21

0

5

10

15

20

Intake Six Months 12 Months

Loss of Personal Time

A LittleA little

0

45

0

5

10

15

20

Intake Six Months 12 Months

Loss of Personal Time

Somewhat

Somewhat

6

4

2

0

5

10

15

20

Intake Six Months 12 Months

Loss of Personal Time

Quite a Bit

Quite a Bit

65

7

0

5

10

15

20

Intake Six Months 12 Months

Loss of Personal Time

Very Much

Very Much

75

4

0

5

10

15

20

Intake Six Months 12 Months

Missing Work or Neglecting Other Duties

32

7

44 56

7

02

9

334

10

5

10

15

20

Intake SixMonths

TwelveMonths

Not at allA littleSomewhatQuite a bitVery Much

Missing Work or Neglecting Other Duties

Not at all

3

5

9

0

5

10

15

20

Intake Six Months 12 Months

Missing Work or Neglecting Other Duties

A little

2 23

0

5

10

15

20

Intake Six Months 12 Months

Missing Work or Neglecting Other Duties

Somewhat

7 7

3

0

5

10

15

20

Intake Six Months 12 Months

Missing Work or Neglecting Other Duties

Quite a Bit

4

0

4

0

5

10

15

20

Intake Six Months 12 Months

Missing Work or Neglecting Other Duties

Very Much

4

21

0

5

10

15

20

Intake Six Months 12 Months

Family Members Having To Do Without Things

332

6644

33

6

9

1

433

0

5

10

15

20

Intake SixMonths

TwelveMonths

Not at allA littleSomewhatQuite a bitVery Much

Family Members Having To Do Without Things

Not at all

34

9

0

5

10

15

20

Intake Six Months 12 Months

Family Members Having To Do Without Things

A Little

34

1

0

5

10

15

20

Intake Six Months 12 Months

Family Members Having To Do Without Things

Somewhat

23

4

0

5

10

15

20

Intake Six Months 12 Months

Family Members Having To Do Without Things

Quite a Bit

6

3 3

0

5

10

15

20

Intake Six Months 12 Months

Family Members Having To Do Without Things

Very Much

6 6

3

0

5

10

15

20

Intake Six Months 12 Months

$$ COSTS BENEFITS $$

Therapeutic Foster Care (CHAP): 4,000.00 (50% From NSMHA & 50% From CA)

Juvenile Detention: 3,720.00 (Detainees do not receive Mental Health Services)

Psychiatric Hospitalization: 41,666.00 CLIP Facility: 9,166.00 Wraparound: 1,500.00

Program Growth

Program Growth Chart

0

2

4

6

8

10

12

14

16

18

Fam

ilie

s se

rved

per

mo

nth

Wraparound Washington Pilot Sites

Skagit County, Grays Harbor, and Cowlitz County

Combined Results

Client Demographics at Intake N %

Age

-5-9 7 21%

-10-14 17 50%

-15-18 10 29%

Gender

-Male 22 65%

-Female 12 35%

Race

-White 27 82%

- African American 2 6%

-Native American 2 6%

-Biracial 2 6%

-Other 1 3%

Hispanic (missing=7)

-Yes 2 7%

-No 25 93%

Referral Source

Referral Source N = 34 Percentage

Mental Health Agency 24 71%

DSHS 2 6%

Parent/Family 1 3%

Juvenile Justice 1 3%

School 1 3%

Other 5 15%

School Status at Intake, 6 Months, and 12 Months (n=34)

Baseline Yes No %

Enrolled in School or Child Care

31 3 91%

School Changes or Disruptions (missing=1)

17 16 52%

Suspended (missing=5)

11 18 38%

Expelled (missing=8)

3 23 12%

6 Months Yes No % % Change

Enrolled in School or Child Care (missing=1)

30 3 91% No Change

School Changes or Disruptions (missing=1)

11 22 33% -19%

Suspended (missing=3)

4 27 13% -25%

Expelled (missing=3)

1 30 3% -9%

12 Months Yes No % % Change

Enrolled in School or Child Care (missing=1)

26 7 79% -12%

School Changes or Disruptions (missing=3)

9 22 29% -4%

Suspended (missing=8)

2 24 8% -5%

Expelled (missing=8)

0 26 0% -3%

Youth Risk Factors at Intake, 6 Months, and 12 Months

Baseline 6 Months 12 Months

Yes No % Yes No % % Change Yes No % %Change

Police Involvement (missing=3)

6 28 17% 3 31 9% -8% 2 29 7% -2%

Suicidal Gestures (missing=1, 2, 3 )

13 20 39% 7 25 25% -14% 6 25 19% -6%

Strike Another Person (missing=1, 1, 2)

23 10 70% 15 18 46% -24% 14 18 43% -3%

Damage Property (missing=2, 2)

23 11 68% 11 21 34% -34% 9 23 28% -6%

Take Property (missing=2, 4, 2)

19 13 59% 13 17 43% -16% 8 24 25% -18%

Run Away (missing=1, 2, 3)

7 26 21% 7 25 22% +1% 4 27 13% -9%

Act Worried or Fearful (missing=2, 2, 2)

27 5 84% 20 12 63% -21% 13 19 41% -22%

Problems Due to Drugs (missing=1, 2, 3)

1 32 3% 2 30 6% +3% 1 30 3% -3%

Receive Outpatient MH Counseling (missing= 1, 1)

31 3 91% 28 5 85% -6% 24 9 73% -12%

Receive Inpatient MH Treatment (missing=1, 2)

9 25 27% 5 28 15% -12% 3 29 9% -6%

Caregiver Risk Factors at Baseline, 6 Months, and 12 Months

Baseline 6 Months 12 Months

Yes No % Yes No % % Change Yes No % %Change

Under Supported Chronic Physical Illness (missing=5, 3, 2)

5 24 17% 6 25 19% +2% 3 29 9% -10%

Untreated Mental Illness (missing=4, 2, 2)

8 22 27% 3 29 9% -18% 2 30 6% -3%

Untreated Substance Abuse (missing=5, 2, 3)

0 29 0% 0 32 0% No Change 0 31 0% No Change

Psychiatric Hospitalization (missing=4, 2, 3)

3 27 10% 1 31 3% -7% 1 30 3% No Change

Incarceration (missing=4, 2, 3)

3 27 10% 2 30 6% -4% 0 31 0% -6%

Domestic Violence (missing=5, 3, 5)

6 23 21% 7 24 23% +2% 1 28 3% -20%

Victim of Sexual Abuse (missing=5, 3, 5)

5 24 17% 1 30 3% -14% 0 29 0% -3%

Poverty (missing=7, 1, 4) 11 16 41% 14 19 42% +1% 12 18 40% -2%

Exposure to Substance Abuse In The Home (missing=4, 3, 4)

3 27 10% 0 31 0% -10% 0 30 0% No Change

Community Supports for Wraparound Inventory (CSWI)

Skagit County

Community Supports for Wraparound Inventory (CSWI) A tool that assesses the level of development of a

particular community’s system-level support for wraparound.

Data collected December-January 08-09. 42 items grouped into 6 themes

1. Community Partnership2. Collaborative Action3. Fiscal Policies and Sustainability4. Access to Needed Supports & Services5. Human Resource Development & Support6. Accountability

Skagit County CSWI

39 invited to take the CSWI 30 of the 39 invitees responded = 76.9%

CSWI Overall and Theme Means-Skagit County

Theme Means: Pilot Sites and Comparison

0 0.5 1 1.5 2 2.5 3

Accountability

Human Resource Development

Availability of Services and Supports

Fiscal Policies and Sustainability

Collaborative Action

Community Partnerships

Cowlitz CountyGrays HarborSkagit CountyNational

Total Score

Cowlitz County 66.3

Grays Harbor 81.2

Skagit County 79.2

National 79.4

Wraparound Fidelity Index

Wraparound Washington

Total Fidelity Scores

Youth InformationNumber of Youth Assessed 56Interviews completed (total)

-Caregiver 31

-Facilitator 55

-Youth 14

Gender (missing=1)

-Male 34

-Female 21

Race (missing=2)

-White 44

-American Indian/Alaskan Native 3

-Mixed Race 3

-Black or African American 1

-Native Hawaiian/Other Pacific Islander 1

-Other 2

Overall Fidelity for All Sites

WF CG Youth

Pilot Sites 84 83 85

National Mean 83 75 73

0

20

40

60

80

100

WF CG Youth

Per

cen

t Fi

del

ity

Pilot SitesNational Mean

Fidelity Scores by Phase for All Sites

Phase 1: Engagement

Phase 2: Plan Development

Phase 3: Implementation

Phase 4: Transition

Pilot Sites 86 81 85 75

National Mean 76 76 81 69

0

20

40

60

80

100

Percent Fidelity

Phase 1:Engagement

Phase 2:Development

Phase 3:Implementation

Phase 4:Transition

Pilot SitesNational Mean

Fidelity Scores by Principle for All Sites

Family Voice and Choice (FVC) Team Based (TB) Natural Supports (NS) Collaboration (CO) Community Based (CB)

Pilot Sites 93 82 76 90 72

National Mean 83 72 64 85 71

0

20

40

60

80

100

Percent Fidelity

FVC TB NS CO CB CC IN SB PE OB

Pilot SitesNational Mean

Culturally Competent (CC) Individualized (IN) Strengths Based (SB) Persistence (PE) Outcome Based (OB)

Pilot Sites 96 77 87 89 69

National Mean 91 69 83 82 67