Methods Measure

1. What Predicts Wraparound Fidelity? Findings from the Wraparound Fidelity Index April Sather, MPH, Michael Pullmann, Ph.D., andEric J. Bruns, Ph.D. University of Washington School of Medicine – Division of Public Behavioral Health & Justice Policy Discussion As shown in Tables 2 and 3 and Figure 3, a number of factors were found to be significantly associated with overall wraparound fidelity: The presence of natural supports, especially friends of parents and youths; being in the custody of a birth or adoptive parent; and having a family partner on the team. Older youth reported higher fidelity on the Youth form of the WFI-4. Certain factors were associated with lower fidelity, such as the youth being in the custody of the state or county. Other factors were associated with fidelity but were inconsistently related across respondents; for example, when representatives of certain public systems (juvenile justice and child welfare) were part of the team, fidelity scores were found to be significantly lower as rated by Facilitators but not Caregivers or Youths. On the other hand, when school representatives were on teams, Facilitators’ mean WFI-4 scores were higher. Meanwhile, mean duration of enrollment in wraparound was associated with higher fidelity for Facilitators but not Caregivers and Youths. The relationship between team membership and fidelity scores was also complex; as shown in Figure 2, for Facilitators, smaller (<4 team members) and larger (>8 members) teams were associated with higher fidelity scores, while teams of 5-7 people tended to be associated with lower fidelity. Conversely, Youth ratings indicated higher fidelity for medium-sized teams teams of between 4-7 people. Finally, as shown in Figure 1, mean fidelity scores have increased since the WFI-4 was introduced in 2006. This could be due to several factors, including the increased understanding of requirements of wraparound implementation or attention nationally to training and coaching. The increase could also be due to greater expectations of programs to achieve certain levels of fidelity; however, the fact that Facilitator scores have remained relatively consistent while Caregiver and Youth fidelity scores have increased counters that explanation somewhat. Introduction The Wraparound Fidelity Index, Version 4 (WFI-4) measures adherence to the principles and activities of wraparound via structured interviews with facilitators, caregivers, youth, and other team members. The Wraparound Evaluation and Research Team at the University of Washington has been compiling data collected by over 70 sites nationally for the last 6 years. During that time reliability and validity of the WFI-4 has been established, including several studies indicating association with more positive child and family outcomes, and nationally normed percentile scores have been established for fidelity scores. Given findings associating fidelity with positive outcomes, wraparound initiatives and researchers have frequently inquired what factors may predict wraparound fidelity as measured by the WFI-4. Using data collected from over 4,000 wraparound teams in 50 WFI-4 user sites, we explored what factors may predict wraparound fidelity, focusing on associations between overall wraparound fidelity percentile scores and other variables that are measured by the WFI-4, such as youth and family characteristics, wraparound team membership, duration of enrollment in wraparound, caregiver relationship to the youth, and other factors. Sample Characteristics Demographics Table 2: Between-Group Differences in Wraparound Fidelity for Predictors, by Type of Respondent Table 1: Mean fidelity and population percentile scores for the CG, WF, and Youth forms of the WFI-4 Table 3: Correlations between Predictors and Wraparound Fidelity, by Type of Respondent • Implications • Large sample sizes yielded many significant findings from this analytic exercise and these results are only correlational. Nonetheless, results will help aid interpretation of WFI-4 fidelity data. For example, sites implementing wraparound for youths in state custody will likely show lower scores and will need to interpret results accordingly. • Certain relationships found here also point to interesting implications for wraparound implementation and research: • As has often been theorized, involving family partners, natural supports, and friends and advocates of families is likely to be supportive of model adherent wraparound implementation. Future research should more rigorously evaluate the impact of active involvement of such individuals. • Facilitators may feel that their ability to facilitate high fidelity wraparound teams are compromised by involvement of certain team members (e.g., child welfare case workers, probation officers); this points to the importance of collaboration and good role definition in wraparound implementation efforts. • Increasing fidelity scores over time suggest wraparound initiatives are likely to increasingly encounter ‘ceiling effects’ in their scores. Additional or alternative methods for assessing wraparound quality and fidelity beyond WFI-4 interviews may need to be considered. Figure 1: Trends in National fidelity scores for WFI-4, 2006 - 2011. Methods Measure The WFI-4 has versions for wraparound facilitators (WF), caregivers (CG), other team members (TM), and youth (Y). WF, CG, and TM forms include 40 items, and the Y form includes 32 items. Items are organized by the 4 phases of wraparound: engagement (6 items), planning (11 items), implementation (15 items), and transition (8 items). Each item also relates to one of the 10 principles of wraparound. Items are scored as Yes, Sometimes/Somewhat, and No. Several items are reverse-scored, and higher scores indicate increased wraparound fidelity. Procedures Collaborating sites conducted interviews with caregivers, wraparound facilitators, and youth at least one month after families began wraparound. Interviewers were trained to criteria via manualized procedures. Data were compiled locally in the Wraparound Online Data Entry and Reporting System (WONDERS) web portal, and submitted from over 4000 unique wraparound teams based in 50 different sites, and included data from 4004 wrap facilitators, 3382 caregivers, and 1262 youth. Figure 3: Differences in WFI-4 Fidelity Scores When Different Team Members are Present Figure 2: Relationship between fidelity score and Number of Team Members for Facilitator form of the WFI-4. References Bruns, E. J., Suter, J., Force, M.M., Sather, A.K., & Leverentz-Brady, K. (2009). Wraparound Fidelity Index 4.0: Manual for training, administration, and scoring of the WFI 4.0. Seattle, WA: Division of Public Behavioral Health and Justice Policy, University of Washington. WFI total score WF form Acknowledgments: This work was supported by the Child, Adolescent and Family Branch of the SAMHSA Center for Mental Health Services and the National Institute of Mental Health (MH72759, MH07735). Number of members on team