Implementation of the WFI-EZ in a Multi-Site Wraparound Agency

March 3, 2014

Choices

• Care Management Entity– System of Care– Wraparound– Managed Care

• Established in 1997

• Over 1500 youth served daily

Agenda

• Choices experience with the WFI

• Integrating the WFI-EZ into Practice

• Using the WFI for Quality Improvement

Experience with WFI 3.0 and 4.0

• Wraparound Comparison Study– Dawn Project– University of Maryland

• Choices Technical Assistance Center– Subcontractor– Choices Outcomes and Evaluation Staff

Experience with WFI 3.0 and 4.0

• Advantages– External evaluation– Trained interviewers– Alignment with phases and principles

• Disadvantages– Staff resources– Completion rates– Limited assessment options

WFI-EZ

• Short-form– Wraparound Fidelity– Youth Outcomes– Satisfaction

• Self-Report– Paper– On-line– Interview

Part 1

Integrating the WFI-EZ into Practice

Administration Options

• On-line– Care Coordinators introduce– Email to caregivers– Survey Monkey

• Challenges– Caregivers have limited access to Internet– Reading levels

Administration Options

• Paper– Care Coordinators introduce– CCs give survey to families• Sign sealed envelope and return• Mail in stamped envelope

• Challenges– Potential for bias– Reading levels

Administration Options

• Interviews– Program staff– CCs introduces– Conducted by phone

• Challenges– Resource cost– Successful contacts with caregivers– WFI-EZ format

Implementation Process

• Allowed sites to select method

• Generated random samples

• CCs completed WFI-EZ on one youth

• 30 days to get completed surveys from caregivers

Results

• 3 of 4 sites selected paper surveys

• 1 site conducted phone interviews

• Response rates– Interviews (44%)– Paper (22-36%)

Results

• Consistent data quality

• Bias from CC involvement not observed

• Cost/benefit analysis

Next Steps

• 2nd administration underway

• Improve CC introduction to WFI-EZ

• Formalize mechanism for returning paper surveys

• Incentives for caregivers and youth

Part 2

Using the WFI-EZ for Quality Improvement

Importance of the WFI-EZ

• Family voice

• Fidelity monitoring vs. task management

• Opportunities for quality improvement

Quality Improvement

• Multiple levels of analysis

• Opportunities for celebration

• Common areas for improvement

• Site-specific strengths and needs

18

Total Caregiver Fidelity Score

High Fidelity (85% and above)Good Fidelity (75% - 84%)Adequate Fidelity (65% - 74%)

WFI Louisiana - October 2013

Wraparound Fidelity Principles

Outcomes Based

Teamwork Natural Supports

Needs Based Strength and family driven

WFI Total Score

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Wraparound

Adequate

Not Wraparound

Good

High

Strength and Family Driven

Wraparound

Adequate

Not Wraparound

Good

High

B1: Had

a majo

r role in

choosin

g tea

m

B3: Fam

ily descr

ibed vi

sion

B11: Cele

brate s

uccesse

s at e

ach m

eeting

B14: Stra

tegies ti

ed to

family

likes

B17*: Tea

m members

do not unders

tand fa

mily

Stren

gth an

d family

driven

Ove

rall

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Satisfaction

DC Indiana Louisiana Maryland Choices0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

I am satisfied with the wraparound process in which my family and I have participated.

% o

f Car

egiv

ers S

tron

gly

Agre

e or

Agr

ee

Outcomes

Cause stress or strain on family

Disrupt home life Interfer with success at school

Difficulty developing friendships

Difficulty participating in community activities

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Quality Improvement

• Multiple Levels– Agency– Programs – Teams

• Multiple Data Sources– Fidelity– Process measures– Outcomes

Conclusions

• Integrate WFI-EZ into practice

• Balance response rates and resources

• Quality improvement requires multiple types of data

• Ongoing assessment is important

Thank You!

Vicki Sprague Effland, Ph.D.Director, Outcomes and EvaluationChoices, Inc.4701 N. Keystone Ave., #150Indianapolis, IN 46205

(317) 205-8232

Veffland@ChoicesTeam.org