Using Data to Adjust a Population of Focus for Wraparound · CASII Score of 4 or higher 2....

Advancing Systems Enhancing the Workforce Improving Outcomes

Using Data to Adjust a Population of Focus for Wraparound

Beverly BurtonNevada System of Care / DCFS

Elizabeth ChristiansenUniv. of Nevada-Reno

Karen TaycherNevada PEP: Education, Empowerment, Encouragement

Spencer Hensley & Eric J. BrunsUniversity of Washington / NWIC

Today’s Story

Today’s presentation is about the journey from an on-the-ground experience in Wraparound to system-level changes, using

existing, available data to guide the way.

Background

Nevada is currently working with the National Wraparound Implementation Center (NWIC) to develop their workforce, systems supports, and accountability infrastructure.

Background

Early in implementation, NWIC and NV leadership and staff became concerned that Wraparound youth experienced lower needs than would typically be appropriate for WraparoundYouth and families were also disengaging from services early, or not engaging at all. Meanwhile, many youth with higher needs were being referred directly to residential care without being considered for wraparound

Evaluation Activities to Date

Spring 2017Baseline Wraparound Fidelity Assessment

• WFI-EZ fidelity surveys from Caregivers

• DART fidelity data using documentation

2017National Evaluation

(NOMS) data reviewed regarding Wraparound

population

May 2018NWIC + NV DCFS follow-

up investigation of whether the "right"

youth were being served by Wraparound.

Summer 2018Follow-up WFI-EZ fidelity surveys from Caregivers

January 2019Follow-up DART fidelity

data using documentation

Spring 2019Initiating a statewide,

standardized screening and assessment pilot

Baseline Fidelity and Outcomes DataWhat did wrap services and population look like before NWIC's involvement?

Follow-up Fidelity and Outcomes DataWhat do wrap enrolled youth and services look like as a result of NWIC's support?

Throughout and On-goingCollected and reported training and coaching data

YOUTH CURRENTLY SERVEDTesting a hypothesis

Wraparound is for the highest-need youth in your system

Wraparound: Reserved for youth with multiple helpers, involved with multiple systems, and with the highest risk of out-of-community placement

Leve

l of N

eed

Targeted services: Evidence-based treatments, peer support & navigation, “intermediate” care coordination

Prevention programs and universal health services

NWIC identified 5 criteria for “high needs,” Wraparound-appropriate youth

1. CASII Score of 4 or higher2. Involvement with multiple systems3. Imminent risk of out-of-home placement4. History of 3 or more interventions5. Underlying needs for other family members

Data sources

• Nevada DCFS– CASII– CANS– Previous service use

• National Outcomes Measures for Nevada System of Care– Systems Involvement– Caregiver Strain Questionnaire

NWIC Criteria for Wraparound


66% of NV wrap youth have a CASII Level of Care recommendation of less than 4

52% of youth are involved in the Mental Health System but not other systems.

52%

27% 21%

Mental Health Systemonly

Mental Health + 1other system

Mental health + 2 ormore other systems

System Involvement of SOC WIN Children/Youth

Data Source: NOMS

30% of youth are involved in both Mental Health and Child Welfare Systems

12%2% 3%

30%11% 15%

PhysicalHealth

SubstanceAbuse

IntellectualDisabilities

ChildWelfare

FamilyCourts

JuvenileCourts

Percentages of SOC WIN Children/Youth Involved in Mental Health and Other Systems

Data Source: NOMS

We don’t have a direct measure of “Imminent Risk of Out of Home Placement,” but we can look at the Child and Adolescent

Needs and Strengths (CANS) assessment and juvenile justice involvement for proxies.

Most youth have few “needs” as captured by the CANS

Median number of actionable needs is 2

38% of youth have 1 or 0 actionable needs

The most common needs are not associated with imminent risk of out of home placement

Item

Percent Actionable Need

Caregiver Strengths & Needs: Family Stress 36%

Caregiver Strengths & Needs: Social Resources 25%

Caregiver Strengths & Needs: Understanding of Child's Needs 23%

Caregiver Strengths & Needs: Mental Health/PTSD 16%

Caregiver Strengths & Needs: Supervision 16%

Caregiver Strengths & Needs: Transportation 14%

Caregiver Strengths & Needs: Medical Physical 14%

Caregiver Strengths & Needs: Organization 14%

Caregiver Strengths & Needs: Access to Public Resources 12%

Caregiver Strengths & Needs: Residential Stability 12%

Caregiver Strengths & Needs: Involvement with Care 11%

Caregiver Strengths & Needs: Communication 6%

Caregiver Strengths & Needs: Domestic Violence 4%

Caregiver Strengths & Needs: Developemtal 4%

Caregiver Strengths & Needs: Safety 4%

Caregiver Strengths & Needs: Substance Use 2%

Item


Youth Risk Behaviors: Intentional Misbehavior 23%

Youth Risk Behaviors: Danger to Others 20%

Youth Risk Behaviors: Other Self Harm (Recklessness) 14%

Youth Risk Behaviors: Runaway 13%

Youth Risk Behaviors: Bullying Others 13%

Youth Risk Behaviors: Self Injury 9%

Youth Risk Behaviors: Suicide Risk 8%

Youth Risk Behaviors: Deliquent Behavior 8%

Youth Risk Behaviors: Victimization/Exploitation 7%

Youth Risk Behaviors: Problematic Sexual Behavior 5%

Youth Risk Behaviors: Sexual Agression 2%

For youth age 7-18

The most common needs are not associated with imminent risk of out of home placement

Item


















Item


Youth Risk Behaviors: Intentional Misbehavior 23%

Youth Risk Behaviors: Danger to Others 20%

Youth Risk Behaviors: Other Self Harm (Recklessness) 14%

Youth Risk Behaviors: Runaway 13%

Youth Risk Behaviors: Bullying Others 13%

Youth Risk Behaviors: Self Injury 9%

Youth Risk Behaviors: Suicide Risk 8%

Youth Risk Behaviors: Delinquent Behavior 8%

Youth Risk Behaviors: Victimization/Exploitation 7%

Youth Risk Behaviors: Problematic Sexual Behavior 5%

Youth Risk Behaviors: Sexual Aggression 2%

For youth age 7-18

84% of youth have never had a prior arrest


1. CASII Score of 4 or higher2. Involvement with multiple systems3. Imminent risk of our-of-home placement4. History of 3 or more interventions5. Underlying needs for other family members

We can only speak to multiple interventions within the child welfare system.

Wraparound represents the first or second DCFS intervention for most youth

67% of youth have had 0 or 1 previous DCFS “episodes”

82% of youth had no recent history of mobile crisis intervention


1. CASII Score of 4 or higher2. Involvement with multiple systems3. Imminent risk of our-of-home placement4. History of 3 or more interventions5. Underlying needs for other family members

Caregivers have few needs, according to the CANS

49% of caregivers have 1 or 0 actionable needs

Caregiver needs items

Item


















Mean Total CGSQ (37) for NV SOC-enrolled youth found to be at low end of intensive needs samples

0

1

2

3

4

5

6

7

25 26 27 28 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45

Num

ber o

f Stu

dies

Mean Caregiver Strain Questionnaire Score

Nev

ada

Were the right youth and families receiving Wraparound?

• The CASII does not recommend a high level of care for most youth

• A minority of youth are involved in multiple systems• There is little evidence that youth are at high risk for

imminent out of home placement– Few have needs directly related to out of home placement– Few have been arrested

Were the right youth and families receiving Wraparound?

• Although we don’t have data about other systems, most youth do not have a record of multiple DCFS “episodes”

• Most caregivers found to have few or zero needs• Caregiver strain in SOC-enrolled youth high

– However, SOC enrolled youth not the same as Wraparound-enrolled

IMPLICATIONS FOR NEVADA’S SYSTEM OF CARETurning data into action

Are the right youth and families receiving Wraparound?

Ideal Wraparound Population Nevada Wraparound Population

Are the right youth and families receiving Wraparound?

Where are these youth?How will we identify them sooner for WraparoundHow can we best ensure they are diverted from residential placement?

Finding the right families for Wraparound

SAMHSA estimates that Nevada has about 3,000 youth (0-18) with “Serious Emotional Disturbance”

DCFS is hoping to identify appropriate youth in several places in Nevada:• Youth leaving/entering residential treatment• Juvenile Justice • AFC • The Harbor• Mobile Crisis

These youth still need care, even if Wraparound is not the best match. What will they get and who will provide it?

Lower tiers of care

NV Focus

Navigation, Information,

Referral & Warm Line

Intermediate Care Coordination

(FOCUS)

Intensive Care Coordination(Wraparound)

MCOs, Family Support Organizations

Public Mental Health Services (TCM), CMHCs, Child Welfare, Juvenile Justice

CMEs, CCOs, specialized providers

Risk Factors are Different

FOCUS: Intermediate Care Coordination

• Behavioral Health Needs• Social Determinants of Health

• Economic Stability• Education• Social and Community Context• Health and Health Care• Neighborhood and Built

Environment

• Developmental Delays• System Involvement

Wraparound: Intensive Care Coordination

• Multi-System Involved• High risk of OHP• Complex Behavioral Health

Needs

May be compounded by:• Social Determinants of

Health• Developmental delays

Proposed Screening/ Assessment Process

• Wraparound:• Imminent risk of OHP OR• CASII of 4 + 2 systems and 3 prior

attempts OR• CASII of 3 + elevated CIS and CGSQ

• FOCUS (ICM):• CASII of 4 but no multiple systems or

prior attempts at service• CASII of 3 + moderate CIS and • CGSQ

• Outpatient Services:• CASII of 2• CASII of 3 but no SED• CASII of 3 or 4 but CIS or CGSQ not

elevated

Family and Youth Perspectives

• Statewide Family Network and Youth M.O.V.E. Nevada– Influences of our Systems Work

• Youth and Family Experiences & CASSP, SOC, Olmstead– We strive for a responsive system: When families ask for help they

get it– Strong Belief in Wraparound– Strong Hope in Focus

• Next Steps

THANK YOU! CONTACT US AT:[email protected]

[email protected]

[email protected]@UW.EDUWWW.NWIC.ORG

mailto:[email protected]


http://www.nvpep.org/



http://www.nwic.org/

Using Data to Adjust a Population of Focus for Wraparound · CASII Score of 4 or higher 2....

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