Ten Principles of the Wraparound Process

This document was produced through the full NWI consensus process. The Principles of Wraparound: Chapter 2.1 Ten Principles of the Wraparound Process

Eric Bruns, Co-Director, National Wraparound Initiative, and Associate Professor, University of Washington School of Med- icine

Janet Walker, Co-Director, National Wraparound Initiative, and Research Associate Professor, Portland State University School of Social Work

National Wraparound Initiative Advisory Group

he philosophical principles of wraparound have long Tprovided the basis for understanding this widely-practiced service delivery model. This value base for working in collaboration and partnership with families has its roots in early programs such as Kaleidoscope in Chicago, the Alaska Youth Initiative, Project Wraparound in Vermont, and other trailblazing efforts. Perhaps the best presentation of the wraparound value base is provided through the stories contained in Everything is Normal until Proven Otherwise (Dennis & Lourie, 2006). In this volume, published by the Child Welfare League of America, Karl Dennis, former Director of Kaleidoscope, presents a set of stories that illuminate in rich detail how important it is for helpers to live by these core principles in service delivery. As described in the Resource Guide’s Fore- word, these stories let the reader “experience the wraparound process as it was meant to be” (p.xi). For many years, the philosophy of wraparound was expressed through the work of local initiatives and agencies such as Kaleidoscope, but not formally captured in publications for the field. Critical first descriptions were provided by VanDenBerg & Grealish (1996) as part of a special issue on wraparound, and by Goldman (1999) as part of an influential monograph on wraparound (Burns & Goldman, 1999). These resources presented elements and practice principles that spanned activity at the team, organization, and

This is an updated version of The Ten Principles of the Wraparound Process, which was originally published in 2004.

The Resource Guide to Wraparound Section 2: The Principles of Wraparound

system levels. In other words, some elements were of a small team of wraparound innovators, family intended to guide work at the team level with the advocates, and researchers working together over youth, family and hands-on support people, while several months. This team started with the original other elements described activities at the pro- elements and practice principles, reviewed other gram or system level. For many, these documents documents and training manuals, and drafted a were the best means available for understanding revised version of the principles as expressed at the wraparound process. They also provided the a family and team level. These descriptions were basis for initial efforts at measuring wraparound then provided to a much larger national group of implementation. (See the chapter on wraparound family members, program administrators, train- fidelity in chapter 5e.1 of this Resource Guide.) ers, and researchers familiar with wraparound. Through several stages of work, these individuals The Ten Principles as Presented by voted on the principles presented, provided feed- the National Wraparound Initiative back on wording, and participated in a consensus- building process. At the outset of the National Wraparound Ini- Though not complete, consensus on the NWI tiative’s work, it was recognized that presentation principles document, initially created in 2004, of the principles of wraparound would be a cen- was strong. Nonetheless, there were several key tral part of the NWI’s mission to enhance under- areas where the complexity of wraparound made standing of wraparound and support high-quality consensus difficult within our advisory group. In wraparound practice. So what, if anything, was many cases, advisors were uncomfortable with needed to communicate the principles clearly? brief definitions of the principles because they did In the first place, the early descriptions of not acknowledge tensions that could arise in “real wraparound’s philosophical base included a se- world” efforts to put the principles into practice. ries of elements that were described only briefly, These tensions were acknowledged and addressed or not at all. If these values were truly to guide in the consensus document in several ways: practice, it seemed important to provide some information about what was meant by key terms • First, in addition to the one- to two-sen- and phrases like “culturally competent,” “based tence definition for each principle, more in the community” and “individualized.” Second- in-depth commentary is also provided, ly, since the principles were intended to serve as highlighting tensions and disagreements a touchstone for wraparound practice and the and providing much greater depth about foundation for the NWI’s subsequent work, it was the meaning of each principle. important that a document describing the prin- • Second, we have allowed our NWI “commu- ciples receive formal acceptance by the advisors nity of practice” to revisit the principles. who comprised the NWI. Finally, for clarity, it Most notably, at the behest of a number seemed optimal to express the principles at the of advisors, the NWI revisited the principle level of the family and team. Once the principles of Persistent, and asked whether the origi- were clarified and written in this way, descriptions nal name for the principle, Unconditional of the organizational and system supports neces- Care, might be more appropriate and a sary to achieve high-quality wraparound practice new definition possible. The results of this (see Chapter 5a.1 of this Resource Guide) could 2008 survey of advisors are reflected in the be presented as “what supports are needed to definitions presented here, and a descrip- achieve the wraparound principles for families tion of this process is presented for your and their teams?” Furthermore, descriptions of information in Chapter 2.5 of this Resource the practice model for wraparound (See chapter Guide. 4a.1 of this Resource Guide) could be presented as “what activities must be undertaken by wrap- • Finally, true to the wraparound model, around teams to achieve the principles for youth all the materials of the NWI are intended and families?” to be resources for use by local initia- The current document began with the efforts tives, families, and researchers to use as

Chapter 2.1: Bruns, et al.

they see fit. Thus, documents such as this around stems from this recognition and acknowl- one, as well as the Phases and Activities edges that the people who have a long-term, of the Wraparound Process, are conceived ongoing relationship with a child or youth have as “skeletons” to be “fleshed out” by in- a unique stake in and commitment to the wrap- dividual users. For example, in Canada, a around process and its outcomes. This principle new nationwide initiative north of the bor- further recognizes that a young person who is re- der has adapted the NWI principles. As a ceiving wraparound also has a unique stake in the result, they have used the NWI principles process and its outcomes. The principle of family to describe the value base in ways to suit voice and choice affirms that these are the people their purposes, such as a description of the who should have the greatest influence over the paradigm shifts necessary for wraparound wraparound process as it unfolds. and the personal values expected of par- This principle also recognizes that the likeli- ticipating helpers. hood of successful outcomes and youth/child and family ownership of the wraparound plan are in- Many have expressed a need to move beyond creased when the wraparound process reflects a value base for wraparound in order to facili- family members’ priorities and perspectives. The tate program development and replicate positive principle thus explicitly calls for family voice—the outcomes. However, wraparound’s philosophical provision of opportunities for family members to principles will always remain the starting point fully explore and express their perspectives dur- for understanding wraparound. The current docu- ing wraparound activities—and family choice—the ment attempts to provide this starting point for structuring of decision making such that family high-quality practice for youth and families. members can select, from among various options, Considered along with the rest of the materi- the one(s) that are most consistent with their own als in the Resource Guide to Wraparound, we hope perceptions of how things are, how things should that this document helps achieve the main goal be, and what needs to happen to help the fam- expressed by members of the NWI at its outset: ily achieve its vision of well-being. Wraparound To provide clarity on what it means to do wrap- is a collaborative process (principle 3); however around, for the sake of communities, programs, within that collaboration, family members’ per- and families. Just as important, we hope that NWI spectives must be the most influential. documents such as this continue to be viewed as The principle of voice and choice explicitly works in progress, updated and augmented as recognizes that the perspectives of family mem- needed based on research and experience. bers are not likely to have sufficient impact during wraparound unless intentional activity occurs to The Ten Principles of the ensure their voice and choice drives the process. Wraparound Process Families of children with emotional and behavioral disorders are often stigmatized and blamed 1. Family voice and choice. Family for their children’s difficulties. This and other fac- and youth/child perspectives are inten- tors—including possible differences in social and tionally elicited and prioritized during all educational status between family members and phases of the wraparound process. Plan- professionals, and the idea of professionals as ex- ning is grounded in family members’ per- perts whose role is to “fix” the family—can lead spectives, and the team strives to provide teams to discount, rather than prioritize, family options and choices such that the plan re- members’ perspectives during group discussions flects family values and preferences. and decision making. These same factors also decrease the probability that youth perspectives The wraparound process recognizes the impor- will have impact in groups when adults and pro- tance of long-term connections between people, fessionals are present. particularly the bonds between family members. Furthermore, prior experiences of stigma and The principle of family voice and choice in wrap- shame can leave family members reluctant to express their perspectives at all. Putting the prin-

Section 2: The Principles of Wraparound

ciple of youth and family voice and choice into people who have the deepest and most persistent action thus requires intentional activity that sup- connection to the young person and commitment ports family members as they explore their per- to his or her well-being. spectives and as they express their perspectives Special attention to the balancing of influence during the various activities of wraparound. Fur- and perspectives within wraparound is also neces- ther intentional activity must take place to ensure sary when legal considerations restrict the extent that this perspective has sufficient impact within to which family members are free to make choices. the collaborative process, so that it exerts prima- This is the case, for example, when a youth is on ry influence during decision making. Team proce- probation, or when a child is in protective custody. dures, interactions, and products—including the In these instances, an adult acting for the agency wraparound plan— may take on caregiving and/or decision making should provide evi- responsibilities vis-à-vis the child, and may exer- dence that the team cise considerable influence within wraparound. In is indeed engaging in conducting our review of opinions of wraparound intentional activity experts about the principles, this has been one of to prioritize the fam- several points of contention: How best to balance The wraparound ily perspectives. the priorities of youth and family against those While the princi- of these individuals. Regardless, there is strong team should ple speaks of family consensus in the field that the principle of family be composed voice and choice, the voice and choice is a constant reminder that the of people who wraparound process wraparound process must place special emphasis recognizes that the on the perspectives of the people who will still have a strong families who partici- be connected to the young person after agency commitment to pate in wraparound, involvement has ended. the family’s well- like American families generally, come 2. Team based. The wraparound team being. in many forms. In consists of individuals agreed upon by many families, it is the family and committed to the family the biological parents through informal, formal, and community who are the primary support and service relationships. caregivers and who have the deepest and Wraparound is a collaborative process (see most enduring com- principle 3), undertaken by a team. The wrap- mitment to a youth or child. In other families, this around team should be composed of people who role is filled by adoptive parents, step-parents, ex- have a strong commitment to the family’s well-be- tended family members, or even non-family care- ing. In accordance with principle 1, choices about givers. In many cases, there will not be a single, who is invited to join the team should be driven unified “family” perspective expressed during the by family members’ perspectives. various activities of the wraparound process. At times, family members’ choices about team Disagreements can occur between adult family membership may be shaped or limited by practi- members/ caregivers or between parents/caregiv- cal or legal considerations. For example, one or ers and extended family. What is more, as a young more family members may be reluctant to invite person matures and becomes more independent, a particular person— e.g., a teacher, a therapist, it becomes necessary to balance the collabora- a probation officer, or a non-custodial ex-spouse— tion in ways that allow the youth to have growing to join the team. At the same time, not inviting influence within the wraparound process. Wrap- that person may mean that the team will not have around is intended to be inclusive and to manage access to resources and/or interpersonal support disagreement by facilitating collaboration and that would otherwise be available. Not inviting a creativity; however, throughout the process, the particular person to join the team can also mean goal is always to prioritize the influence of the that the activities or support that he or she offers

Chapter 2.1: Bruns, et al.

will not be coordinated with the team’s efforts. It 3. Natural supports. The team actively can also mean that the family loses the opportuni- seeks out and encourages the full partici- ty to have the team influence that person so that pation of team members drawn from fami- he or she becomes better able to act supportively. ly members’ networks of interpersonal and If that person is a professional, the team may also community relationships. The wraparound lose the opportunity to access services or funds plan reflects activities and interventions that are available through that person’s organiza- that draw on sources of natural support. tion or agency. Not inviting a particular professional to join This principle recognizes the central impor- the team may also bring undesired consequenc- tance of the support that a youth/child, par- es, for example, if participation of the probation ents/caregivers, and other family members re- officer on the wraparound team is required as a ceive “naturally,” i.e., from the individuals and organizations whose connection to the family is independent of the formal service system and its resources. These sources of natural support are sustainable and thus most likely to be available for the youth/child and family after wraparound and other formal services have ended. People who represent sources of natural support often have a high degree of importance and influence within family members’ lives. These relationships bring value to the wraparound process by broadening the diversity of support, knowledge, skills, perspectives, and strategies available to the team. Such individuals and organizations also may be able to provide certain types of support that more formal or professional providers find hard to provide. condition of probation. Family members should be The primary source of natural support is the provided with support for making informed deci- family’s network of interpersonal relationships, sions about whom they invite to join the team, which includes friends, extended family, neigh- as well as support for dealing with any conflicts bors, co-workers, church members, and so on. or negative emotions that may arise from work- Natural support is also available to the family ing with such team members. Or, when relevant through community institutions, organizations, and possible, the family should be supported to and associations such as churches, clubs, librar- explore options such as inviting a different rep- ies, or sports leagues. Professionals and parapro- resentative from an agency or organization. Ulti- fessionals who interact with the family primar- mately, the family may also choose not to partici- ily offer paid support; however, they can also pate in wraparound. be connected to family members through caring When a state agency has legal custody of a relationships that exceed the boundaries and ex- child or youth, the caregiver in the permanency pectations of their formal roles. When they act in setting and/or another person designated by that this way, professionals and paraprofessionals too agency may have a great deal of influence over can become sources of natural support. who should be on the team; however, in accor- Practical experience with wraparound has dance with principle 1, efforts should be made shown that formal service providers often have to include participation of family members and great difficulty accessing or engaging potential others who have a long-term commitment to the team members from the family’s community and young person and who will remain connected to informal support networks. Thus, there is a ten- him or her after formal agency involvement has dency that these important relationships will be ended. underrepresented on wraparound teams. This

Section 2: The Principles of Wraparound

principle emphasizes the need for the team to act members’ ideas and opinions. Team members must intentionally to encourage the full participation also be willing to provide their own perspectives, of team members representing sources of natural and the whole team will need to work to ensure support. that each member has opportunities to provide input and feels safe in doing so. As they work to 4. Collaboration. Team members work reach agreement, team members will need to re- cooperatively and share responsibility for main focused on the team’s overarching goals and developing, implementing, monitoring, how best to achieve these goals in a manner that and evaluating a single wraparound plan. reflects all of the principles of wraparound. The plan reflects a blending of team mem- The principle of collaboration emphasizes that bers’ perspectives, mandates, and resourc- each team member must be committed to the es. The plan guides and coordinates each team, the team’s goals, and the wraparound plan. team member’s work towards meeting the For professional team members, this means that team’s goals. the work they do with family members is governed by the goals in the plan and the decisions reached by the team. Similarly, the use of resources available to the team—including those controlled by individual professionals on the team—should be governed by team decisions and team goals. This principle recognizes that there are certain constraints that operate on team decision making, and that collaboration must operate within these boundaries. In particular, legal mandates or other requirements often constrain decisions. Team members must be willing to work creatively and flexibly to find ways to satisfy these mandates and requirements while also working towards team goals. Finally, it should be noted that, as for principles 1 (family voice and choice) and 2 (team-based), defining wraparound’s principle of collaboration raises legitimate concern about how best to strike a balance between wraparound being youth- and family-driven as well as team-driven. This issue is difficult to resolve completely, because it is clear that wraparound’s strengths as a planning and implementation process derive from being team- based and collaborative while also prioritizing the Wraparound is a collaborative activity—team perspectives of family members and natural sup- members must reach collective agreement on ports who will provide support to the youth and numerous decisions throughout the wraparound family over the long run. Such tension can only be process. For example, the team must reach deci- resolved on an individual family and team basis, sions about what goals to pursue, what sorts of and is best accomplished when team members, strategies to use to reach the goals, and how to providers, and community members are well sup- evaluate whether or not progress is actually being ported to fully implement wraparound in keeping made in reaching the goals. The principle of col- with all its principles. laboration recognizes that the team is more likely to accomplish its work when team members ap- 5. Community based. The wraparound proach decisions in an open-minded manner, pre- team implements service and support pared to listen to and be influenced by other team strategies that take place in the most in-

Chapter 2.1: Bruns, et al.

clusive, most responsive, most accessible, or professional rela- and least restrictive settings possible; and tionships. Thus, this that safely promote child and family inte- principle also empha- gration into home and community life. sizes the importance of embracing these This principle recognizes that families and individuals and orga- Undesired young people who receive wraparound, like all nizations, and nurtur- behavior, events, people, should have the opportunity to participate ing and strengthening fully in family and community life. This implies these connections or outcomes that the team will strive to implement service and resources so as to are not seen as and support strategies that are accessible to the help the team achieve family and that are located within the commu- its goals, and help the evidence of child nity where the family chooses to live. Teams will family sustain posi- or family “failure” also work to ensure that family members receiv- tive momentum after and are not seen ing wraparound have greatest possible access to formal wraparound the range of activities and environments that are has ended. as a reason to available to other families, children, and youth This principle fur- eject the family within their communities, and that support posi- ther implies that the from wraparound. tive functioning and development. team will strive to ensure that the service 6. Culturally competent. The wrap- and support strate- around process demonstrates respect for gies that are included and builds on the values, preferences, in the wraparound beliefs, culture, and identity of the child/ plan also build on and youth and family, and their community. demonstrate respect for family members’ beliefs, values, culture, and identity. The principle re- The perspectives people express in wrap- quires that team members are vigilant about en- around—as well as the manner in which they ex- suring that culturally competent services and sup- press their perspectives—are importantly shaped ports extend beyond wraparound team meetings. by their culture and identity. In order to collab- orate successfully, team members must be able 7. Individualized. To achieve the goals to interact in ways that demonstrate respect for laid out in the wraparound plan, the team diversity in expression, opinion, and preference, develops and implements a customized set even as they work to come together to reach de- of strategies, supports, and services. cisions. This principle emphasizes that respect toward the family in this regard is particularly This principle emphasizes that, when wrap- crucial, so that the principle of family voice and around is undertaken in a manner consistent with choice can be realized in the wraparound pro- all of the principles, the resulting plan will be cess. uniquely tailored to fit the family. The principle of This principle also recognizes that a family’s family voice and choice lays the foundation for in- traditions, values, and heritage are sources of dividualization. That principle requires that wrap- great strength. Family relationships with people around must be based in the family’s perspective and organizations with whom they share a cultur- about how things are for them, how things should al identity can be essential sources of support and be, and what needs to happen to achieve the lat- resources; what is more, these connections are ter. often “natural” in that they are likely to endure Practical experience with wraparound has as sources of strength and support after formal shown that when families are able to fully ex- services have ended. Such individuals and organi- press their perspectives, it quickly becomes clear zations also may be better able to provide types of that only a portion of the help and support re- support difficult to provide through more formal quired is available through existing formal ser-

Section 2: The Principles of Wraparound

vices. Wraparound teams are thus challenged to team continues working towards meet- create strategies for providing help and support ing the needs of the youth and family and that can be delivered outside the boundaries of towards achieving the goals in the wrap- the traditional service environment. Moreover, around plan until the team reaches agree- the wraparound plan must be designed to build on ment that a formal wraparound process is the particular strengths of family members, and no longer necessary. on the assets and resources of their community and culture. Individualization necessarily results This principle emphasizes that the team’s as team members collaboratively craft a plan that commitment to achieving its goals persists regard- capitalizes on their collective strengths, creativi- less of the child’s behavior or placement setting, ty, and knowledge of possible strategies and avail- the family’s circumstances, or the availability of able resources. services in the community. This principle includes the idea that undesired behavior, events, or out- 8. Strengths based. The wraparound comes are not seen as evidence of youth or family process and the wraparound plan identify, “failure” and are not seen as a reason to reject build on, and enhance the capabilities, or eject the family from wraparound. Instead, knowledge, skills, and assets of the child adverse events or outcomes are interpreted as and family, their community, and other indicating a need to revise the wraparound plan team members. so that it more successfully promotes the positive outcomes associated with the goals. This principle The wraparound process is strengths based in also includes the idea that the team is commit- that the team takes time to recognize and validate ted to providing the supports and services that the skills, knowledge, insight, and strategies that are necessary for success, and will not termi- each team member has used to meet the chal- nate wraparound because available services are lenges they have encountered in life. The wrap- deemed insufficient. Instead, the team is commit- around plan is constructed in such a way that the ted to creating and implementing a plan that re- strategies included in the plan capitalize on and flects the wraparound principles, even in the face enhance the strengths of the people who partici- of limited system capacity. pate in carrying out the plan. This principle also At the same time, it is worth noting that many implies that interactions between team members wraparound experts, including family members will demonstrate mutual respect and appreciation and advocates, have observed that providing “un- for the value each person brings to the team. conditional” care to youth and families can be The commitment to a strengths orientation challenging for teams to achieve in the face of is particularly pronounced with regard to the certain system-level constraints. One such con- child or youth and family. Wraparound is intend- straint is when funding limitations or rules will not ed to achieve outcomes not through a focus on fund the type or mix of services determined most eliminating family members’ deficits but rather appropriate by the team. In these instances the through efforts to utilize and increase their as- team must develop a plan that can be implement- sets. Wraparound thus seeks to validate, build on, ed in the absence of such resources without giving and expand family members’ psychological assets up on the youth or family. Providing unconditional (such as positive self-regard, self-efficacy, hope, care can be complicated in other situations, such optimism, and clarity of values, purpose, and as the context of child welfare, where uncondi- identity), their interpersonal assets (such as so- tional care includes the duty to keep children and cial competence and social connectedness), and youth safe. Regardless, team members as well their expertise, skill, and knowledge. as those overseeing wraparound initiatives must strive to achieve the principle of unconditional 9. Unconditional. A wraparound team care for the youth and all family members if the does not give up on, blame, or reject wraparound process is to have its full impact on children, youth, and their families. When youth, families, and communities. faced with challenges or setbacks, the

Chapter 2.1: Bruns, et al.

10. Outcome based. The team ties the and their families. Washington DC: Center for goals and strategies of the wraparound Effective Collaboration and Practice. plan to observable or measurable indica- VanDenBerg, J.E. & Grealish, E.M. (1996). Indi- tors of success, monitors progress in terms vidualized services and supports through the of these indicators, and revises the plan wraparound process: Philosophy and proce- accordingly. dures. Journal of Child and Family Studies, 5, 7-22. This principle emphasizes that the wraparound team is accountable—to the family and to all team Acknowledgments members; to the individuals, organizations and agencies that participate in wraparound; and, We would like to thank the following Advisory ultimately, to the public—for achieving the goals Group members for contributing materials to the laid out in the plan. Determining outcomes and “Ten Principles of the Wraparound Process” docu- tracking progress toward outcomes should be an ment, and for participating in interviews and the active part of wraparound team functioning. Out- Delphi process through which feedback was re- comes monitoring allows the team to regularly as- ceived on initial drafts: sess the effectiveness of plan as a whole, as well as the strategies included within the plan, and to determine when the plan needs revision. Track- ing progress also helps the team maintain hope, A. Michael Booth Julie Radlauer cohesiveness, and efficacy. Tracking progress and Beth Larson-Steckler Kelly Pipkins outcomes also helps the family know that things Bill Reay Knute Rotto are changing. Finally, team-level outcome moni- Carl Schick Kristen Leverentz-Brady toring aids the program and community to demon- Carol Schneider Lucille Eber strate success as part of their overall evaluation plan, which may be important to gaining support Christina Breault Lyn Farr and resources for wraparound teams throughout Christine S. Davis Marcia Hille the community. Collette Lueck Marcus Small Constance Burgess Mareasa Isaacs References Constance Conklin Maria Elena Villar David Osher Marlene Matarese Burns, B. J., & Goldman, S. K. (Eds.). (1999). Dawn Hensley Mary Grealish Systems of care: Promising practices in children’s mental health, 1998 series: Volume IV. Don Koenig Mary Jo Meyers Promising practices in wraparound for chil- Eleanor D. Castillo Mary Stone Smith dren with severe emotional disorders and Frank Rider Michael Epstein their families. Washington, DC: Center for Ef- Gayle Wiler Michael Taylor fective Collaboration and Practice, American Holly Echo-Hawk Solie Neil Brown Institutes for Research. Jane Adams Norma Holt Dennis, K.W. & Lourie, I.S. (2006). Everything is Jane Kallal Pat Miles normal until proven otherwise: A book about Jennifer Crawford Patti Derr wraparound services. Washington, DC: Child Jennifer Taub Robin El-Amin Welfare League of America. Jim Rast Rosalyn Bertram Goldman, S.K. (1999). The conceptual framework John Burchard Ruth A. Gammon for wraparound. In Burns, B. J. & Goldman, K. (Eds.), Systems of care: Promising prac- John Franz Ruth Almen tices in children’s mental health, 1998 series, John VanDenBerg Theresa Rea Vol. IV: Promising practices in wraparound Josie Bejarano Trina W. Osher for children with severe emotional disorders Julie Becker Vera Pina

Section 2: The Principles of Wraparound

Authors that affect the ability of organizations and individuals to provide high quality services and treat- Eric Bruns is a clinical psychologist and Associate ment, and 3) developing and evaluating interven- Professor at the University of Washington School tions to increase the extent to which youth with of Medicine in Seattle. He spends much of his emotional or mental health difficulties are mean- professional life conducting research on innova- ingfully involved in care and treatment planning. tive community-based models for helping youth Together with Dr. Eric Bruns, Dr. Walker co-directs and families with complex needs, including fam- the National Wraparound Initiative. ily treatment drug courts, treatment foster care, parent support programs, and the wraparound process. He is a lead developer of the Wraparound Fidelity Assessment System and, with Janet Walk- er, co-directs the National Wraparound Initiative. Suggested Citation: Janet Walker is Research Associate Professor in the Bruns, E. J., Walker, J. S., & The National School of Social Work at Portland State University Wraparound Initiative Advisory Group. and co-Director of the Research and Training Cen- (2008). Ten principles of the wraparound ter on Pathways to Positive Futures. Her current process. In E. J. Bruns & J. S. Walker (Eds.), research focuses on 1) exploring how individuals The resource guide to wraparound. Port- and organizations acquire capacity to implement land, OR: National Wraparound Initiative, Research and sustain high quality practice in human service and Training Center for Family Support and Chil- settings, 2) describing key implementation factors dren’s Mental Health.

10 This document was peer reviewed through the NWI. The Principles of Wraparound: Chapter 2.2 ADMIRE: Getting Practical about Being Strength-Based

John Franz, Consultant Paperboat Consulting

cardinal principle of the wraparound approach is that it A must be a strength-based practice. But if one asks what it means to be strength-based, the answer often contains a tautology—a strength-based practice is one that is based on people’s strengths. For wraparound to make a successful transition from a philosophy to a methodology, a more concrete formulation is needed. First we need to explain why being strength based is important, then we have to describe actions or behaviors that would characterize a strength- based practice, and finally we need specific metrics for determining whether and to what degree a given service, including wraparound, is being delivered in a strength-based way.

Why be Strength Based? A variety of strength-based interventions have been developed in the mental health, child welfare, developmental disability, medical and juvenile justice fields (See accompanying box, next page). The rationale given for the shift from what is usually described as a deficit or problem-based model is that when an intervention focuses on what’s right about a person or family who is in a difficult situation, rather than on what’s wrong, a number of benefits accrue: • First, a therapeutic relationship is likely to have a stronger foundation when a family experiences the provider as recognizing and valuing positive aspects of the family members’ personalities, life histories, accomplishments and skills.

The Resource Guide to Wraparound Section 2: The Principles of Wraparound

• Second, if the point of the service encounter is to help the family develop improved coping skills for dealing with the Selected Strengths-Based challenges in their life, it will be easier to Interventions start that process using the family’s existing competencies and characteristics as a In addition to wraparound, strengths- foundation. based interventions have been developed • Third, since a significant challenge for many within a variety of fields. Descriptions of a families served through the wraparound few are provided in the resources below: process is the lack of a natural social support network, a process that elucidates and illuminates the strengths of the fam- Nissen, Laura. (2006). Bringing strength- ily members will make it easier to identify based philosophy to life in juvenile potential points of attachment that can justice. Reclaiming Children, 15(1), grow into informal sources of friendship 40-46. and support. Linely, P. A. (2006). Counseling psycholo- • Finally, if our goal is to help families with gy’s positive psychological agenda: A complex needs transition from service de- model for integration and inspiration. pendence to normalized social interdepen- Counseling Psychologist, 34(2), 313- dence, an approach that only focuses on 322 eliminating negative characteristics and conditions is less likely to be successful Green, B. L., McAllister, C.L. & Tarte, J.M. than one that balances the reduction in (2004). The strengths-based prac- vulnerabilities with a measurable and sus- tices inventory: A tool for measuring tained increase in capabilities. strengths-based service delivery in early childhood and family support What Does Being programs. Families in Society, 85(3), Strength Based Look Like? 326-334. Despite the widespread advocacy noted Neff, J.M., Eichner, J.M., Hardy, D. R., above, it remains difficult to describe the- com Klein, M., et al. (2003). Family-cen- mon elements of a strength-based approach with tered care and the pediatrician’s role. sufficient clarity to support reliable implementa- Pediatrics, 112(3), part 1, 691-696. tion, maintenance and improvement. Existing descriptive materials often concentrate on a given Blundo, R. (2001). Learning strengths- model’s underlying value structure, or focus on based practice: Challenging our per- its highly specific process steps. The reason why sonal and professional frames. Fami- it’s hard to pin down the components of strength- lies in Society, 82(3), 296-304. based practice is that it is a metaskill1. As such it represents a context or perspective within which Rowlands, A. (2001). Ability or disability? Strengths-based practice in the area of traumatic brain injury. Families in 1 A metaskill is a capacity for knowing not just how to do a particular task, but also why and when to do it, and having a grasp Society, 82(3), 272-287. of the larger meaning of a given activity. Thus a skill would be knowing how to ask a youth to tell you a story about times when some of the problems she had been experiencing were less of a Saleebey, D. (Ed.) (1997). The strength problem, as part of a strength-based inquiry. A metaskill would perspective in social work practice. be recognizing the context of the conversation in terms of the youth’s culture, immediate life situation, relationship with the New York: Longman. person asking the question, and the purpose for learning about the youth’s coping strategies, as well as a variety other aspects of the personal and interpersonal dynamics at play during the interaction.

Chapter 2.2: Franz

a variety of services and activities can be carried enter into each service interaction with a disci- out. plined and informed conviction that it is a family’s To help strength-based practice make the tran- strengths that will ultimately empower them to sition from an underlying value or philosophical accomplish the changes or growth that are need- goal to a consistent way of doing business, three ed for them to have better lives. things are necessary: Discovery: To put a strength-based attitude • First, the elements of strength-based prac- into practice, a provider needs a range of tools for tice must be defined with enough clarity identifying family member’s functional strengths to facilitate their implementation by prac- and key unmet needs, even when they are masked titioners and allow an objective observer or hidden, and place them in a context that sup- to determine when they are, and are not, ports proactive and individualized planning, assis- present. tance and change. • Second, sufficient resources must be in Mirroring: To establish an effective rela- place to help practitioners acquire the un- tionship with a family based on this discovery of derstanding, knowledge and skills neces- strengths and needs, the provider should reflect sary to comfortably and consistently use a back these observed strengths to insure accuracy strength-based approach in their interac- and mutual understanding, to facilitate engage- tions with families. ment and to help family members see themselves • Third, the organizational climate of any as having strengths. agencies whose staff are expected to use Intervention: To move this relationship into a strength-based approach, and of the sys- action, the provider must have a repertoire of tem of care in which those agencies are op- strength-based and competency-building services erating, must actively encourage and sup- that can be matched with or be adapted to fit port the use of strength-based services. with each family and family member’s unique profile of strengths and needs. Defining the Elements Recording: To maintain consistency and accu- What are the specific steps that a wraparound racy, a strength-based practitioner should have a facilitator, family support worker, or other service reliable system for documenting observations, as- provider should follow in developing a strength- sessments, interventions and impacts, as well as based relationship with a family? The arc of in- families’ opinions, responses and outcomes. volvement of any service encounter starts with the Evaluation: Finally, to assess the fidelity and point of view the provider carries into the rela- effectiveness of current practices and to build a tionship, then moves to the process through which foundation for service improvement, the provider the provider gets to know the family, includes the should have a system for determining whether pro- way the provider shares information and develops posed practices are actually being implemented, a plan of action with them, flows into the inter- whether they are helping families achieve their ventions, actions or services that form the heart hoped-for goals, how families feel about the as- of the encounter, and concludes with the way that sistance they are receiving, and whether the pro- the provider captures and evaluates the results of vider is finding ways of improving the assistance. the interaction and services. Together the six ADMIRE characteristics define One way to describe how these six steps could qualitative elements that should be present in be carried out in a strength-based manner would any strength-based practice model2 (Cox, 2006). be to use the acronym ADMIRE: These elements can be expressed in many ways, Attitude: A strength-based practitioner should depending on the type of service being provided

2 The core elements of the ADMIRE system were inspired by the innovative research of Kathleen Cox, who developed a model linking the attitudes and behaviors of practitioners who were aspiring to be strength-based with the outcomes being achieved by their clients.

Section 2: The Principles of Wraparound

and its context. model should be expressed in providers’ behavior For example, attitude in a strength-based ju- during each element of a service encounter: venile probation service model might be founded Attitude: The perspective or orientation on an understanding of the role that personal, with which providers enter into service relation- family and community protective factors play in ships will have a major impact on the outcomes helping youth shift from a developmental pathway achieved through those relationships. While it leading towards habitual delinquency to a more is easy to say that they should start every new prosocial sequence, and be linked to assessment encounter with a positive regard for the person tools, structured interactions, interventions, doc- or family they are being asked to assist, in real- umentation and evaluation that are built on this ity many factors make this a difficult practice to understanding (Pullman, Kerbs, Koroloff, Veach- maintain. Just knowing that one is supposed to White, Gaylor, & Dieler, 2006). be looking for strengths is not enough. Providers An equally strength-based service for women should understand why the exposition of strengths with co-occurring disorders who also have experi- supports effective engagement with clients, feeds enced severe traumas may be based on an under- into a proactive service response, and helps sup- standing of the role that positive, mutual and report development of a positive narrative of future ciprocal relationships play in supporting resiliency success for the individual and/or family. Providers and recovery (Markoff, Finkelstein, Kammerer, should know how to express this understanding in Kreiner, & Prost, 2005). a variety of service encounters, and have the skill to maintain a strength-based orientation even Implementation at the when their own situation or the behaviors of the Individual Level individual or family militate against this attitude. A strength-based practice model must have Discovery: This element will be reflected at at its foundation resources to help service pro- the practice level when providers understand that it is important to take the time to identify functional strengths in each service encounter, know how to use a variety of formal and informal tools and techniques to accomplish strengths discovery (to be discussed later in this article), and have the ability to use the right tool in each situation. Mirroring: For this element, strength-based practice will be present to the degree that providers understand that families must see and validate the potential strengths that the provider is attempting to identify through the discovery process, know how to use a variety of techniques to provide feedback and obtain family input without cueing excessive defensiveness, and be able to facilitate reciprocal relationships with family mem- viders understand why identifying and building bers who come from a wide variety of personal on strengths is important, learn how to discover situations and present with highly idiosyncratic strengths and incorporate them into the service characteristics. response, and acquire the skills to put this understanding and knowledge into action, even in Intervention: Unless a practice can link challenging situations. The model must also pro- strengths discovery with strengths development, vide the tools needed to determine whether these it is only halfway there. A strength-based practi- providers have in fact acquired and implemented tioner should understand that the most effective a strength-based perspective. The understanding, interventions are those that help families acquire knowledge and skills supported by the practice or improve key personal and interpersonal com-

Chapter 2.2: Franz

or system of care, it is essential that an ongoing dialog about purpose, performance, outcomes, Directive Supervision impact and improvement be maintained among direct service providers, service recipients, super- Patricia Miles has developed a system visors and managers and community stakeholders. that uses strength-based feedback on a For complex methodologies like strength-based selected group of service data points as practice, this dialog must be anchored in con- a core element of staff support and su- crete and measurable descriptions of what is be- pervision. In her system, key information ing done, how it is affecting the people involved, from family satisfaction reports, activity and what is being learned about ways of doing it documentation and client outcomes are better. gathered and interpreted at the direct Therefore if we are to identify wraparound as service, unit and agency levels and or- a strength-based practice, we must have a system ganized in an integrated model of human in place that succinctly conveys both the reasons resource management, continuous quality improvement, value clarification and why establishing helping relationships through skill development. To learn more about the discovery and support of families’ functional her model, visit www.paperboat.com strengths is essential to assisting them in the pro- and click on the section entitled “Direc- cess of growth and change, and also the ways in tive Supervision.” which this discovery and assistance is carried out. In addition, the system must have the capacity to quickly and accurately gauge the degree to which the core elements of strength-based practice are petencies to counteract the challenges they are being expressed at any given time in the interac- facing and know enough about the available range tions with specific children and families, in the of interventions to decide which ones are best ongoing conduct of individual staff and in the cul- matched with the strengths and needs of a given ture and functions of the agency as a whole. family. The practitioner should also have the skill Finally, the system must have the ability to ac- necessary to implement a chosen intervention, or quire, aggregate, interpret, and feed back these to link families and family members with provid- evaluations to practitioners, managers and stake- ers who can deliver those services. holders in a timely, accurate and useful format so that they have the opportunity to translate the Reporting: Documentation is rarely a prac- information they receive into better ways of help- titioner’s favorite activity. Nonetheless, without ing the families they are serving. To do this, staff consistently recording the activities and results will need an understanding of why data about per- of a service encounter, the reliability of a given formance and its effects should drive continual practice model can easily erode. Therefore a practice improvement, knowledge of how to use strength-based practitioner must understand why evaluation tools and interpret their results, and it is as important to gather and record informa- the skill to translate evaluative information into tion about family and family member strengths, service improvement. (See accompanying sidebar, culture and preferences as it is to identify and left, for an example of one such method.) label the nature and extent of the challenges they face. These days, it is also important to know how to operate the information management system Support at the Agency associated with the practice model, and to have and System Levels the skills needed to accurately, succinctly and An agency seeking to accomplish a consis- quickly record appropriate data, including how to tent implementation of strength-based practice tweak the system if necessary in order to include throughout its operations, or a system designed competencies and accomplishments in the chart. to make this happen across all of the participating Evaluation: For any methodology to become agencies, must diligently create an organizational infused throughout the operations of an agency climate that models, guides, supports and rein-

Section 2: The Principles of Wraparound

forces the practice model regardless of the spe- DVDs and on-line training programs to show what cific modality in which it is being expressed. Five these skills look like in practice. Finally, agen- specific components of this climate that must be cies can hold pre-service and in-service trainings aligned to accomplish reliable implementation of that teach this approach; host recognition events the model are: for those who display exceptional understanding, knowledge and skills; and present ongoing work- • Incentives for appropriate practice, shops to demonstrate new techniques for improv- • Disincentives and corrections for digres- ing strength-base practice. sions, Disincentives. If those expected to implement • Removal of barriers to consistent practice a strength-based approach observe that while implementation, agency administration or system leadership give • Provision of resources to enable effective lip-service to the model, no repercussions occur practice activities, and for the failure to deliver it, a natural tendency will be to drop back to more familiar strategies • Expressed understanding of and support for client interactions and services. Some hier- for strength-based practice by leaders, archy of response should be in place that is de- managers and supervisors (Allen, Lehrner, signed to encourage accurate implementation. At Mattison, Miles, & Russell, 2007). the system level, agencies that fail to document Putting all five elements together in an agency continual improvement in their ability to provide or system of care is no easy feat, but the more strength-based services may need to face reduc- each is present, the greater the likelihood that tion in or even loss of their contracts. the agency or system will acquire a pervasive At the practice level, agencies should have strength-based orientation. the means to identify staff members who are having difficulty implementing Incentives. The number strength-based approaches and one incentive to strength- remediation systems to help based practice is establishing them find ways to improve their a staff recruitment, selection, work. It is important, how- retention and advancement ever, to take this suggestion in system that reflects strength- the strength-based context in based principles. Human re- which it is offered. The point is source departments should not to punish staff when they have the capacity to identify get it wrong, but to help them staff that bring a strength- become more comfortable with based attitude to their work, doing it right. For example, a and reward those who prac- supervisor might see from fam- tice what they preach at ily member feedback or from each stage of their service her staff person’s self-report encounters. Agencies can that a wraparound facilitator also post or circulate materi- had a tendency to focus more als that support and encour- on problems than solutions in age strength-based work. For a child and family’s situation. example, a number of agen- Her response might be to team cies using the wraparound the staff person with a more ac- approach publish a monthly complished facilitator to co-fa- newsletter that includes de- cilitate some teams. Or perhaps scriptions of successful efforts by family teams and she might gather some of the other staff and set celebrations of accomplishments and innovations up some scenarios for them to role-play together. by youth, families, facilitators and service provid- The point is that since strength-based practice is a ers. More recently some agencies are developing

Chapter 2.2: Franz

metaskill, knowing how to walk through the steps emerging to overcome this barrier. First, clinicians isn’t enough; practitioners have to get a feel for are discovering ways of using assessment and di- it to be able to use it successfully. agnosis in a more strength-based and productive Removal of barriers. Strength-based practice way. When children and adults have serious be- is a new approach and many of the traditional op- havioral, emotional or neurobiological conditions, erational components of service systems aren’t having a clear grasp of what is going on and what well aligned with the practice model. Service ac- can be done about cess, billing, quality assurance and productivity it can be an impor- measures, the old practice manuals lying about tant step in the heal- the office, and the habits that have become a part ing process. Second, of day-in, day-out work can all present barriers to when a mental health the consistent implementation of strength-based diagnosis is not going Probation officers, work. To overcome these barriers, agencies and to be a useful part of systems may form quality practice groups to help the assistance a child child welfare identify and resolve barriers to effective imple- and family needs, workers, public mentation of the model, to provide in vivo sup- agencies are learn- health nurses and port to staff who are making the transition to the ing how to “port” new approach, and to recognize and share innova- wraparound technol- economic support tions as they emerge. The transition from a stan- ogy into non-mental specialists are all dard model to a strength-based approach in any of health contexts: pro- using child and the operational aspects of human service delivery bation officers, child is likely to be challenging. For example, service welfare workers, family teams to access in standard publicly-funded human service public health nurses support their and economic sup- models is often based on things having gone terri- clients. bly wrong. Many financially strapped child welfare port specialists are agencies have limited intake to “petitionable” all using child and situations – meaning that there has to be grounds family teams to sup- for filing a court petition on abuse or neglect – be- port their clients. fore services can be provided. The strength-based Provision of re- shift that is currently working its way through the sources. If an agency nation’s systems is called Alternative Response or or system is serious about transforming its current Differential Response. Families who are at risk of practices into strength-based approaches, a rich disruption, but whose current situation is not so array of resources to support this change should severe as to require formal intervention are being be provided. These ought to include consistent, connected with a wide variety of resources (in- practical training, mentoring and case consulta- cluding wraparound in some cases) on a voluntary tion for staff, supervisors and managers, access to and informal basis.3 outside workshops to enhance staff understanding Billing may be an even more difficult barrier to and skills, strength-based formal tools for assess- overcome than access. Many programs using the ment, planning and evaluation, opportunities to wraparound process rely on medical assistance observe implementation of strength-based prac- as a principal funding source. But medical assis- tices in other agencies either in person or through tance requires that a specific deficit—via diagno- video recordings, and making sure that a strength- sis—must be present. This means that many wrap- based orientation is built into the service access, around facilitators have to start their supposedly delivery and funding pathways. strength-based relationship with a family by first Support from leadership. Staff notice what diagnosing and labeling the child. Two trends are leadership pays attention to. All the words in the

3 For more information on Alternative Response, visit http://www.childwelfare.gov/famcentered/overview/approaches/alternative. cfm.

Section 2: The Principles of Wraparound

world are quickly either reinforced or erased by a few actions by leadership. Specifically, staff will Resources for Practitioners be guided by the way that leaders react to crises, provide recognition for accomplishments, share For an example of a broad based applica- in learning experiences, allocate rewards, frame tion of mindfulness, see: challenging situations and in the way that choices Thich Nhat Hanh (1987). The Mira- are made about advancement and dismissal of cle of Mindfulness. Boston: Beacon employees. If these events reflect the importance Press. of using strength-based approaches with clients then that model will gradually become a part of the agency or system’s culture. If the overt ac- Or visit the website of the University of tions of leaders contradict the espoused value of Massachusetts Center for Mindfulness in strength-based practice, the labels may remain Medicine, Healthcare and Society at: but the heart of the model will erode. http://www.umassmed.edu/cfm/ Resources Information about Nonviolent Commu- Many published and on-line resources are nication and links to training opportuni- available to help agencies and practitioners learn ties around the world can be found at about and adopt a more strength-based approach the website of the Center for Nonviolent in their work. Some are practice specific; others Communication: are more generally oriented. A few examples are www.cnvc.org provided here as a sampling of what is available, but interested individuals will find that a few mo- ments of research will identify a trove of useful Or, see: ideas for bringing a strength-based perspective to Rosenberg, Marshall B. (2002). the full breadth of human services and education- Nonviolent Communication: A Lan- al approaches. guage of Compassion. Encinitas, CA: Puddledancer Press. Attitude: Sometimes the best first step toward a more strength-based attitude in human service delivery is to step back and find a way of An extensive bibliography on Appreciative grounding one’s perspective on a broader founda- Inquiry can be found at a website main- tion. Examples of tools that can help one in this tained by Case Western Reserve Univer- effort are the practice of mindfulness, the use of sity: non-violent communication, and the technique of http://appreciativeinquiry.case.edu. appreciative inquiry. (See accompanying box at left.) An overview by Dr. David Cooperrider, who Discovery: Wraparound uses a narrative ap- developed the model, is available there proach to informal strengths discovery during the as well. For a more detailed description initial engagement phase of the process. A facili- of Appreciative Inquiry, published by the tator listens to the family’s stories and extracts institute Dr. Cooperrider founded, see: from them examples of descriptive, contextual and functional strengths that can serve as a foun- Barrett, Frank & Fry, Ronald (2005). Appreciative Inquiry: A Positive dation for an effective action plan. Another ap- Approach to Building Cooperative proach to identifying strengths can be found in Capacity. Chagrin Falls, OH: Taos the solution-focused practice model developed Institute Publications. by Insoo Kim Berg and Steve DeShazer (1994) in which clients are asked to identify times when the current problem has been less of a problem and coping strategies that they have used to address

Chapter 2.2: Franz

similar challenges in the past. Several tools for formal strengths discovery have been developed Measures and Instruments for including the BERS, the CANS, the Assessing Strengths CALCAT and the YCA. (See accompanying box, right). The Behavioral and Emotional Rating Scale assesses Mirroring: Agencies and sys- child strengths within the dimensions of interpersonal ca- tems looking for a way of help- pacity, family involvement, intrapersonal competence, ing staff become more effective school functioning and affective ability. Scoring produc- at hearing what clients are say- es an overall strengths quotient and standard subscale ing and reflecting that informa- scores within each domain. It can be obtained through its tion back to them to make sure website at http://www3.parinc.com/products/product. information and meaning are be- aspx?Productid=BERS-2. ing accurately shared need look no further than the well-known The Child and Adolescent Needs and Strengths Assess- 4 practice of active listening. ments are a suite of open use (no fee) tools designed to Intervention: An increasing support effective service and support planning for chil- number of services and interven- dren with complex needs and their families. Currently tions are being designed from the there are six tools available depending on whether the ground up to help parents and focus is on issues in early childhood, child welfare, devel- children establish and enhance opmental disabilities, mental health, juvenile justice, or competency and resiliency (Caspe sexual development. The tools can be used both for initial & Lopez, 2006). Many of these screening and for measuring client progress, and can also efforts are working their way be used to look at system of care functioning. The manu- through the evaluation process als and forms and a description of their development are in an effort to gain recognition available from the CANS website, operated by the Buddin as evidence-based practices.5 An Praed Foundation, which was established by the devel- agency or a system seeking to be- oper of the CANS, John Lyons of Northwestern University, come firmly grounded in strength- to support the dissemination of these tools. http://www. buddinpraed.org/. based practice should regularly and carefully examine these options and maintain an up-to-date The California Child Assessment Tool is a child welfare resource array well-aligned with specific tool developed by the SPHERE Institute in Stan- the needs of the population they ford for use in California’s county-operated child welfare are serving. systems. The tool is designed to support consistency in Recording: The documenta- assessing strengths and needs with regard to child safety, tion and information management permanency and well-being and is being piloted in about 5 systems used by agencies and sys- counties. Information about it is at http://www.spherein- stitute.org/cat.html.

4 There are many references for active lis- The Youth Competency Assessment tool was developed tening. For example, Joe Landsberger has by NPC Research in Portland, Oregon, to support strength- posted a succinct summary on his website at http://www.studygs.net/listening.htm. based restorative justice assessment of youth in the juve- 5 The federal Substance Abuse and Mental nile justice system. Although copyrighted, the tool can be Health Services administration has estab- reproduced and used for nonprofit purposes. Information lished a National Registry of Evidence- based Programs and Practices that keeps an is at http://npcresearch.com/ (Click on “materials” to updated roster of interventions that have get to the section on the YCA.) met the criteria to be identified as promising programs, effective programs or model programs. http://nrepp.samhsa.gov.

Section 2: The Principles of Wraparound

tems seeking to support strength-based practice Evidence-based clinical practice is an ap- must evolve beyond being a time consuming ob- proach to decision making in which the ligation through which practitioners demonstrate clinician uses the best scientific evidence rote compliance to become tools that guide ap- available, in consultation with the patient, preciative, interpretive and reflective inquiry into to decide upon the option which suits the the relationships they are forming with clients and patient best. the impact those relationships are having on the Applying this principle to strength-based prac- outcomes clients are achieving (Hornberger, Mar- tice, the purpose of the ADMIRE framework is to tin, & Collins, 2006). Two examples of such sys- identify a series of anchor points so that reflective tems are the Synthesis data management system practitioners can not only check themselves on the used by Wraparound Milwaukee (for more infor- degree to which they are expressing a strengths mation visit their website at http://www.milwau- orientation in their ongoing interactions with fam- keecounty.org/WraparoundMilwaukee7851.htm) ilies, but also observe whether maintaining that and the information technology system used by orientation is associated with helping those fami- Choices, Inc. in a variety of its efforts, including lies achieve positive changes in their lives. the Dawn Project in Marion County, Indiana (India- In the specific case of wraparound as a napolis). http://www.choicesteam.org. strength-based practice, the framework can pro- Evaluation: Although many new methodologies vide an outline for an ongoing conversation among identify themselves as strength-based, and there facilitators, family members, agencies, formal and is a growing consensus that the use of strength- informal family supports and community stake- based approaches is a more effective way of help- holders. To the extent that wraparound is a co- ing people achieve and sustain positive outcomes, created system of reciprocal support for recovery, the true impact of these practices must be tested all of us participating in using this approach and both in clinical settings and in the field to prove in establishing the organizational and community their promise. From a clinical perspective, well- environment that sustains it should regularly ask designed experimental models are needed to reli- ourselves several questions: ably demonstrate what works and what doesn’t (Harrell, [undated]). From the point of view of an • Are we consistently expressing a strength- agency or a system of agencies, the operational based orientation in our interactions both structure must include an information collection with families and with other service pro- and analysis mechanism that provides practitio- viders and family team members? ners, supervisors and managers with a functional • Do we begin each new relationship with a and timely dashboard that keeps them reliably in- family with an engagement process that formed about key aspects of the services they are includes formal and informal processes for providing and presents this data in the context of strengths discovery? a metric that reflects the core values of strength- • Do we share the results of our observations based practice (Cohen, 2005). with our families and teams in a way that supports an increase in mutual understand- Conclusion ing and a shared commitment to finding a Ultimately, the point is not to be strength way to make things better? based, but to be helpful and promote positive out- • Do we build the interventions in our plans comes. The goal of an effective practitioner is to of care on the strengths of our families and bring the best understanding of the current state design them to help families make prog- of the art in a given area of service to each client ress toward accomplishing the mission they interaction, and to use what is learned through have chosen for themselves? these interactions to constantly advance the stan- • Have we documented the essence of what dard of practice in that art. One of the originators we have observed, what we are doing, why of the concept of evidence-based practice has put we are doing it and what is happening as a it this way (Muir Gray, 1997):

10 Chapter 2.2: Franz

result, both in terms of family progress and March 10, 2007 from http://www.ojp.usdoj. family and community satisfaction? and gov/BJA/evaluation/guide/documents/evalu- • Are we collecting and aggregating infor- ation_strategies.html. mation about our services in a way that Hornberger, S., Martin, T. & Collins, J. (2006). In- provides a useful overview of what works, tegrating systems of care: Improving quality where things could be better and how best of care for the most vulnerable children and to achieve this improvement? families. Washington, D.C.: CWLA. The re- These checkpoints can help us maintain our fo- port is available at http://www.cwla.org/pro- cus on strengths so that we bring to every service grams/bhd/1integrating.pdf. encounter the best of what we are learning about Markoff, L.S., Finkelstein, F., Kammerer, N., how to assist families with complex needs. Ulti- Kreiner, P. & Prost, C.A. (2005). Relational sys- mately, the measure of our implementation of a tems change: Implementing a model of change strength-based methodology will be the degree to in integrating services for women with sub- which both families and family teams experience stance abuse and mental health disorders and a shared sense of recovery, growth and change. histories of trauma. The Journal of Behavioral Health Services & Research, 32, 227. References Muir Gray JA. (1997). Evidence-based medicine: Allen, N.E., Lehrner, A., Mattison, E., Miles, T. & how to make health policy and management Russell, A. (2007). Promoting systems change decisions. London: Churchill Press. in the health care response to domestic vio- Pullman, M.D., Kerbs, J., Koroloff, N., Veach- lence. Journal of Community Psychology, 35, White, E., Gaylor, R. & Dieler, D. (2006). Ju- 103-120. venile offenders with mental health needs: Berg, Insoo Kim (1994). Family-based services. Reducing recidivism using wraparound. Crime New York: W.W. Norton, and de Shazer, Steve and Delinquency, 52, 375-397. (2005). More than miracles: The state of the art of solution-focused therapy. Binghampton, Author NY: Haworth Press. John Franz, a former school teacher and legal advocate for children and families, now works Caspe, M. & Lopez, M. E. (2006). Lessons from with communities and agencies around the United family strengthening interventions: Learning States, helping them develop more integrated, from evidence-based practice. Published by strength-based and family-centered systems of the Harvard Family Research Project. Available care. on line at www.gse.harvard.edu/hfrp/projects/fine/resources/research/lessons.html. Cohen, D.S. (2005). The heart of change field guide: Tools and tactics for leading change in your organization. Boston: Harvard Business Suggested Citation: School Press. Franz, J. (2008). ADMIRE: Getting practical Cox, K.F. (2006). Investigating the impact of about being strength-based. In E. J. Bruns strength-based assessment on youth with & J. S. Walker (Eds.), The resource guide to emotional or behavioral disorders. Journal of wraparound. Portland, OR: National Wrap- Child and Family Studies, 15, 278-292. around Initiative, Research and Training Harrell, A., et al. (undated). Evaluation strate- Center for Family Support and Children’s Mental gies for human service programs, retrieved Health.

11 This document was peer reviewed through the NWI. The Principles of Wraparound: Chapter 2.3 A Roadmap for Building on Youth Strengths

Kathy Cox, Clinical Director EMQ Children and Family Services

core element of the wraparound process is the plan- A ning of services that build not only on family assets, but also on youth strengths and capabilities. This principle is founded in the belief that by capitalizing on the capabilities of children and adolescents, wraparound providers create a sense of hope for the future and enhance motivation for change (Saleebey, 2002). To facilitate the process of assessing the internal and external resources of youth, a variety of methods and tools have been advanced, ranging from informal “strengths chats” (VanDenBerg & Grealish, 1996) to standardized measures, such as the Behavioral and Emo- tional Rating Scale (BERS; Epstein & Sharma, 1998). Little work has been done, however, to delineate the process of tapping the strengths identified through these and similar means. In an effort to fill this gap, this chapter provides a roadmap for wraparound practitioners, intended to guide their efforts in developing plans of care that build on the skills, interests, and capacities of the youth served. A Conceptual Framework for Understanding Strengths One conceptual model that is useful in guiding the assessment of youth strengths is offered by Cowger (1997). This author contends that a comprehensive assessment gathers information along two intersecting continuums: the environmental versus individual axis and the strengths versus obstacles axis. Four domains can be created when these continuums are enclosed and have been labeled as follows: personal strengths, personal obstacles, environmental strengths, and environmental obstacles. Strength-

The Resource Guide to Wraparound Section 2: The Principles of Wraparound

based assessment does not ignore the challenges Building on Strengths in Wraparound represented in the obstacles domains, but it does The practice model offered below aims to highlight and emphasize the personal and envi- capitalize on the youth’s personal strengths in or- ronmental strengths that each youth brings to the der to enhance his or her environmental assets. It process of meeting needs, overcoming barriers, does so by first conducting an in-depth assessment and resolving problems. of the youth’s capacities, interests, and resourc- A concept that illuminates the role of environ- es. It continues with a formal process of strengths mental strengths in guiding intervention planning recognition and, finally, the design and implemen- is that of the enabling niche. James Taylor (1997) tation of strength-based intervention focused on defines the social niche as an “environmental habi- two main goals: tat of a category of persons, including the resources they utilize and the other category of persons 1. Creating an enabling niche, and they associate with” (p. 219). Within the broader 2. Utilizing this niche as a vehicle for further- concept of the social niche, he draws a distinction ing the youth’s progress toward improved between entrapping niches and enabling niches. emotional or behavioral functioning. (See Entrapping niches tend to stigmatize individuals Figure 1.) and offer few incentives for skill development or goal attainment. In contrast, enabling niches are Assessing Youth Personal Strengths said to recognize capacities, and offer rewards A wide range of strategies, both formal and for skill acquisition and/or progress toward goals. informal, can be used to facilitate the process of The development of such spaces and places for strengths assessment. The “strengths chat” rec- encouragement and enrichment can be critical to ommended by VanDenBerg and Grealish (1996) youth recovery and healthy development. involves the practitioner having a conversation with the individual about what they view their

Figure 1. Process for Building on Youth Strengths

Personal Strengths Strength-Based Strengths Recognition Intervention Assessment Creating & Utilizing an Enabling Niche Capacities Resources

Social Mechanical Interests Athletic Academic Cultural

Artistic

Chapter 2.3: Cox

strengths and resources to be (p. 12). This type of ventions may prove beneficial, they would be en- strengths chat conducted with a child or adoles- hanced by a plan to create or support an enabling cent can be focused around the completion of an niche for this youth. For instance, he might be assessment tool developed by the current author, enrolled in a stock car racing club or provided an referred to as the Personal Strengths Grid. (See opportunity to learn auto repair by assisting a me- Table 1, end of this chapter.) This tool is designed chanic at a neighborhood auto shop. During such to guide discussion of the youth’s capacities, in- endeavors the boy could be assisted in practicing terests, and resources within the domains of so- his newfound skills in impulse control. cial, academic, athletic, artistic, mechanical, and cultural/spiritual functioning. Case Example Alicia is a 15-year- Strengths Recognition old girl who resides A key component of the wraparound process is with her mother, Ana, the acknowledgement of the youth’s skills, inter- and 10 year old broth- ests, aims, and abilities. This ideally takes place er, Jason. The family during team meetings, with participation by ser- lives near Alicia’s ma- A focus on assets vice providers, family members, and their natural ternal grandmother supports, such as friends, neighbors, and men- and aunt in a semi-ru- increases the child tors. One can speculate that this focus on assets ral area. Mother was or adolescent’s increases the child or adolescent’s willingness to struggling financially willingness to engage with formal and informal providers and as she sought employ- participate actively in the wraparound process. ment as a nurse’s aid. engage with Additionally, parents have been found to be signif- Alicia displayed symp- formal and icantly more satisfied with human services when toms of severe anxiety informal providers such strengths recognition is performed (Cox, and traumatic stress 2006). The positive impact of this practice is like- stemming from an epi- and participate ly to be enhanced, however, when combined with sode of sexual abuse by actively in the her mother’s ex-boy- the use of interventions that build on the unique wraparound strengths of the child recipient of wraparound. friend that occurred 2 years previously. She process. Strengths-Based Intervention also appeared angry at her mother for initial- The wraparound team is also charged with ly refusing to believe designing a plan for services that is tailored to her when she first dis- the unique strengths and needs of the youth. It is closed the abuse. Ali- common for the needs to include the child’s emo- cia has a flare for dra- tional or behavioral problems. Strength-based in- matics and can be playful and engaging yet had terventions aimed at resolving such challenges tap difficulty sustaining friendships. She spent her a particular youth asset, while striving to improve free time alone in her room watching old movies the child’s functioning at home, in school, and/or on T.V. and writing in her journal. in the community. For example, a boy who loves During her assessment with the wraparound cars (and who has issues with impulsivity) might provider, the Personal Strengths Grid was used be taught to manage his behavior by learning to to guide discussion about Alicia’s interests and “put the brakes on” and “read the stop signs.” His abilities. As a result, she disclosed that she en- family might be encouraged to adopt language in- joys both writing and play-acting. These strengths fused with auto-related metaphors while praising were recognized at the first wraparound team his progress toward following directions at home meeting that included her mother, grandmother, and at school. He might be offered an opportunity aunt, school counselor, and therapist along with to work toward earning a remote control car by the wraparound facilitator and family partner. consistently completing tasks. While these inter- Her therapist began work in helping her acquire

Section 2: The Principles of Wraparound

to addressing youth emotional and/or behavioral challenges is often critical to the overall effectiveness of wraparound. References Cowger, C. (1997). Assessing client strengths: As- sessment for client empowerment. In D. Salee- bey (Ed.), The strengths perspective in social work practice (pp. 59-73). New York: Long- man. Cox, K. (2006). Investigating the impact of strength based assessment on youth with emo- coping skills in preparation for the creation of a tional or behavioral disorders. Journal of Child written trauma narrative. When the narrative was and Family Studies, 15, 278-292. completed, joint mother-daughter sessions were Epstein, M.H. & Sharma, J.M. (1998). Behavioral held in which Alicia shared parts of her narrative and emotional rating scale. Austin, TX: Pro- with her mother. Ana had been prepared by the Ed. therapist to respond to Alicia’s story in a manner Saleebey, D. (2002). The strengths perspective in that was supportive and validating. In addition social work practice. Boston, MA: Allyn and Ba- to therapy, the wraparound plan included a fo- con. cus on job search assistance for mother and social Taylor, J. (1997). Niches and ecological practice: skill development for Alicia. The school counsel- Extending the ecological perspective. In D. or helped Alicia connect with the drama club at Saleebey (Ed.), The strengths perspective in school and she was offered a part in the school social work practice (pp. 217-227). New York: play. This counselor also coached her in strategies Longman. for initiating and maintaining friendships with the VanDenBerg, J.E. & Grealish, E.M. (1996). Indi- other students in the play. Alicia’s mother, grand- vidualized services and supports through the mother, aunt and brother were all present for wraparound process: Philosophy and proce- opening night of the performance. Alicia’s symp- dures. Journal of Child and Family Studies, 5, toms lessened as she neared the end of her thera- 7-21. py and found a social niche that was enabling. Author Conclusion Kathy Cox is a Clinical Director for EMQ Children If wraparound practitioners are to give more and Family Services. As such, she oversees three than lip service to the notion of building on wraparound teams in the Sacramento region that strengths, they must embrace not only a philosophy serve up to 98 youth and families each year. She that recognizes youth assets, but also a practice has conducted research and published articles on methodology that leverages child and adolescent strength-based assessment, wraparound, and oth- capacities and interests toward the achievement er community-based approaches to serving high- of service planning goals. The framework above risk youth and families. is intended to guide providers in the implementation of strength-based planning as it applies to Suggested Citation: children and adolescents. It is understood that Cox, K. (2008). A roadmap for building on the wraparound process entails much more than youths’ strengths. In E. J. Bruns & J. S. Walk- this one element of service. Indeed, strength- er (Eds.), The resource guide to wraparound. based planning often entails building on natural Portland, OR: National Wraparound Ini- supports of families in order to meet their needs tiative, Research and Training Center for within a wide variety of life domains. However, Family Support and Children’s Mental Health. a well-designed and strength-focused approach

Chapter 2.3: Cox

Table 1. Personal Strengths Grid Sources of Information Regarding Strengths:

Youth’s Name: □ Youth Interview □ Caregiver Interview □ Other Age: □ Teacher Interview □ Observation

Strength Social Academic Athletic Domain Capacities □ Initiates relationships □ Good reading skills □ Good at team sports with ease □ Good writing skills (e.g. basketball, foot- ball, baseball) □ Sustains relationships □ Good math skills over time □ Good at independent □ Good verbal skills □ Good interpersonal or non-competitive boundaries □ Good computer skills sports (e.g. swimming, gymnastics, jogging, □ Relates well with peers rock- climbing, yoga) □ Relates well with adults Comments: Comments: Comments:

Interests □ Wants to have friends □ Enjoys reading □ Wants to play team □ Wants relationships with □ Enjoys writing sports caring adults □ Enjoys math or □ Wants to learn □ Wants to belong to peer science individual or non- competitive sports groups, clubs □ Enjoys computers □ Likes to help others □ Enjoys caring for animals

Comments: Comments: Comments:

Resources □ Has close (pro-social) □ Has access to oppor- □ School offers athletics friend(s) tunities to display, programs □ Has access to adult share, or enhance □ Neighborhood offers mentor academic abilities athletics programs □ Has access to naturally occurring groups, clubs, volunteer work, opportunities etc.

Comments: Comments: Comments:

Section 2: The Principles of Wraparound

Personal Strengths Grid (Continued)

Strength Artistic/Creative Mechanical Cultural/Spiritual Domain Capacities □ Talent in visual arts □ Able to assemble & □ Knowledge of own (drawing, painting, disassemble bikes, appli- heritage etc) ances, computers, etc. □ Knowledge of spiritual □ Talent in performing □ Skills in using tools for belief system arts (singing, dancing, carpentry, woodworking, □ Practices cultural/ drama, music, etc.) etc. spiritual customs/rituals □ Skills in domestic arts □ Skills in car mainte- (cooking, sewing, etc. nance/repair

Comments: Comments: Comments:

Interests □ Desires to develop □ Enjoys fixing appliances, □ Likes to attend church or talent in visual arts etc. other place of worship □ Desires to develop tal- □ Enjoys building, wood- □ Desires to learn about ent in performing arts working own heritage □ Desires to develop tal- □ Enjoys working on cars □ Desires to participate in ent in domestic arts or desires to learn cultural or spiritually mechanics oriented activities

Comments: Comments: Comments:

Resources □ School offers programs □ School offers vocational □ Connected to place of in type of art program in mechanical worship preferred area of interest/skill □ Has access to opportuni- □ Neighborhood offers □ Has opportunity to serve ties to participate in cul- programs in type of as apprentice in me- turally oriented activities art preferred chanical area of choice Comments: Comments: Comments:

Other strengths:

Completed by: Date: Supervisory Review: Date: Copyright EMQ 2006 This document was peer reviewed through the NWI.

The Principles of Wraparound: Chapter 2.4 Creating Community- Driven Wraparound

Bob Jones, Planner and Program Developer Washington State Division of Children and Family Services

The King County Blended Funding Project he King County Blended Funding Project (the Project) Twas created as part of a Robert Wood Johnson grant designed to meet the needs of children who had experienced years of failure in the mental health, child welfare, education and juvenile justice systems. The Project demonstrated extraordinary success in working with a historically difficult and isolated group of families and youth. Youth referred to the Project had long histories of multiple placements. Their families had limited or no support systems. Thus, it was believed that the most effective wraparound effort would be one that emphasized building support systems to engage families in their communities.1 Family participants were trained and supported in managing the process and were given control of the resources. Ultimately, the program evaluation for the Project demonstrated that the program’s ability to develop community relationships and supports for families were among the most important factors in its success. Many of the families had been involved in wraparound processes prior to coming into the Project. The teams had been primarily professionally driven because the families were so isolated they had few or no natural supports to participate on their teams. A lack of trust of systems was pervasive among the families. Families were not ready for “another program” that looked the same as other programs

1 In this discussion, “community” refers to individuals and not agencies. When dis- cussing system-driven wraparound, we are referring to wraparound based in service-providing agencies.

The Resource Guide to Wraparound Section 2: The Principles of Wraparound

that they felt had failed them. There needed to organization was a provider of parent partner and be a different approach for engagement, program training services. The parent organization went development and a shift in how the process was through several iterations over the years and managed. eventually focused less on service provision and The Project went through several ups and more on mutual support and Co-Production. downs. Initially the planning was totally centered The Project evaluation highlighted the need on family needs and worked inside and outside of for developing a supportive community. Unlike existing service structures and many of the system many evaluations, the evaluation of the Blended rules. This resulted in tension with funders and Funding Project was used as a guide to keep the system regulators. The approach was described Project aligned with its values. When the Project as “too pure” to wraparound principles. Changes strayed, the evaluation helped bring it back to its were put in place as a requirement for funding. original vision. As was true in all parts of the Proj- The energy was moving away from community to ect, the evaluation was created and implemented meeting bureaucratic requirements. The qual- by family members. The evaluation demonstrated ity of outcomes and community involvement de- that relationships among family members and the creased. The Project was beginning to look like community were a significant factor in families’ several other programs that families felt had success. As a result, connectedness to supportive failed them in the past. The introduction of the individuals and institutions was measured as a key concepts of co-production (to be discussed later) indicator of success in the evaluation. This rein- to families helped move back to a more commu- forced the Project’s focus on building supportive nity-based approach while still meeting systemic community relationships for families and youth. requirements. Discussed here are some observa- (A fuller description of this innovative evaluation tions about factors that helped the Project and its has been published previously. See Vander Stoep, participants move through the tension between A., Williams, M., Jones, R., Green, L., and Trupin, system requirements and the desire to implement E., 1999.) wraparound that is truly based in the community. In the end, achieving a wraparound process that Creating Community- focused on developing community where none Driven Wraparound was available was made possible by utilizing the To create a truly community-driven wraparound strengths of family members in the Project to pro- effort, the Project emulated early wraparound vide both services and support for each other. work that operated outside the mainstream of traditional service systems. Instead of conceiving What Did this Wraparound itself as a system intervention or service, the Proj- Effort Look Like? ect took a community-based approach in working From the beginning, the parents’ level of par- with children and families. Resources were direct- ticipation and involvement was unique. The pared at members of the community working togeth- ents took leadership roles in all aspects of the er to do “whatever it takes” to achieve positive Project. Family members who had a lot of train- outcomes for children and families. ing in wraparound helped design the structure, Historically, such an approach to wraparound trainings and project evaluation. They developed has demonstrated success and became appealing a wraparound program that relied heavily on par- to systems because it reduced need for services ents supporting other parents. and kept children out of expensive residential One of the goals of the Project was to ensure services. However, as system-of-care thinking and that the families were part of a supportive com- family-centered work gained acceptance, it be- munity. This was achieved by using parent partners came a preferred approach for the formal system who reached out and engaged families. There was itself to use in working with children and families also a separate and independent parent-led orga- with complex needs. This once radical approach nization that was created to become the hub of became a mainstream approach, often embedded community activity for Project participants. The in the mental health system. As it became codi-

Chapter 2.4: Jones

fied in mental health, requirements increased and the thinking of those providing wraparound. Fund- standards were established. Wraparound plans ing of service selection is ultimately constrained became surrogate treatment plans and the system within certain parameters. Those who know the itself began controlling the process. Wraparound system can manipulate it to make it work, but fre- began to look like the system. Wraparound did not quently those who know the rules limit creativity transform the system but in many cases was trans- and dialogue by saying what cannot be done. As a formed by the system. result, conversations about family and community As described by Mario Hernandez and Sharon needs inevitably turn to a discussion about rules Hodges in the Michigan Outcome Project (Hernan- and services and creativity is lost. dez, Hodges, Macbeth, This is in contrast to a family-driven system Sengova, & Stech, where controls and decisions are based at the 1996), different stake- family/community level. The management of holders propose dif- funds in the Project was totally flexible. Decisions ferent outcomes. The were made at the team level for all services and desired outcomes as nonservices. Teams did not appreciate being re- Wraparound did stated by families are strained by bureaucratic rules. When limits were not transform different than for sys- imposed, they would fight to maintain their inde- the system but in tem directors and pro- pendence. When questioned, families took great viders. Families are pride and power in saying, “It was a team deci- many cases was concerned about the sion,” voicing their choices as rights. transformed by quality of their lives Funding is usually seen as the most significant the system. while, as mentioned resource for helping children and families within above, systems want systems. The use of families and individuals as non to reduce service uti- funded resources is frequently an afterthought to lization. Desired out- planning. In the Project there was a shift in em- comes drive program phasis and individuals and families were utilized design and structures. as the major resources and giving more respon- Thus, it is not surpris- sibility to communities helped this happen. This ing that the families in the Project wanted a struc- strategy became the most significant factor in ture very different than those that were in exis- creating change. tence and that were “blessed” by the systems. The example below demonstrates the differ- As communities implement “high-fidelity wrap- ence between system-run vs. family-run teams: around,” leaders of such efforts need to maintain One mother, referred to the Project, had ad- a focus on creating community-driven wraparound opted her nine-year old daughter from an Eastern and be aware that system-driven wraparound ef- European orphanage at the age of four. The girl fects design and implementation. By being aware had been severely abused, was nonverbal, and of these factors and looking to families and com- had experienced four years of extreme malnutri- munities as resources, wraparound efforts will tion. The daughter was in an acute psychiatric be more likely to achieve core principles such as hospital because of her aggressive behavior. The “community based,” “family driven,” and “natu- mother had been asked by a hospital psychiatrist, ral supports” in practice. “Why did you ever adopt this child? She will never be able to live outside an institution!” They saw Family-Run vs. System Ownership no hope. A team representing the various systems Bureaucracies are managed from the top was formed to find alternatives to hospitalization. down. Policy decisions may be made with com- No residential programs or foster homes would ac- munity input but rules and procedures are passed cept her. down through silos. Funding is managed through During a referral call a team member said, contracting requirements that put limits on spend- “We have a great team but we do not know what ing and what can be purchased. Such limits shape to do with this child.” The team perceived itself

Section 2: The Principles of Wraparound

as strong because it worked collaboratively across ly without professionals. Her experience with her systems but it was at a loss to find workable op- new team was quite different. She saw them as tions. For the team members there was a sharing supportive and available for her and her family. of frustration that created a divide with the fam- Services were added that she felt were effective, ily. The reaction was projected as frustration with including alternative therapies that would not the family and they started to define the family be available in traditional service systems. Since as pathological. The mother’s perception of the funds were flexible, those services were contract- same team was that it was a huge barrier to get- ed for and purchased by the Project. Her daughter ting needs met and that team members had no was returned to the community from the hospital understanding of her or her child. Her response and had a program designed to meet her needs was to get an advocate and a lawyer to see if she and her family’s needs. Help was available imme- could force the team to provide her with services, diately when she needed it. The mother led the including residential care and specific therapies team and did much of her own case management. for her daughter. Eventually her daughter became her own team Shortly after the family entered the Project, leader. The ownership of the process had shifted a new approach yielded different outcomes. Her from system representatives to the family. first contact with the Project was a parent Dependence on the System partner who took her The example above is not uncommon for in- to her neighbors to dividuals who find themselves dependent on sys- talk about her situa- tems. The mother was desperate for help, had Universally, tion. To the mother’s exhausted her resources and was being told there amazement, they families and youth was nothing that could be done. It felt to her that found people not only help was being withheld from her family. That was were more positive willing to help but not the case; it was just that no one could think of and hopeful eager to reach out. service options that would work. The mother and For instance one of when they felt in the team of professionals had all viewed the situ- her neighbors was an ation through the same lens, looking for profes- charge of their emergency medical sional resources and looking to the same source technician and was for funding: the bureaucracy. When she came into lives and were not willing to be on call dependent on the the Project, a whole new set of resources became for her 24 hours a day. available that no one had known how to access— system to meet A local horseback rid- neighbors and friends from whom she had with- their needs. ing business offered drawn because of her family struggles. Her parent riding lessons in ex- partner was aware of this and had a different idea change for the daugh- of what kind of help to seek out and who to ap- ter grooming horses. proach. There were several The situation the mother and daughter found other supports found themselves in has been described as a “connec- in the community but tivity trap,” in which reduced connections in the the mother reported later that one of the most community lead to a heightened need for profes- supportive things the parent partner did was buy- sional services, which leads to further reduction ing her daughter a tooth brush. The smallest of of connections in the community. The spiral leads basic needs had great importance to her and was to greater isolation and a loss of the feeling of symbolic of caring. being able to control one’s life. Typically, families The parent partner was very tuned in to the with children with complex needs look to services range of needs for the family, not just the behav- to fix problems. Professionals are the experts. The ioral problems of her daughter. This helped the relative position of anyone looking for service in mother feel very supported and with the help of this situation is “one down.” There is a built-in her parent partner she created a team complete-

Chapter 2.4: Jones

expectation that more services mean better out- around. Incorporating a co-production framework comes. If individuals need more support, the way turns wraparound from a treatment-centered mo- to get it is by being worse off or by continuing dality to one that is contribution centered. It fo- to have problems that require service. Many of cuses on the contributions that clients can offer the families in the Project came to realize this to one another, and to the larger community. The dilemma, and were united against reliance on idea is that, through their contributions, fami- the systems or “professionals.” As often occurs, a lies: schism had developed between professionals and families due to the lack of positive outcomes. • Experience themselves as assets with skills, This is a typical problem in system-driven capacities and talents that others value, wraparound: When outcomes are not achieved, • Are provided with both psychological and families are blamed or professionals are blamed, other rewards for doing the real work and the answer is frequently more of the same needed to build the family and community services. Universally, families and youth were of which they are a part, more positive and hopeful when they felt in • Define themselves as providers as well as charge of their lives and were not dependent on recipients of services, and the system to meet their needs. The challenge for the Project was to build an effective process by • Become the creators as well as the ben- which the community and family were the drivers eficiaries of natural support systems that of the wraparound effort, with professionals and help assure new levels of resiliency. systems providing supports as needed, and most importantly, when identified by families.

Bridging the Gap from System to Community Using Co-Production The Project supported parent-driven work and created an environment that encouraged mutual dependence, but it learned that it could go further than that. A new theoretical construct came to the Project with the introduction of co-production by Edgar Cahn, author of No More Throw- Away People: The Co-Production Imperative. Ed- gar and Chris Cahn visited the Project and talked with parents about the importance of the work in raising children, building families, and strengthening the sense of community. Their observations Thus, the co-production approach adds a new, and views were invaluable in further directing the extended role for community that stands as a crit- Project work. ical countervailing force to professional, system- They observed that wraparound incorporated atized care. community-based “natural” supports as a critical Co-production builds on the insight that for all element of care. But in most cases those natural its strengths, the wraparound process is limited supports and services look very much like grass- by a framework that ultimately rests on the provi- roots versions of their professional counterparts, sion of services. Professionalized services are the as in mentoring, tutoring and so on. This is be- norm. And because they had become the norm, cause the overall prevailing paradigm is treat- they become the framework within which natu- ment centered. ral supports are offered. As a result, the difficul- As an alternative, the Cahns have proposed co- ties associated with professionalized care, which production, the idea that clients/consumers can the natural supports were intended to overcome, “co-produce” outcomes, as a new twist on wrap- remain an inherent characteristic of the overall

Section 2: The Principles of Wraparound

system of care. of need and they had limited options of people to Identifying individual assets in planning is be with socially. The family group recognized this standard practice in wraparound planning. In the and built in social activities for all family mem- concept of co-production those strengths are put bers. These were usually in the form of meals or to use not just in the family but in the greater picnics but also included recreational activities. community as well. One of the parents in the Proj- Parent partners were used to engage families not ect whose daughter had severe problems, strongly only with the Project but also with social activi- objected to diagnoses. “My child is more than just ties. The development of the relationship started a borderline personality disorder” was her com- with the outreach of the parent partner to introduce families to the Project. As an example, a parent from one of the families referred had been ostracized by her family after an uncle had sexually abused her daughter. When the parent partner first met the mother, she had no one to include on her team, she was unemployed and had no friends or social groups. The parent partner took an active role in going with her to fill out paperwork, attending school meetings, helping deal with her children in the home, and negotiating with the residential treatment center in which her child was living at the time of referral. They also talked on the phone frequently and were involved in social activities. The relationship changed from being task oriented to social. The mother, who had been very cautious about becoming involved, began to see plaint. She felt no one saw her child’s positive at- everyone as supportive. She was able to have her tributes. In the Project her strengths became ap- son home and when there were problems, she had parent at family get-togethers. Even though the professionals to call, but she maintained her clos- child had been very self-destructive, she was very est contact with her original parent partner and gentle and very sweet to younger children. She called her first. helped provide child care during meetings. As she became more involved with others, her self confi- Utilizing Strengths in the Community dence grew, her self-image changed, and others’ When the Project turned to the contribution- perception of her changed. She was more than centered approach of co-production, families who just a borderline personality disorder. She had were referred to the Project were now evaluated real personal gifts that were appreciated and she for what they could offer others, with the expec- began to form relationships with others that sup- tation that they would become an active part of a ported her recovery and involvement in the com- community. This was not always easy for families munity. to accept because they were more accustomed to being judged and defined as problems. Parent Partners With the contribution-centered approach, as- As mentioned above, the Blended Funding Proj- sets took on whole new meanings. One of the par- ect was built on evaluation results that showed ent partners observed that her history with drugs the number of relationships a family and child and the prison system was her biggest strength in had was the most reliable indicator of improve- helping other families. She saw this as experience ment. Most of the families initially had far more she would not have received in any education pro- professional relationships than informal relation- gram. Her history was not seen as a strength when ships. Families had few people to turn to in time she applied for a job that required a background

Chapter 2.4: Jones

check. It took some negotiating to hire her. At the one of the other families who could not be same time, her life experience allowed her to be at home during afternoons. very comfortable with severe problems. She could • Another one of the grandmothers in the confront people when necessary and was not Project became a support for grandmoth- shocked by extreme behaviors. She recognized ers in and out of the Project who were rais- that almost all families have dreams and want ing their grandchildren. the best for their children, and she could draw on her experience and encourage people to find their • The best thing for the family members was dreams and contribute to a network. having each other. In times of crisis the first As a parent partner she had a unique ability call tended to be to other family members to engage families. She recognized it was impor- rather than crisis lines or professionals. In tant to set a tone that the Project was different nearly every situation families were able and that families were valued. More than once to support each other through crisis. she would introduce a family to the Project and These activities cost nothing but were invalu- find that she had known them years ago on “the able to the families. If the above services were to streets.” This was sometimes amazing to new be priced out they would be prohibitively expen- families, but it helped them realize change was sive. They tended to be invisible and passed on possible. At a lunch, she and another parent were in team meetings or at family groups. The fam- sitting with one of the staff and she was relating ily relationships were important in time of need her past on the streets to the staff member. The but the friendships were equally important during other parent kept looking at her. When they were good times. alone, she said, in shock, “You tell them all of that?!” It helped develop trust between profes- Developing Connections to sionals and families. Community Resources With parent partners and family members playing new roles, the families were achieving In the develop- new levels of success. The members of the family ment of the Project group had collectively been seen as dysfunctional there was an empha- to the system, but they were not seen as dysfunc- sis in creating relational to each other. They began to share their tionships with com- The members of abilities and to support each other in ways that munity organizations were not available to them before. They were to help support the the family group also available to meet others’ needs informally. development and had collectively By knowing each other, they shared their capabili- functioning of wrap- been seen as ties. Some examples: around teams. The effort was not very dysfunctional to • A father who could not read wanted to successful in most the system, but start his own business. He was embarrassed cases. Funds from about his inability to read and would not the Project could they were not seen seek help with people he did not know. be used to purchase as dysfunctional to One of the parents in the group helped services and some each other. him with the paperwork to get his busi- unique contracts ness license. He was able to start his busi- were developed. For ness, which was a great point of pride for instance a staff posi- him. This father also hired one of the other tion was paid for at a family members. In addition, he also had local Boys and Girls mechanical ability and was able to help Club to supervise a youth without the staff being people with minor automotive repairs. identified as an aide. It was a different story when • A grandmother who was home all the time a service was not contracted. Due to the back- became an after school care provider for ground of the youth in the Project, many organi-

Section 2: The Principles of Wraparound

zations were concerned about the child and the the Project, the group was brought together to family. Liability was inevitably brought up. The share responsibility for dealing with the problem. Project experienced the same forces that fami- In one of the meetings the name of the Project was lies encountered in being rejected and isolated in brought up. The Project was looking for a better their communities. There was moral support but name. It was thought everyone agreed “Blended not necessarily tangible supports. Funding Project” was a poor name for this com- The families became emissaries to the commu- plex endeavor. However, a 17-year-old girl who nity for the youth and also great sources of infor- was part of the Project said “You are not changing mation about community organizations that were the name of my project.” Others agreed with her. supportive. When they approached organizations It was obvious that ownership had become shared. they were involved in for support they were much It was decided not to bring up the topic again. The more successful. They referred families to those families had transformed the Project and made it organizations because of the willingness of the or- their own. ganizations to work with their children. They also became a referral source for services to organiza- References tions that were perceived as family friendly and Hernandez, M., Hodges, S., MacBeth, G., Sengova, respectful. They shared opinions and impressions J., & Stech, S. (1996). The Michigan Outcome with each other that helped new families to guide Identification Project. Tampa, FL: University themselves through community options and to of South Florida, Florida Mental Health Insti- learn of choices. tute, Department of Child and Family Studies, The System Accountability Project for Chil- Conclusion dren’s Mental Health. Families in the King County Blended Funding Project cared for children and youth with ex- Vander Stoep, A., Williams, M., Jones, R., Green, tremely complex needs. However, the focus on L., and Trupin, E., 1999. Families as full re- developing community meant that for many fami- search partners: What’s in it for us? The Jour- lies, even when there were serious behavior prob- nal of Behavioral Health Services & Research, lems, they were able to function with far fewer 26, 329-344. services. Support from the group enhanced their ability to handle problems. Reduced stress meant increased energy to support children. For exam- Author ple, the father who started his own business had Bob Jones was the developer and director of the to fight to get his child out of hospital and back King County Blended Funding Project that consoli- home. Professionals felt he was not capable of dated funding to support plans created by fami- meeting his son’s needs. However, the support he lies for the care of their children. He has worked received led him and his support system to a dif- as a director of a residential treatment program ferent conclusion. There were no problems that and as a mental health planner. He is currently he could not deal with. He found great support working for Washington State Division of Children from members of the group. and Family Services as a planner and program de- For most families, the formal role of the Proj- veloper for children with serious emotional prob- ect became diminished over time. This was espe- lems. cially true with the management of the Project. Relationships between professionals working in Suggested Citation: the Project and involved families became more Jones, B. (2008). Creating community- collegial and less hierarchical. Families were seen driven wraparound. In E. J. Bruns & J. S. as resources and when families were in crises or Walker (Eds.), The resource guide to wrap- in need of support, other families were readily around. Portland, OR: National Wrap- called upon for support and insight. around Initiative, Research and Training Center for At a time when there were fiscal problems in Family Support and Children’s Mental Health.

This document was peer reviewed through the NWI.

The Principles of Wraparound: Chapter 2.5 Debating “Persistence” and “Unconditional Care”: Results of a Survey of Advisors of the National Wraparound Initiative

Eric Bruns, Co-Director, National Wraparound Initiative, and Associate Professor, University of Washington School of Med- icine

Janet Walker, Co-Director, National Wraparound Initiative, and Research Associate Professor, Portland State University School of Social Work

National Wraparound Initiative Advisory Group

n 2004, the National Wraparound Initiative (NWI) used a Icollaborative process to create two publications to help meet its stated goal of increasing clarity and consistency of wraparound implementation for youth and families. These two documents were the Ten Principles of Wraparound and The Phases and Activities of the Wraparound Process. Since these publications, the most contentious aspect of these formative documents has arguably been the reframing of the Unconditional Care principle of wraparound as Persis- tence, which was done in order to acknowledge the fiscal and logistical challenges of providing unconditional care in real-world systems. In advance of publishing all the NWI documents in the Resource Guide to Wraparound, it seemed important to revisit the question of how best to present this core principle: Using the newer term of Persistence, or returning to the traditional wraparound term Unconditional. To help figure this out, approximately 200 NWI advisors were sent a two-page document that included the definition of the Persistence principle as it has been presented since 2004, as well as a new description of the principle Unconditional Care. Part 2 of this chapter reproduces this information as it was presented to the advisors. Advisors were provided a link to an on-line survey. The survey asked the advisors to give their opinion on whether the change represented an improvement to the ten principles of wraparound, and also invited open-ended feedback on the wording of the principle as well as the issue overall.

The Resource Guide to Wraparound Section 2: The Principles of Wraparound

Part 1: Summary and Looking at the open-ended feedback, there Interpretation of Feedback was little disagreement with the content of the descriptions of either principle. Debate centered More detailed results from analysis of open- primarily on what title to assign this principle. Ad- ended questions are presented in Part 3 of this visors seemed to be split between those who want chapter. Overall, results showed that: to highlight the more value-based ideal expressed • One hundred members of the NWI Listserv by Unconditional and those who seem to want to (approximately 49%) responded to the re- highlight a more practical or applied version of quest for input. the principle expressed by the title Persistent. • 73% expressed preference for the new de- Discussion scription of Unconditional Care (See Figure 1). Overall, nearly three-quarters of 100 NWI advisors who participated in this exercise expressed • 15% expressed a preference for the defini- a preference for the description of the principle tion and description of Persistence. as “Unconditional Care.” At the same time, 15 • 12% endorsed the option “Neither version advisors expressed a preference for the previous is clearly better.” version, entitled “Persistence.”

Figure 1. Results of Survey of NWI Advisors

100

40 who Selected Option Number of NWI Advisors Number of NWI 20

0 Prefer new Prefer previous Neither version is version of version of clearly better “Unconditional” “Persistence”

Option that NWI Advisors Chose that “Best Reflected their Views of the Proposed Changes”

Chapter 2.5: Bruns, et al.

Despite different opinions among the advi- Part 2: Versions of Unconditional sors in terms of preferences for Unconditional Care and Persistence Presented versus Persistence, it should be noted that comments indicated substantial agreement about the to Advisors for Review main components included in the description of Principle: Unconditional Care. A wraparound the principle. Each description (as presented in team does not give up on, blame, or reject chil- either the Unconditional Care or the Persistence dren, youth, and their families. When faced with version) contains two parts: The first paragraph challenges or setbacks, the team continues working describes the basic vision or value, while the sec- towards meeting the needs of the youth and family ond paragraph points to typical difficulties that and towards achieving the goals in the wraparound are encountered in real-life wraparound. plan until the team reaches agreement that a for- In reviewing the results, we concluded that mal wraparound process is no longer necessary. those who prefer Unconditional Care as the title Description: This principle emphasizes that of this principle tend to want to highlight the the team’s commitment to achieving its goals per- more value-based ideal expressed in the first sists regardless of the child’s behavior or place- paragraph of the description. Those who prefer ment setting, the family’s circumstances, or the the Persistence (or Persistent) title seem to want availability of services in the community. This to highlight a more practical or applied version principle includes the idea that undesired behav- of the principle that acknowledges the limitations ior, events, or outcomes are not seen as evidence expressed in the second paragraph. In general, of child or family “failure” and are not seen as a advisors’ comments did not suggest disagreement reason to reject or eject the family from wrap- either with the ideal of unconditional care or with around. Instead, adverse events or outcomes are the reality that systems are often not set up to interpreted as indicating a need to revise the provide care that is truly unconditional. Rather, wraparound plan so that it more successfully pro- comments seemed to focus more on which aspect motes the positive outcomes associated with the of the principle should be emphasized over the goals. This principle also includes the idea that the other in the single term that will stand for the team is committed to providing the supports and whole principle. Advisors also were interested services that are necessary for success, and will in making sure this would be clear for audiences not terminate wraparound because available ser- who are unfamiliar with wraparound and who may vices are deemed insufficient. Instead, the team have difficulty grasping what this principle really is committed to creating and implementing a plan stands for. that reflects the wraparound principles, even in the face of limited system capacity. Now What? At the same time, it is worth noting that many wraparound experts, including family members Though we respect the feedback from advi- and advocates, have observed that providing “un- sors who voiced a preference for describing wrap- conditional” care to youth and families can be around as Persistent, advisors who prefer to pres- challenging for teams to achieve in the face of ent this principle as Unconditional Care represent certain system-level constraints. One such con- a clear majority. In addition, a large majority of straint is when funding limitations or rules will advisors seemed to be satisfied with the descrip- not fund the type or mix of services determined tion of the practical limitations that were includ- most appropriate by the team. In these instances ed in the second part of the new description. For the team must develop a plan that can be imple- these reasons, a shift to a principle description mented in the absence of such resources but in a entitled Unconditional would seem to be a logi- way that does not give up on the youth or family. cal step. Depending on the future response from Providing unconditional care can be complicated advisors, we may be asking (yet again) for review in other situations as well. For example, when and feedback. wraparound is being implemented in the context of child welfare, protection of children’s safety may require that care is unconditional primarily

Section 2: The Principles of Wraparound

to the child or youth. Regardless, even in these tional” care. This revision reflects feedback from circumstances, team members as well as those wraparound experts, including family members overseeing wraparound initiatives must strive to and advocates, that for communities using the achieve the principle of unconditional care wher- wraparound process, describing care as “uncon- ever possible for the youth and all family mem- ditional” may be unrealistic and possibly yield disappointment on the part of youth and family members when a service system or community can not meet their own definition of uncondition- ality. Resolving the semantic issues around “unconditional care” has been one of the challenges of defining the philosophical base of wraparound. Nonetheless, it should be stressed that the principle of “persistence” continues to emphasize the notion that teams work until a formal wraparound process is no longer needed, and that wraparound programs adopt and embrace “no eject, no reject” policies for their work with families.

Part 3: Detailed Survey Results In addition to analyzing votes from advisors, bers if the wraparound process is to have its full open-ended comments about the two versions and impact on children, families, and communities. the exercise in general were analyzed for themes. Principle: Persistence. Despite challenges, Looking across all three open-ended survey items, the team persists in working toward the goals five major themes were identified: included in the wraparound plan until the team reaches agreement that a formal wraparound 1. Support for returning to a principle focus- process is no longer required. ing on Unconditional Care, Description: This principle emphasizes that 2. Support for using a principle focusing on the team’s commitment to achieving its goals per- Persistence, sists regardless of the child’s behavior or placement setting, the family’s circumstances, or the 3. Ideas for how to revise the name of the availability of services in the community. This principle, principle includes the idea that undesired behav- 4. Ideas for how to revise the wording of the ior, events, or outcomes are not seen as evidence principle, and of child or family “failure” and are not seen as a 5. General comments about this exercise and reason to eject the family from wraparound. In- the issue of defining this principle. stead, adverse events or outcomes are interpreted as indicating a need to revise the wraparound . Brief descriptions of the patterns of open plan so that it more successfully promotes the ended comments in each of these areas is positive outcomes associated with the goals. This presented below. principle also includes the idea that the team is committed to providing the supports and services 1. Support for Unconditional that are necessary for success, and will not termi- Approximately 58 advisors’ open-ended com- nate wraparound because available services are ments included some type of support for returning deemed insufficient. Instead, the team is commit- to the notion of Unconditional Care. Most of these ted to creating and implementing a plan that re- were simple statements such as: flects the wraparound principles, even in the face of limited system capacity. • “The revised statement better reflects the It is worth noting that the principle of “per- intent of the wraparound process and pro- sistence” is a notable revision from “uncondi- vides more clarity to the definition,” or

Chapter 2.5: Bruns, et al.

• “The wording is good and I think more all the more important to help us advocate strength based. Unconditional Care fits for families.” better into the wraparound philosophy.” • “Unconditional Care goes along with ‘unconditional positive regard’—empathizing In addition, however, there were more spe- even if you disagree.” cific endorsements of the Unconditional wording. These tended to fall into two categories. First, • “Persistence would bring us back to the many advisors expressed that Unconditional is a idea that at some point a family can be more appropriate expression of a principle than kicked out of wraparound.” Persistence, which was viewed in these comments • “Persistence allows professionals an ‘out,’ as more pragmatic and focused on how wrap- as in: ‘we’ve been persistent, but…’” around is actually implemented. For example: Several advisors also referenced this concern • “Wraparound is a philosophy, not a man- as a reason to eliminate some of the wording at date. It is unrelated to the funding of the end of the explanation of the Unconditional treatment. As such, I think it is preferable principle that described instances in which sys- to unequivocally state that the highest tems may not be able to provide formal supports fidelity to the wraparound philosophy is unconditionally. achieved when service recipients get their services "unconditionally.” 2. Support for Persistence • “These are principles—why replace a val- Approximately 23 advisors gave open-ended ue-based term like Unconditional with comments that voiced support for using the Per- Persistence?” sistence principle. Virtually all of these comments • “Dumbing down the principle because it is expressed objections to the use of the term and difficult is condescending to families—ex- concept “unconditional,” stating a belief that pre- pect poor services, get poor services.” senting a service model as “unconditional” was • “Unconditional is a higher bar to strive unrealistic in real-world systems. For example: for.” • “The title Unconditional Care implies that • “Let’s keep the high ground on these.” services are unlimited. While team mem- • “You can deliver ‘wraparound’ uncondi- bers do not give up on, blame or reject tionally. You may not be able to get FUND- children, the term Unconditional Care ING to deliver some specific services within the context of wraparound systems of out complying with the rules of the funding care is not sustainable and will cause some agency, but it's worthwhile to note the dif- systems not to integrate wraparound into ference, and strive for the highest fidelity their services array.” to the wraparound philosophy no matter • “I have always had a bit of a problem with who funds your services.” the term Unconditional when applied in this context. Whether we like it or not, The second specific rationale expressed by ad- there are always conditions to just about visors in favor of Unconditional was that it would anything we do. The term itself, Uncon- help ensure that specific challenges faced by ditional is so large in scope that it is dif- youth or families would not be used as a reason ficult, if not impossible, to commit toin for terminating services. advance.” • “We don’t want to give providers an ex- • “I don't like the name of the principle, Un- cuse to give up when faced with a special conditional Care. I think it’s misleading to challenge.” families and can create resistance in system partners.” • “Keeping the value of unconditional care is • “There are times when the payor holds the

Section 2: The Principles of Wraparound

cards and requires that services be ended. more positively. Unconditional Care is not possible.” • One advisor suggested that Persistence re- • “Unconditional Care is not a reality when fers to the duration and intensity of support courts, child welfare, juvenile justice are while Unconditional refers to the nature of engaged. The intent (to quote Karl Den- that support; thus the two terms should be nis) of this principle was ‘never give up…. combined into Persistent and Uncondition- If the plan doesn’t work change the plan.’ al Care. Other suggestions included Com- Persistence more closely approximated passionate Care and Adaptability. this, not Unconditional Care. Wraparound • Finally, several advisors indicated that if is a model for organizing multi-system re- persistence was to continue to be used, it sponse, not a religion.” should be expressed as Persistent, so its wording would be parallel to the other The other primary points advisors made in principles of wraparound. favor of Persistence were that this concept was more clear and less vague, and/or easier to train 4. Revisions to the wording staffpersons to do: Many advisors presented feedback on the word- • “I believe that of the two, Persistence ing of the principle descriptions. Many of these provides a clearer description of the effort comments suggested specific revisions to either placed in team collaboration.” Unconditional or Persistence. In addition, there • “Unconditional Care is too vague—Persis- tence is more about doing than feeling, and thus easier to teach.” • “I have struggled with Persistence as a principle and yet when faced with changing it to Unconditional Care I find thatPer - sistence is a more accurate description.” • “I recently asked a class of case management students which term they resonated most with. Most could identify with Per- sistence and understood how to apply it in support of the family. Some found Uncon- ditional Care too vague.”

3. Ideas for the name of this principle Several advisors presented ideas for changing the wording or name of this principle to make it more palatable, descriptive, or clear. • Three advisors suggested that Uncondi- tional Care was less on target than Uncon- ditional Commitment. Another respondent suggested Ongoing Commitment, making were several general themes that arose across the for a total of four suggestions that “com- comments received: mitment” would be a better word choice • At least four reviewers suggested that the than “care.” term Persistence should be maintained, • Two advisors proposed that Perseverance but the definition and description updated would express the notion of Persistence with the new language that was presented

Chapter 2.5: Bruns, et al.

in the new explication of Unconditional. process because professionals find them • Four additional advisors commented that, ‘difficult.’ This consensus is often estab- regardless of the definition used, the lan- lished in so-called sidebar sessions from guage of the principles document should which the family is excluded.” be more “plain and simple,” “less wordy,” • “I find the lan- and/or “family friendly.” guage [of uncon- • Finally, three reviewers specifically sug- ditional care] gested that the second section of the de- good but would scription of Unconditional Care (describing add something to the challenges of providing support in this the effect of that “It is not the way) should be deleted. “Don’t apologize the team should wording that we for unconditional care,” said one; “Sounds give attention to use, as the way like excuses,” said another. ensuring that the goals reflect the that we teach 5. General comments real goals of the the concept. family/youth. I Some of the most interesting pieces of open- have observed Unconditional ended feedback from this survey were not related teams resort to Care or to the question of how to present the wraparound blaming the fam- Persistence principle of Unconditional vs. Persistence. These ily/youth when themes related to the exercise itself, or to the the plan does not both need to be methods employed by the community of practice work as the ‘team’ explained and we have called the National Wraparound Initia- envisioned. Often I understood.” tive. For example, several comments expressed have observed the that the issue is more complex than can be ex- source of this fail- pressed in a written principle, or that the effort ure as the result - NWI Advisor transcends how the NWI presents the principle: of the team sub- • “What seems to be most important is to stituting their val- let families know the intent of wrap team ues and practice philosophy—which is to be pledged (com- experience for the mitted) to ongoing flexible service (regard- family/youth's real less of circumstance) until goals are met desires/goals.” and/or the team is no longer needed or appropriate.” Several advisors also offered interesting alternative perspectives on how to express this princi- • “It is not the wording that we use, as the ple. A couple advisors suggested ways to differen- way that we teach the concept. Uncondi- tiate the two concepts. As mentioned above, one tional Care or Persistence both need to be advisor suggested that Persistence is something explained and understood.” related to “doing” while Unconditional is more related to “feeling.” Another advisor suggested Consistent with the above theme, several ad- that the two versions of the principle may be re- visors presented specific concerns about -wrap lated to people in different types of roles: around implementation related to the issue of providing unconditional or persistent care: • “The wording Unconditional Care in my mind is reserved for natural supports who • “I have a problem with using team consen- will be a resource for a child over a life- sus rather than outcome achievement as time. This concept does not pertain to a a graduation criterion. I've been in lots of group of professionals representing a sys- situations in which families that have the tem of care on a child and family team.” most complex needs are thrown out of the

Section 2: The Principles of Wraparound

And one advisor offered this interesting per- Authors spective: Eric Bruns is a clinical psychologist and Associate • “It does not seem to be the wording that Professor at the University of Washington School is problematic, but rather the constructs of Medicine in Seattle. He spends much of his themselves. In somewhat rhetorical fash- professional life conducting research on innova- ion, I would ask you to consider what would tive community-based models for helping youth be lost if both were simply dropped. The and families with complex needs, including family treatment drug courts, treatment foster care, gains seem more obvious... there would be parent support programs, and the wraparound both a streamlining of the principles and process. He is a lead developer of the Wraparound concomitant increase in clarity.” Fidelity Assessment System and, with Janet Walk- er, co-directs the National Wraparound Initiative. Finally, 38 advisors expressed in their comments that they appreciated that the NWI was Janet Walker is Research Associate Professor in the soliciting feedback on this issue and/or conduct- School of Social Work at Portland State University ing this exercise. At the same time, there were and co-Director of the Research and Training Cen- several advisors who questioned the approach of ter on Pathways to Positive Futures. Her current using a community of practice/consensus build- research focuses on 1) exploring how individuals ing approach to defining the wraparound practice and organizations acquire capacity to implement model: and sustain high quality practice in human service settings, 2) describing key implementation factors • “There are many limitations in defining that affect the ability of organizations and indi- a model by consensus. It's time for us to viduals to provide high quality services and treat- move beyond this. If we are to remain with ment, and 3) developing and evaluating interven- a consensus approach to model clarifica- tions to increase the extent to which youth with tion then it is ESSENTIAL that proposed emotional or mental health difficulties are mean- changes are identified by source and with a ingfully involved in care and treatment planning. rationale rather than sending out a survey Together with Dr. Eric Bruns, Dr. Walker co-directs for ‘consensus’." the National Wraparound Initiative. • “Is this wraparound or that Survivor TV show? I'm not sure any of these focus Suggested Citation: group/survey methods are working.” Bruns, E. J., Walker, J. S., & The National Wraparound Advisory Group. (2008). De- Acknowledgments bating “Persistence” and “Unconditional Care”: Results of a survey of advisors of We would like to thank the 100 advisors of the the National Wraparound Initiative. In E. NWI for taking the time to participate in this sur- J. Bruns & J. S. Walker (Eds.), The resource guide to vey. We would also like to thank all NWI partici- wraparound. Portland, OR: National Wraparound Ini- pants who have participated in such exercises in tiative, Research and Training Center for Family Sup- the past and continue to do so in the future. port and Children’s Mental Health.

This document was peer reviewed through the NWI.

The Principles of Wraparound: Chapter 2.6 Implementing Culture- Based Wraparound

Scott Palmer, Tang Judy Vang, Gary Bess, Harold Baize, Kurt Moore, Alva De La Torre, Simone Simpson, Kim Holbrook, Daedalys Wilson, & Joyce Gonzales

Connecting Circles of Care

ulture-based wraparound is an approach that expands Con the wraparound services model defined by the Na- tional Wraparound Initiative by establishing a higher standard for cultural competence. This article describes how to implement these cultural components and offers preliminary comparative findings based on the experience of Con- necting Circles of Care (CCOC), a SAMHSA-funded systems of care grantee. The enhanced model ensures that families can receive treatment services that are (a) grounded in their cultures; (b) designed by members of their cultures; and, (c) provided by culturally matched staff. CCOC focuses on four distinct cultural groups: African-Americans, Hmong, Latinos and Native Americans. The process of implementing culture-based wraparound services is examined relative to the community and organization structural supports, the four phases of wraparound, and the adaptations for specific cultural communities. Statistically significant differences were found among CCOC youth and family participants compared to other systems of care grantee sites.

Culture Based Wraparound In this article, we describe “Connecting Circles of Care,” a culture-based wraparound model that expands on the basic description of wraparound from the National Wraparound Initiative by establishing a higher standard for cultural competence. The concept of “culture” has its own definition, which is dependent upon the subjective view of an individual, community, and population. In this article, culture is defined as the wisdom, healing traditions, and transmitted values that bind people together from one generation to another (Duran, 2006); thus, “culture-based wraparound”

The Resource Guide to Wraparound Section 2: The Principles of Wraparound

aligns with the healing power of culture. Wrap- tant to note that many wraparound programs may around, as defined by the federal Substance use similar or other methods to exceed the basic Abuse and Mental Health Services Administration standards of cultural competence, which reduces (SAMHSA), is a “unique set of community services the differences presented in Table 1. and natural supports for a child/adolescent with serious emotional disturbances based on a defin- Connecting Circles of Care able planning process, individualized for the child Connecting Circles of Care (CCOC) is a and family to achieve a positive set of outcomes.” SAMHSA-funded, six-year systems of care initia- Wraparound is a relational process of caring for tive in a rural northern California community that youth that is designed to keep the family togeth- emphasizes its culture-based focus. While wrap- er, thus avoiding the risk of out-of-home place- around programs are intended to adapt to specific ments. The wraparound planning process involves local needs and goals (Walker, 2008), attention a community care team that consists of the youth, to cultural components is generally not as decid- his/her natural support system (e.g., family mem- edly focused upon as in CCOC. CCOC started in bers and friends), and formal supports (e.g., so- response to a palpable concern that one in fifteen cial workers, teachers, probation officers, and African-American and Native-American children judges). The goal of the focused planning process in the county were being placed in group homes is to help youth thrive and live harmoniously with- or foster care, while Latino-American and Hmong- in their families and communities by respecting, American children were typically not receiving honoring, and incorporating the families’ cultures mental health services due to language and pro- and spiritual belief systems into the wraparound found cultural differences that impeded their ac- process. cess to and engagement in treatment. Wraparound embraces cultural competence In 2000, a multiservice health center serving as one of its 10 principles (Bruns, Walker, and al., Native Americans received a SAMHSA Circles of 2004). This principle reads, “The wraparound pro- Care grant to engage in a needs assessment and cess demonstrates respect for and builds on the planning process to address emotional and behav- values, preferences, beliefs, culture, and identity ioral needs among Native-American youth. The in- of the child/youth and family, and their commu- depth planning process catalyzed local agencies nity.” Culture-based wraparound, as we propose to listen to the needs and wisdom of families and to define it, distinguishes itself from the basic leaders from among other underserved popula- description of wraparound by setting higher stan- tions. These cultural communities included Afri- dards for the cultural competence principle. For can Americans, Native Americans, Latino Ameri- instance, in the basic description of wraparound, cans, and Hmong Americans. Members of each researchers and experts pose that by sharing a cul- group reported common concerns about their tural identity with natural supports, family part- ability to access and be well treated by youth and ners, treatment professionals, community-based family service agencies. Issues included distrust organizations, and formal and informal supportive of local law enforcement and child protective ser- services, families may be more effectively served vices agencies that were characterized as focused (Bruns, Walker, et al., 2004; Penn and Osher, 2008). solely on removing children from their homes and Culture-based wraparound—as implemented by placing them in institutional care, as well as men- CCOC—is intended to build on this principle by af- tal health professionals who were perceived as fording specific mechanisms for achieving it, such (a) condescending and demeaning, (b) not trust- as by allowing families the opportunity to select worthy (e.g., assessments could lead to remov- culturally and linguistically matched care team ing children from their families), and/or (c) not members, as well as culture-based services (i.e., understanding of families’ needs. Additionally, Native American drumming group, Black Effective language translator services were seen as inac- Parenting Group, or healing ceremonies led by a curate, extremely cumbersome, and ineffective. Hmong shaman). Additional examples of how CCOC Out of Circles of Care, a vision for a culture-based extends basic expectations of cultural competence wraparound program emerged by combining the in wraparound are presented in Table I. It is impor-

2 Chapter 2.6: Palmer, et al.

wisdom of local cultural communities, the wrap- culture-based wraparound at the service delivery around implementation research in tribal groups level across each of the four wraparound phases. (Cross, et al., 2000), and the commitment from Finally, we will discuss outcomes and implications representatives of local agencies to retool their of culture-based wraparound for youth and fami- service models. The effort to achieve the culture- lies. To better understand these issues, examples based wraparound vision was primarily funded by will be provided on how culture-based wraparound SAMHSA through its Systems of Care funding pro- operates within specific cultures. gram, starting in 2005. This article will present lessons learned in Creating the Organizational Context implementing culture-based wraparound at the for Culture-Based Wraparound organizational level using the six areas identified by the Community Supports for Wraparound Families receiving services generally experi- Inventory (Walker, 2008). This will be followed ence culture-based wraparound as a tapestry that by lessons learned regarding implementation of interweaves culture with the 10 principles and

Table 1: Expanding on the Cultural Competence of Basic Wraparound

Wraparound with Cultural Competence Culture-Based Wraparound

Integrates culture into wraparound Integrates wraparound into the youth and family’s culture

Trains staff to respect and understand family view- Staff are culturally matched and view the world through points and then adapt services to the culture the eyes of a family’s culture

Trains staff in the principle of cultural competence Expertise in a particular culture requires decades of im- in 4-40 hours mersion

Focuses on culturally competent techniques of Realizes that a youth or family member’s perceptions of, staff to develop therapeutic relations and level of trust, for staff from different cultures may impair relationship formation no matter how culturally competent staff may be

Often does not offer youth and families the choice Offers youth and families the choice to have culturally to have culturally and linguistically matched pro- and linguistically matched professionals fessionals

Translation with a qualified interpreter is consid- Fully bilingual staff provided to ensure that true mean- ered sufficient ings are not lost and family members can emotionally process easier in their first language

Culture is often seen as a family’s traditions and Culture is seen as the wisdom, healing traditions, and ways of doing transmitted values that bind people from one generation to another (family traditions are honored and valued, but not seen as culture)

Wraparound is accountable to families and local Wraparound is accountable to families, cultural commu- agencies nities, cultural organizations, and local agencies

3 Section 2: The Principles of Wraparound

four phases of wraparound. Their experiences, from culturally diverse groups and youth and fam- however, reflect the implementation of cultural- ilies. based processes and wraparound at the organiza- Therefore, the first step toward ensuring that tional level, which may or may not transfer to the diverse stakeholders’ voices are equally heard is client intervention level. Yet, successful wrap- the formation of a governance body and adjunct committees in which a minimum of one-half of the members are from the community members, families, and youth belonging to the culturally diverse populations targeted. In CCOC, this commitment to ensuring that family and youth have a mean- ingful voice in this process has led to each cultural group being represented on the governance body. This included an African-American minister as chair, a Native-American youth as co-chair, and the president of the leading Hmong organization as a parent partner. In an effort to be inclusive, CCOC also has translation services using wireless headsets that are available for public meetings, trainings, and for community events. In addition, the collaborating agencies need to ensure that other community-based cultural around requires transforming the organizational organizations are full partners. Community-based system to create a hospitable environment and cultural organizations promote a culture-based culturally appropriate context to enable service emphasis within the program and thereby coun- delivery to families (Walker and Koroloff, 2007). teract the tendency of public agencies to carry Walker and Koroloff identified organization- and on business as usual. As a show of commitment system-level conditions that foster wraparound to these values, CCOC established a co-director- implementation, and these were later grouped ship whereby a public behavioral health agency into six essential domains—community partner- and Native American agency each provided equal ship, collaborative action, fiscal policies & sus- oversight for the CCOC initiative. While the for- tainability, access to supports & services, human mer brought experience in launching large scale resource development & support, and account- initiatives, the latter offered years of experience ability—that comprise the Community Supports in designing services in response to the cultural for Wraparound Inventory (CSWI). The discussion needs of Native Americans, as well as the cred- that follows focuses on standards for implement- ibility needed to propagate trust among other ing culture-based wraparound in each of the six cultural communities that theretofore had per- domains. ceived themselves as being marginalized from mainstream services and resources. Community Partnership CSWI defines community partnership as “Col- Collaborative Action lective community ownership of and responsibility Collaborative action is the practical steps that for wraparound which is characterized as collab- stakeholders take “to translate the wraparound oration among key stakeholder groups” (Walker, philosophy into concrete policies, practices and 2008b). Ensuring that all community voices are achievements” (Walker, 2008b). Collaborative represented and heard can be a challenge. For action between governmental agencies is of- instance, institutional and professionally trained ten easier than between a governmental agency stakeholders from education, mental health, pro- and non-traditional cultural groups and cultural bation, the courts, protective services, and /or organizations. When involving culturally diverse welfare can eclipse the voices of representatives groups, leaders, family members, and organiza-

4 Chapter 2.6: Palmer, et al.

tions, it can not be assumed that the representa- An important component of this process has tives possess an understanding of public agency been the CCOC family partner and youth em- processes. It is thus important that people from powerment specialist staff. Individuals occupy- governmental agencies meet with cultural group ing these positions have been certified in county- representatives so that institutional stereotypes sponsored training programs that permit them to are dispelled, a mutual understanding of how to bill Medicaid (Medi-Cal in California) to support satisfy cultural needs is fostered, and adherence their services. Moreover, a non-profit CCOC off- to public policy regulations is maintained. Through shoot entity has been created to provide culture- this process, issues that might seem challenging based training outside of the service area as a at first—such as inviting cultural leaders to sit in revenue generation strategy for supporting local on interviews and make recommendations on the culture-based services, as well as for engaging in hiring of agency staff—can become standard prac- grant writing and other fundraising activities on tice. Cultural leaders and families also need time behalf of CCOC. to adequately acquaint agency leaders with their respective customs and traditions, as well as to Access to Needed Supports and Services orient other cultural groups to differing practices Access to needed supports and services indi- among partners. This will serve to ensure that the cates that the “community has developed mecha- cultural groups’ needs are effectively addressed, nisms for ensuring access to the wraparound pro- and that cross-cultural communication among cess and the services and supports that teams need agencies, among cultural groups and agencies, to fully implement their plan” (Walker, 2008b). and among cultural groups, is standard practice. In short, these strategies collectively facilitate CCOC’s ability to take collaborative action with the support of all stakeholders.

Fiscal Policies and Sustainability Fiscal policies and sustainability pertain to how the “community has developed fiscal strategies to meet the needs of children and methods to collect and use data on expenditures from wraparound-eligible children”(Walker, 2008b). To be culture-based in this area means that youth, families, staff members, and cultural leaders must have access to accurate, up-to-date financial information. More precisely, they need to actively participate in the making of financial decisions that affect budget expenditures, thus ensuring that funds are available for healing ceremonies and other cultural activities. This also means that sufficient dollars are set aside to make certain that service providers receiving CCOC funds receive training in culturally competent services and that funds are available to support internships in wraparound services or other activities that enhance short- and long-term sustainability of cul- In the culture-based wraparound model, CCOC ture-based services. Supplemental funding may families exercise choice over the services they be required to sustain training and internships, receive, and may elect, for example, culture- along with the engagement of volunteer experts based parent education; coping and social skills sometimes drawn from the target communities. training for youth embedded in cultural activities;

5 Section 2: The Principles of Wraparound

and counseling from culturally and linguistically most knowledgeable in these matters. Indeed, in matched staff members. They may also request some cultural groups it may be deemed culturally the use of flex funds for healing ceremonies and inappropriate to seek advice from a young adult other cultural activities, as well as access to peer rather than from a respected elder. support from members of their cultural group. If it is not possible for a program to hire a Additionally, it is important to have a cultural member from a given culture, it is still impera- competence coordinator and a cultural compe- tive that members of that cultural community tence subcommittee of the governance body to participate in the hiring process. This is because ensure that these types of services and supports they bring penetrating insight into the process of are available, and that they address the needs of identifying individuals who possess the requisite participants. skills to work effectively in a particular cultural milieu. However, perhaps the best way to identify Human Resource Development and Support superior candidates for staff positions is through Human resource development and support re- responses obtained from the following questions: lates to how “the community supports wraparound (a) Do the cultural communities and families trust and partner agency staff to work in a manner that and respect the staff member? (b) Does the staff allows full implementation of the wraparound member understand and embrace the families and model” (Walker, 2008). Culture-based wraparound cultural community? (c) Does the staff member requires the recruitment, hiring, and retention of help families to achieve their goals while embrac- culturally diverse staff so that families can have ing their culture? the choice of working with staff members who are of their culture. CCOC staff members from the lo- Accountability cal cultural communities report being naturally Accountability pertains to the community hav- drawn to culture-based wraparound due to sever- ing “implemented mechanisms to monitor wrap- al factors: (a) their own culture is embraced, (b) around fidelity, service quality, and outcomes, clinical consultation and supervision is provided and to assess the quality and development of the by culturally diverse supervisors, and (c) they can overall wraparound effort.”(Walker, 2008b) While effectively serve their cultural communities. To at the service level, wraparound teams are clear- obtain the best staff, it is important to have the ly accountable to the family, at the organizational cultural communities actively participate in the and system levels, it is important to clearly define recruitment and hiring process. In this context, to whom the wraparound program is accountable, cultural matching is facilitated by having family and what data and other information will be used members and leaders recruit prospective candi- to determine whether programmatic, collabora- dates from individuals whom they not only know, tive, managerial, and fiscal goals are reached. In but also have observed helping youth and families culture-based wraparound, primary accountabil- in their community. Family members and cultural ity is to the cultural communities, their leader- leaders also participate on the hiring panels. ship, and organizations that they represent. There In CCOC, this selection process has led to the is also accountability to funders and participating hiring of several limited-English-speaking staff who community-based group and agencies. are respected elders within their ethnic communi- While collecting quantitative data that mea- ties. They are among CCOC’s most effective staff sures fidelity to culture-based services, the wrap- as they have the trust and respect of their com- around process, and treatment outcomes are im- munity. In cultural groups where many members portant, this information is sometimes difficult to have recently arrived in the U.S., hiring younger, interpret due to the lack of normative data on more fluent English-speaking staff members is specific population groups. Furthermore, many often interpreted as a failure on the part of the cultural groups’ internal values are not easily cap- agency to adequately embrace the cultural values tured quantitatively. Conducting interviews and and traditions of the ethnic group in question par- focus groups with culturally diverse families, and ticularly since elders are often perceived as being involving cultural leaders in the interpretation

6 Chapter 2.6: Palmer, et al.

of findings, are necessary steps to ensuring that tion, or child protective services). Most families cultural needs are being met. It is also of con- in CCOC self-refer based on an informal recom- sequence to operationally define what is meant mendation. Families referred by local agencies by cultural competence and culture-based pro- are often aware of the program since CCOC hires cesses, so that the project can assess for these family partners and elements within the context of continuous quality professional members improvement (CQI). For example, if cultural com- from local cultural petence is defined as the ability to interact ef- communities. Most fectively with people within a cultural context, it enrolled families in could be assumed that we will not see differences small communities Culture is defined in outcomes across cultural groups, assuming that are extended family as the wisdom, high quality wraparound is provided. Identifying members of at least culture-specific elements, however, and review- one of the team mem- healing traditions, ing their implementation and client satisfaction, bers or have friends and transmitted is important information for the CQI process. who know team mem- values that bers. Family members Wraparound Phases often make inquiries bind people regarding wraparound The process of culture-based wraparound im- together from team members in plements the four phases of wraparound—engage- one generation to their own cultural ment, initial plan development, plan implemen- community to deter- another (Duran, tation, and transitioning; however, within each mine whether these phase there is an enhanced focus on culture. The 2006); thus, members are people following discussion of the wraparound phases “culture-based whom they can trust concentrates on explicating the context of cul- and have the skills to wraparound” ture and implementing culture-based processes help them. Therefore, at each phase. aligns with the it is important that healing power of every team member Phase One: Engagement Phase has the respect of the culture. The engagement phase, lasting from one to cultural community, two weeks, is characterized by wraparound staff and can act as a cul- meeting with the family to explain the wraparound tural liaison (i.e., a process, hear the family’s story, explore the fam- person who knows and ily’s cultural preferences and strengths, and iden- understands the cul- tify informal supports (e.g., people who currently tural values, supports, and treatments available help the youth and family members to thrive) to community members, as well as the education- (Walker et al., 2004). Explaining the wraparound al, mental health, and social service systems in process to families from cultural communities is the larger community). often easy to do as the wraparound approach re- A family’s first contact with CCOC is gener- flects a way of caring for youth and families that ally with a family partner from their own culture. has been practiced by indigenous cultures for While each of the CCOC-employed family partners thousands of years (Cross et al., 2000). has gained expertise through having a youth that Referrals for culture-based wraparound pref- has struggled in school, at home, or in the com- erably come from families requesting services munity, he or she is also selected for having strong after hearing about the program from a family connections and effective leadership skills in their member, friend, or cultural leader. When a family cultural group. Many wraparound programs have is referred by someone they trust, they often ap- discovered that involving a family partner accel- proach the program with greater trust than if they erates the trust-building and engagement process. are referred by an arm of the criminal justice or CCOC staff has also observed that having the fam- social services systems (e.g., the courts, proba- ily partner culturally and linguistically matched

7 Section 2: The Principles of Wraparound

to the family generally increases the speed and form a wraparound team and create a family plan efficacy of trust building. Trust is exemplified (plan of care). The wraparound team identifies when both families receiving services and CCOC the youth and family’s strengths, challenges and- team members refer to each other in such famil- values, and the influential people in their lives. ial terms as brothers, sisters, and uncles when it Based on this information, the team produces a is culturally appropriate. Cultural matching thus family vision, develops goals to actualize the vi- emphasizes the salient relational and trust pro- sion, and establishes action steps and services to cesses that are crucial for success in the engage- accomplish the goals. When services are needed ment phase. Cultural matching, however, does not to reach goals, implementing culture-based wrap- preclude the need to discover and embrace each around requires that families have the option of family’s unique traditions and values that are not culture-based services. If these services are not part of the cultural community. readily available, they need to be created. Ex- CCOC’s psychotherapy, family meetings, case amples of services available in a successful cul- management, counseling, parenting education, ture-based wraparound program can be found in and social skills training are provided in the lan- the services CCOC offers: guages of the families -- primarily English, Hmong, • Ability to select culturally-matched fam- and Spanish, but also available in Laotian, Mien, ily partners, facilitators, and clinicians for Thai, French, and Korean. This is because a range targeted cultural communities (e.g., Native of potentially adverse dynamics may otherwise American, Latino American, Hmong American, occur, which include: (a) information is often lost and African American); or distorted in translation; (b) services in English shift power from parents and elders to the Eng- • Mental health, family partner, and youth coor- lish-speaking children (using children to trans- dinator services, as well as wraparound facili- late creates family dysfunction as it increases the tation, are available in languages families un- power of the child and often breaks cultural ta- derstand (e.g., Hmong, Spanish, and English). boos where traditions have focused on deference • Inclusion of cultural leaders within wraparound and respect toward elders); (c) speaking in Eng- teams. lish for a limited-English speaker requires effort, • Cultural-based parenting education groups particularly when speaking about complex and (e.g., Positive Indian Parenting, Southeast emotionally difficult problems, such as trauma, Asian Parent Education, Los Niños Bien Educa- which is generally encoded and interpreted in a dos, and Effective Black Parenting) person’s primary language and culture; and,(e) immigrant families feel further isolated and es- • Multicultural events that honor each culture tranged from processes when translation is pro- through cultural performances and community vided for them rather than for the English-only convenings (the honor of one is the honor of team members. Moreover, if psychiatric consulta- all) tions or psychological evaluations are needed and • Flex funds available for cultural and spiritual the psychologist or psychiatrist is not fluent in the activities (e.g., shamans and healing ceremo- participant’s native language, a bilingual/bi-cul- nies). tural wrap-team member provides translation, in- • Culturally based activities (e.g., weekly Na- cluding cultural information. tive American youth drumming group). Phase Two: Initial Plan Development • Multicultural youth program with youth staff hired from the local cultural communities, In this phase of culture-based wraparound, where youth staff serve as mentors devising the family invites relatives, friends, culturally- activities that honor the local cultures. matched CCOC staff (i.e., family partners, family support workers, and clinicians), church mem- Phase Three: Plan Implementation bers, community members, probation officers, school teachers, and other supportive persons to Phase three comprises the implementation of the family plan (plan of care). Family meetings

8 Chapter 2.6: Palmer, et al.

focus on reviewing accomplishments, assessing poseful transition from formal wraparound to a whether the plan of care has worked, adjusting mix of formal and natural supports in the com- action steps for goals not being met, and assigning munity (and, if appropriate, to services and sup- new tasks to team members (children and families ports in the adult system). It is important to note included) to reach the family’s vision (Walker et that the focus on transition is continual across all al., 2004). CCOC has observed that when the plan phases of the wraparound process in that prepara- of care is achieved, family vision and goals are tion for transition is apparent even during the ini- strongly associated with the youth’s pride in his or tial engagement activities (Walker et al., 2004), her cultural background, appreciation for the con- though it culminates in phase 4. tributions of elders, and development of a strong Successful transition requires a plan for the connection between family and culture. For in- family to cope with stressors that occur after the stance, a Latino child who has refused to speak formal wraparound process is no longer available. Spanish to his mother shows pride after seeing her Though families have acquired problem-solving lead Latino families and other CCOC families in skills and learned how to work effectively as a cooking Latino foods. He begins speaking in Span- team with their formal and natural supports, their ish and taking pride in his heritage, demonstrating skills have not been put to the test. Often, the dramatic improvements at school and stopping his most challenging and difficult task for transition- gang activity. Another example is a Native Ameri- ing families is to sustain formal and natural sup- can child participating in a drum group during ports. Culture-based wraparound helps in building which he receives positive feedback from Native- and sustaining community supports. CCOC helps American elders and from leaders outside of the families create a community by providing oppor- Native-American community. Embracing his cul- tunities for families to develop friendships with ture and experiencing success lead to his achiev- other families in CCOC and the community (e.g., ing success both at school and at home. culturally-matched parenting groups, culture- specific parent education programs, multicultural youth activities, and multicultural family activities). Youth and families continue to participate in these activities even after successful graduation from CCOC, which helps to maintain cultural connections.

Integrating Wraparound into Different Cultures A youth and a family’s difficulties may reflect the trauma that the family has experienced due to past or current racism, persecution, and oppression, as well as the state of balance and well- being within their local cultural community. Many families in CCOC discover that much of the disharmony and dysfunction in their lives are related to the trauma that their family members have en- dured for generations, as with Native Americans and African Americans. This perspective often liberates family members to release feelings of guilt, despair, stigma, and hopelessness as they realize their problems are not self-created. By Phase 4: Transitioning studying the strengths and healing traditions from their culture, families find new pride in their cul- During this phase, plans are made for a pur- ture and in their personal identity.

9 Section 2: The Principles of Wraparound

Many of the families in CCOC have become within the Maidu community is the result of vari- isolated from their relatives, their cultural com- ous losses, including loss of homeland, spiritual munities, and the general community. CCOC staff practices (which were outlawed from 1883 to have observed that taking pride in their culture 1978), local Maidu language, federal tribal sta- raises families’ hope, confidence, and self-es- tus, and family members who have been involun- tarily taken away to federally-mandated board- ing schools (where children were often severely abused) and to out-of-home placements through adoption or foster care. Cumulatively and indi- vidually, these losses have led many individuals and their families to develop coping mechanisms, some of which are harmful, such as alcohol and other substance abuse, antisocial behaviors stemming from distrust and fear of the dominant society, and lateral oppression (family members act out the violence and oppression they have received on other family members). Such responses have contributed to medical problems (e.g., dia- betes, high blood pressure, and obesity), mental health issues, and other socioeconomic difficulties ranging from poverty to limited social con- teem, and also leads them to connect with others. nections (Duran, 2006). In turn, these issues lead Additionally, CCOC staff has found that cultural to disharmony, or imbalance within the “sacred healing practices (e.g., seasonal and life-stage circle.” Dave Chief from the Oglala Lakota Tribe ceremonies) are often effective ways of heal- explains the “sacred circle”: ing and bringing balance to families. Successful implementation of culture-based wraparound The Circle has healing power. In the Circle, requires that it is shaped by the specific needs we are all equal. When in the Circle, no one is of the cultural communities targeted by the pro- in front of you. No one is behind you. No one gram. CCOC staff members integrate wraparound is above you. No one is below you. The Sacred services into the family’s culture, rather than in- Circle is designed to create unity. The Hoop tegrating the family’s culture into wraparound. of Life is also a circle. On this hoop there is Examples of how CCOC implements culture-based a place for every species, every race, every wraparound services for Native American, Latino- tree and every plant. It is this completeness American, African-American, and Hmong-Ameri- of Life that must be respected in order to can cultural communities are described in the bring about health on this planet. following sections. While the following sections Healthy relationships complete the sacred deal with CCOC’s methods for tailoring its servic- circle, bringing unity, harmony, and balance. Mai- es to different cultures, this does not negate the du basket makers, for instance, are renowned for fact that the wraparound principle of individu- using plants to weave baskets capable of holding alization demands that each family’s traditions, water. Basket weavers begin by creating strong, values, and circumstances need to be explored, balanced circular weaves using materials neces- understood, and embraced, and used as the basis sary for the basket’s purpose. In this manner of for that family’s wraparound plan. creation, they gather the best materials for their endeavor, using them to create a balanced, se- Native American Wraparound cure basket. The CCOC Native American wraparound ser- Native American wraparound works similarly vices occur on Maidu tribal lands, though most of in helping families become part of the sacred cir- these lands were confiscated years ago. Trauma cle. Healing often involves the family and natu-

10 Chapter 2.6: Palmer, et al.

ral supports reconnecting to cultural traditions. garnering respect of Outdoor activities are important to help the Hmong elders. CCOC youth and family connect to the sacred circle. hired an elder to be The circle becomes stronger as extended family the Hmong team’s members are added. Elders mentor the children family partner in rec- and connect the children to the natural world. ognition that this po- CCOC’s This circle is connected to other circles, such as sition needs to be approach family gatherings, powwows, ceremonies, danc- trusted among com- ensures es, and holistic healing celebrations. The fam- munity members so ily can also connect to concentric circles of the as to provide credible consistently larger community (i.e., local schools and other cultural expertise and incorporated cultural groups). In this way, a child and family guidance for imple- culturally learn to live harmoniously, engulfed by a dynamic menting Hmong wrap- sacred circle. Maidu and Native Americans’ em- around services. To competent phasis on cultural traditions thus serve as sources additionally enhance services that of strength and motivation, and also as the well- its rapport with the are effective spring from which healing unfolds. Hmong community, CCOC developed a in reducing Hmong Wraparound support network with clinical The Hmong are a subgroup of Asian descent the only Hmong family problems services agency in the with no country of origin, but are known as strong in youth. and collective mountain tribesmen who have region. This linkage forcefully fought their way to become free from provided the Hmong slavery and warfare (Yang, 1995). After the fall of services team with Saigon, many Hmong escaped Laos due to fear of cultural consultation prosecution because they had assisted the U.S. on difficulty cases and during the Vietnam War, and more than one mil- assistance for families lion resettled in the U.S. between 1975 and 2004. in obtaining bi-cultural parenting education, Eng- Many faced trauma, torture, rape and starvation lish as a second language classes, and assistance in Laos or in refugee camps prior to leaving South- with accessing social services. east Asia. Due to these experiences, the Hmong Another important component of the program community suffers from high rates of mental is the integration of cultural traditions and heal- health disorders that include posttraumatic stress ing practices into the client’s mental health treat- disorder, anxiety, and depression, among others ment, and the education of allied providers re- (University of California Irvine Southeast Asian garding these practices. For example, the Hmong Archive, 1999). The Hmong’s transition from a team has utilized a Hmong Shaman/Shawoman in simple agrarian lifestyle based on strong cultural treating mental health difficulties through hand traditions to the fast-paced, technological indus- tying and soul calling ceremonies. And, CCOC’s try of western culture has resulted in significant Hmong staff has been instrumental in educating cultural adjustment issues among this popula- school personnel and medical providers about tion, and especially the elders (Mouanoutoua and Hmong cultural healing practices. Brown, 1995). The Hmong culture has strong traditions that Latino-American Wraparound value family and clan leadership (Yang, 1995). Ac- “La familia” and “la comunidad,” which cordingly, it is essential to develop a strong re- means family and community, are central ele- lationship with elders and culturally competent ments of the Latino culture, which includes its agencies in the service area. For instance, CCOC language (Spanish or Indian dialect), traditions, responded to the needs of the Hmong mental folklores/mythology, music, food and religious or health community by embracing the values and spiritual affiliation; all of which are fundamental

11 Section 2: The Principles of Wraparound

for family norms to be transmitted from one gen- the healing of the family, as well as creating or eration to the next. The Latino families served by strengthening support systems for each family. CCOC are predominately from family systems that La comunidad is often inclusive of the extended have ceased to bond and prosper due to assimi- family, including individuals who are not blood lation, acculturation, severe trauma associated relatives (i.e., godparents, religious or spiritual with violence in the home, strict male patriarchy community members, neighbors or friends from (machismo), ongoing immigration-related legal is- the same country of origin). They offer important sues, and traumatic deportation history. Although emotional and cultural support systems for the migration experiences to the U.S. may be similar, family. CCOC strives to create within each family each family has its own story that often reflects the opportunity to develop new traditions, to pre- painful generational traumas. Situations leading serve traditions, to pay respect to past genera- to immigration from Mexico and Central America tions, to instill cultural pride, to promote emo- include poverty, political persecution, drug cartel tional well-being, and to find a balance between wars, the hope of a better future for children, and the new and the old ways so that the Latino family limited job opportunities. When Latino families system experiences la comunidad and la familia. experience mental health problems or alcohol and substance abuse issues, or engage in gang behav- African-American Wraparound iors or experience violence within the home, the Most African-American community members result can be shame and embarrassment for fam- in the region are descendants of Africans who ily members, ostracism from their religious com- were forcibly removed from their homeland and munity, and the fracturing of the family system. enslaved in America. Many African Americans ex- CCOC assists Latino youth and families to perienced forced separation of family members in integrate the past with the present, to reclaim slavery. After the civil war Black Codes and Jim their heritage, and redefine family roles with a Crow laws continued to break up African-Ameri- positive, strength-based approach. There may be can families. Many African-American families monolingual Spanish-speaking parents trying to came to northern California for the assurance communicate with their first generation English- of good jobs associated with public construction speaking child who speaks and understands lim- projects, with the State promising an economic ited Spanish. Although parents are often proud boom for the region. Unfortunately, this economic to say that their child speaks English, they are boom did not materialize and the African-Ameri- grieved over the communication difficulties this can families that located for employment were creates in the family system and over the way it left without local jobs. Many leaders and gifted impedes cultural bonding within the family and members of the community moved again for high- community. There is a severe level of segregation er paying jobs in other areas, separating families in these family systems between the parents and and relegating those remaining into poverty. Many children, a deep level of denial, and often resig- local African-American families have for genera- nation that the fracturing of the Latino family sys- tions been subject to trauma, led disrupted fam- tem is necessary to achieve the American dream. ily lives and struggled with low paying dead-end CCOC wraparound works with each family and in- jobs. The experience of racial discrimination—ac- corporates Latino folklore/mythology, traditions, tual or perceived—leads to lower levels of mas- food, music, and religious or spiritual affiliation tery and higher levels of psychological distress to help define what la familia and la comunidad (Broman, Mavaddat, & Hsu, 2000). Some males means to them. CCOC also helps families focus on respond to trauma and other stressors through ag- reclaiming their mental health, family unity, and gressive and angry behaviors towards self and oth- cultural pride. One of the simplest, and yet most ers or by using drugs. Amid difficulties of coping, effective interventions is having la familia sit to- and with bouts of anger, some males engage in gether for a meal and start the integration of the illegal behaviors for which they are apprehended past (family stories, folklore/mythology) with the and incarcerated, further fracturing the African- present (education and opportunity). American family. Integrating la comunidad is also vital for

12 Chapter 2.6: Palmer, et al.

Throughout its history, the mental health field tual; (d) mental; (e) social; (f) political; (g) eco- has often pathologized religious or spiritual in- nomic; (h) historical; (i) physical; and (j) cultural. dividuals (Bergin & Jensen, 1990). Nevertheless, The rites of passage personal domain says, “Life reaching the African-American community usu- can seem hard and unfair, but our ability to Love, ally involves collaborating with African-American struggle and overcome obstacles produces the churches. Many African Americans have used their fruit of our labor and gives us the Faith to go on.” church as a major coping mechanism in handling The African-American team uses a faith-based ap- the often overwhelming pain of racial discrimina- proach that has arisen over the centuries of strug- tion (Billingsley, 1994). Acknowledging this, CCOC gling to overcome persecution and legal obstacles has established strong participation of African to find personal, communal, and spiritual libera- American pastors on its governance body, includ- tion. Families’ struggles are discussed in relation ing one who served as its president. Of the four to how they mirror the struggle of people in the African-American staff employed by CCOC, two Bible, as well as African Americans before and af- are pastors and another is a pastor’s daughter. ter emancipation. CCOC families draw strength The African-American team incorporates the from these references, and gain inspiration, in- conceptual framework of the rites of passage, de- sight, and resolve. veloped by Ron Johnson, Executive Director of the National Family Life and Education Center in Los Outcomes of Cultural-Based Angeles. Rites of passage programs have gained Wraparound popularity in many African-American communities as a way of developing a positive African-Ameri- A preliminary look at outcomes suggest that can identity in young male and female adolescents CCOC’s approach ensures consistently incorpo- (Harvey, 2001). The rites of passage are based on rated culturally competent services that are ef- meeting different developmental tasks from a fective in reducing clinical problems in youth. As biblical framework and African ceremonies. The part of the Cultural and Linguistic Competence 10 rites are: (a) personal; (b) emotional; (c) spiri- Implementation Sub-study of the National Evalu-

Figure 1. Caregiver Ratings of Provider Cultural Sensitivity

5.00 M = 4.89 M = 4.63 4.00 CCOC

3.00 Other SOC

2.00 Mean of Five-Point Likert Scale Mean of Five-Point 1.00 Caregiver Ratings of Provider Cultural Sensitivity

13 Section 2: The Principles of Wraparound

Figure 2. Total Problem Scale

70.00 M = 69.08

M = 66.94 M = 65.61 M = 67.83 65.00 M = 65.35

60.00

M = 58.36

55.00 CBCL Total Problem Scale (Mean T Scores) T Scale (Mean Problem Total CBCL Intake 6 Months 12 Months

CCOC Other SOC

ation conducted by Walter R. McDonald & Associ- ation, which allows for the comparison of CCOC ates (WRMA), and ICF Macro (Macro 2009), CCOC to other system of care grantee sites funded by families reported high satisfaction with cultural SAMHSA. The study includes a Cultural Compe- sensitivity and clinical services. WRMA and Macro tence and Service Provision Questionnaire of 10 (2009) also found that CCOC wraparound teams: items that measure the cultural sensitivity of the primary service provider as reported by the create an environment of safety, positive re- youth’s caregiver. The questionnaire uses a five- gard, and nonjudgmental support underpinned point Likert-type format ranging from 1 (never) to by the cultural beliefs and tradition of each 5 (always). An aggregate mean score is created to community. Respondents reported services produce a provider cultural sensitivity quotient. were delivered in the language and from the Mean CCOC scores were compared to those of 29 cultural belief system of the family member. other system of care funded communities. At 12 CCOC participates in the National Evaluation months of service, the scores for CCOC compared of the Comprehensive Community Mental Health with other system of care funded communities Services for Children and Their Families Program were significantly higher for provider cultural sen- of SAMHSA funded systems of care grantees. CCOC sitivity (Figure 1; t (33.7) = 4.59, p < 0.001). youth and families are given the option of enroll- A second measure, the Child Behavior Check- ing in the longitudinal study of the National Evalu- list (CBCL; Achenbach, 1991) also suggests that CCOC outcomes are superior to average improve-

14 Chapter 2.6: Palmer, et al.

ments achieved in other sites based on mean and outcomes, and produces an overall satisfac- score differences. The figure below illustrates tion score. As shown in Figure 3, CCOC was sta- that although CBCL Total Problem Scale for CCOC tistically higher for each scale of the YSS-F at 12- was similar to those of cohort communities at the months compared to the mean of other systems time of intake, youth reassessed after 12 months of care sites, suggesting that culture-based wrap- in CCOC show fewer problem behaviors compared around services may contribute to higher service with other systems of care sites for a comparable satisfaction levels (Services, t (38.0)= 7.14, p < 12-month period. The difference between CCOC 0.001; Outcomes, t (33.2)= 4.61, p < 0.001; Over- and other sites is substantial (more than one stan- all, t (35.2)= 6.06, p < 0.001). dard deviation) and statistically significant for the Total Problem Scale (Figure 2, t (27.7)= -2.43, p = Results of Youth Satisfaction 0.022). Survey (Family) In addition to high scores in cultural sensitivity and greater reduction in problem behaviors, Additionally the Wraparound Fidelity Index v. caregivers of youths enrolled in CCOC also report 4.0 (WFI) was used to assess wraparound fidelity higher satisfaction with CCOC services compared across the four racial and cultural groups (Bruns with average satisfaction scores across caregivers & Walker, 2008). CCOC overall scores were above at other systems of care sites. Satisfaction with national means, which suggests that it is possible services was measured by the Youth Services Sur- to provide culture-based wraparound without los- vey for Families (YSS-F; Brunk, Koch, & McCall, ing fidelity to the wraparound process. 2000), which assesses satisfaction with services

Figure 3. Parent Satisfaction: CCOC Vs. Other SOC

5.00

M = 4.61 M = 4.49

4.00 M = 4.13 M = 4.06 M = 4.06

M = 3.63 3.00

2.00

Mean of Five-Point Likert Scale Mean of Five-Point 1.00 Satisfaction-Services Satisfaction-Outcomes Overall Satisfaction

CCOC Other SOC

15 Section 2: The Principles of Wraparound

Implications and Limitations chiatry. The culture-based wraparound model de- Bergin, A. E., & Jensen, J. P. (1990). Religiosity signed by CCOC is intended to establish a higher of psychotherapists: A national survey. Psycho- standard for cultural competence in wraparound therapy, 27, 3-7. implementation. The preliminary results from this Billingsley, A. (Ed.) (1994). The Black Church. Na- small cohort of youth and their families are prom- tional Journal of Sociology, 8(1-2). ising. Findings from this review suggest that a Broman, C. L., Mavaddat, R., & Hsu, S.-Y. (2000). culture-based wraparound program is responsive The experience and consequences of per- to personal preferences of racially and culturally ceived racial discrimination: A study of the Af- diverse youth and their families, and may contrib- rican Americans. Journal of Black Psychology, ute to greater reductions in problem behaviors 26, 165-180. coupled with higher caregiver satisfaction compared to non-culture based programs. The WFI Brunk, M., Koch, J. R., & McCall, B. (2000). Report results also suggest that it is possible to establish on parent satisfaction with services at com- culture-based processes while maintaining fidelity munity service boards. Virginia Department of to the wraparound model. Mental Health, Mental Retardation, and Sub- Additionally, independent program evaluations stance Abuse Services. for cultural competence have found CCOC to be Bruns, E.J., Walker, J. S., Adams, J., Miles, P., Os- reaching its clinical and programmatic objectives. her, T. W., Rast, J., VanDenBerg, J. D. & Na- Conclusions drawn from these findings are limited, tional Wraparound Initiative Advisory Group however, in that systems of care comparison data (2004). Ten principles of the wraparound represents a range of interventions that while in- process. Portland, OR: National Wraparound cluding wraparound services, also includes inten- Initiative, Research and Training Center on sive case management and other modalities. Family Support and Children’s Mental Health, The statistical differences in results between Portland State University. CCOC and other SAMHSA System of Care sites also Bruns, E. J. (2008). The research base and wrap- could be a result of extraneous factors, such as around. In Bruns, E. J. & Walker, J. S. (Eds.), simply having a high quality wraparound program, The resource guide to wraparound. Portland, rather than having incorporated higher standards OR: National Wraparound Initiative, Research for cultural competence at the organizational and and Training Center for Family Support and service delivery levels. Other possible factors in- Children’s Mental Health. clude CCOC’s comprehensive approach to community engagement, its awareness of intergenera- Bruns, E. J., Sather, A. & Stambaugh, L. F. (2008). tional and historical trauma, its explicit reference National trends in implementing wraparound: to spirituality, or the higher premium that it may Results from the state wraparound survey, place on relationships and trust building with 2007. In Bruns, E. J. & Walker, J. S. (Eds.), families. This being said, additional research as to The resource guide to wraparound. Portland, the benefit of infusing cultural competence into OR: National Wraparound Initiative, Research wraparound programs serving youth from diverse and Training Center for Family Support and cultures is worthy of continued exploration, as Children’s Mental Health. well as the influence of other programmatic and Cross, T., Earle, K., Echo-Hawk Solie, H., & Man- thematic elements that transcend specific cultur- ness, K. (2000). Cultural strengths and chal- al groups. lenges in implementing a system of care model in American Indian communities. Systems of References Care: Promising Practices in Children’s Mental Health, 2000 Series, Volume I. Washington, Achenbach, T. M. (1991). Manual for Child Behav- DC: Center for Effective Collaboration and ior Checklist: 4-18 and 1991 Profile. Burling- Practice, American Institutes for Research. ton, VT: University of Vermont, Dept. of Psy- Duran, E. (2006). Healing the soul wound: Coun-

16 Chapter 2.6: Palmer, et al.

seling with American Indians and other na- Family Support and Children’s Mental Health. tive peoples. New York, NY: Teachers College Walker, J. S., Bruns, E. J., & Penn, M. (2008). In- Press. dividualized services in systems of care: The Harvey, A. R. (2001). Individual and family inter- wraparound process. In B. A. Stroul & G. M. vention skills with the African Americans: An Blau (Eds.), The system of care handbook: Africentric approach. In R. Fong & S. Furuto Transforming mental health services for chil- (Eds.), Culturally competent practice: Skills, dren, youth, and families. Baltimore, MD: interventions and evaluations (pp.225-240). Brookes Publishing. Needham Heights, MA: Allyn & Bacon. Walker, J. S., Bruns, E. J., VanDenBerg, J. D., Mouanoutoua, V. L., & Brown, L. G. (1995). Hop- Rast, J., Osher, T. W., Miles, P., Adams, J., & kins symptom checklist-25, Hmong version: National Wraparound Initiative Advisory Group A screening instrument for psychological dis- (2004). Phases and activities of the wrap- tress. Journal of Personality Assessment, around process. Portland, OR: National Wrap- 64(2), 376-383. around Initiative, Research and Training Cen- Niedzwiecki, M. & Duong, T. (2004). Southeast ter on Family Support and Children’s Mental Asian American statistical profile. Washing- Health, Portland State University. ton, DC: Southeast Asian Resource Action Cen- Walker, J. S., & Koroloff, N. (2007). Grounded ter. theory and backward mapping: Exploring the Penn, M., & Osher, T. (2008). The application of implementation context for wraparound. Jour- the ten principles of the wraparound process nal of Behavioral Health Services & Research, to the role of family partners on wraparound 34, 443-458. teams. In E. J. Bruns & J. S. Walker (Eds.), Walter R. McDonald & Associates, Inc. & Macro In- Resource guide to wraparound. Portland, OR: ternational, Inc. (2009) Cultural and linguistic National Wraparound Initiative, Research and competence implementation substudy: Phase Training Center for Family Support and Chil- V of the national evaluation of the Compre- dren’s Mental Health. hensive Community Mental Health Services for Quincy, K. (1988). Hmong: History of a people. Children and Their Families Program. Rock- Cheney, WA: Eastern Washington University ville, MD: Substance Abuse and Mental Health Press. Services Administration. University of California Irvine Southeast Asian Ar- Yang, N. (1995). History and origin of the Hmong. chive. (1999). Exodus. Retrieved December 05, Retrieved March 01, 2007, from http://www. 2004, from http://www.lib.uci.edu/libraries/ hmongcenter.org/briefhisofhm.html. collections/sea/seaexhibit/exodus.html. SAMHSA’s National Mental Health Information Authors Center, Center for Mental Health Services. Scott Palmer is a clinical and research psycholo- Retrieved April 11, 2010, from http://men- gist, served for four years as clinical director for talhealth.samhsa.gov/resources/dictionary. Connecting Circles of Care, a culture-based wrap- aspx#W around program. He is currently the Systems Per- formance Research Evaluations Manager for Butte Walker, J. S. (2008a). How, and why, does wrap- County Behavioral Health. around work: A theory of change. Portland, OR: National Wraparound Initiative, Portland Tang Judy Vang has served for four years as the State University. clinician on the Hmong Team for Connecting Cir- Walker, J. S. (2008b). Supporting wraparound im- cles of Care, a culture-based wraparound pro- plementation: Overview. In E. J. Bruns & J. gram. She is currently finishing her PhD disserta- S. Walker (Eds.), The resource guide to wrap- tion in the School of Social Work at Portland State around. Portland, OR: National Wraparound University, and works for the University of Cali- Initiative, Research and Training Center for

17 Section 2: The Principles of Wraparound

fornia, Davis AIDS Education and Training Center, Kim Holbrook is the lead family contact for Con- increasing health awareness among culturally di- necting Circles of Care (CCOC), a culture-based verse groups in Northern California. wraparound program. Her family’s benefiting from wraparound services has led to her serving over Gary Bess is the principal for Gary Bess Associ- five years in CCOC as well as her working toward ates where he leads a team of researchers assist- a law degree to enhance her advocacy for youth ing public and private health and human service with special needs. agencies in program evaluation, needs assessment, strategic planning, and applied research. Daedalys Wilson, who has a Master’s in Marriage and Family Therapy, has served as the clinician on Harold Baize has more than 20 years experience the African American team for Connecting Circles conducting research on children’s mental health of Care, a culture-based wraparound program. and evolutionary psychology, including five years Beginning fall 2011, he will be teaching a gradu- as the principal evaluator for Connecting Circles ate course on multicultural counseling at Califor- of Care, a culture-based wraparound program. He nia State University, Chico. has used his award-winning 3D photographic and videographic skills to document CCOC activities. Joyce Gonzales a leader in the local Native Amer- ican community, led cultural competence efforts Kurt Moore is a researcher, psychotherapist, and for Connecting Circles of Care for five years, and teacher with experience in child, adolescent, and co-founded CCOC, Inc., a non-profit technical family mental health programs. As a Research assistance and training agency. It specializes in Manager with Walter R. McDonald & Associates, trainings on implementing wraparound systems of Inc. (WRMA), he works with the Community Men- care with a focus on cultural competency. tal Health Services and the National Child Trau- matic Stress Initiative evaluation projects.

Alva De La Torre-Pena has more than five years of experience as the clinician for the Latino Team for Connecting Circles of Care, a culture-based Suggested Citation: wraparound program. She is a Psy.D candidate in Palmer, S., Vang, T., Bess, G., Baize, H., Forensic Psychology at Alliant International Uni- Moore, K., De La Torre, A., Simpson, S., versity, Sacramento. Holbrook, K., Wilson, D. ,& Gonzales, J. (2011). Implementing Culture-Based Simone Simpson helped start the Stonewall Alli- Wraparound. In E. J. Bruns & J. S. Walker ance Youth Group for Connecting Circles of Care, a (Eds.), The resource guide to wraparound. Portland, OR: culture-based wraparound program. She currently National Wraparound Initiative, Research and Train- is a researcher for FISHBIO Environmental, and is ing Center for Family Support and Children’s Mental preparing for graduate school. Health.