Implementation of the WFI-EZ in a Multi-Site Wraparound Agency
March 3, 2014
Choices
• Care Management Entity– System of Care– Wraparound– Managed Care
• Established in 1997
• Over 1500 youth served daily
Agenda
• Choices experience with the WFI
• Integrating the WFI-EZ into Practice
• Using the WFI for Quality Improvement
Experience with WFI 3.0 and 4.0
• Wraparound Comparison Study– Dawn Project– University of Maryland
• Choices Technical Assistance Center– Subcontractor– Choices Outcomes and Evaluation Staff
Experience with WFI 3.0 and 4.0
• Advantages– External evaluation– Trained interviewers– Alignment with phases and principles
• Disadvantages– Staff resources– Completion rates– Limited assessment options
WFI-EZ
• Short-form– Wraparound Fidelity– Youth Outcomes– Satisfaction
• Self-Report– Paper– On-line– Interview
Part 1
Integrating the WFI-EZ into Practice
Administration Options
• On-line– Care Coordinators introduce– Email to caregivers– Survey Monkey
• Challenges– Caregivers have limited access to Internet– Reading levels
Administration Options
• Paper– Care Coordinators introduce– CCs give survey to families• Sign sealed envelope and return• Mail in stamped envelope
• Challenges– Potential for bias– Reading levels
Administration Options
• Interviews– Program staff– CCs introduces– Conducted by phone
• Challenges– Resource cost– Successful contacts with caregivers– WFI-EZ format
Implementation Process
• Allowed sites to select method
• Generated random samples
• CCs completed WFI-EZ on one youth
• 30 days to get completed surveys from caregivers
Results
• 3 of 4 sites selected paper surveys
• 1 site conducted phone interviews
• Response rates– Interviews (44%)– Paper (22-36%)
Results
• Consistent data quality
• Bias from CC involvement not observed
• Cost/benefit analysis
Next Steps
• 2nd administration underway
• Improve CC introduction to WFI-EZ
• Formalize mechanism for returning paper surveys
• Incentives for caregivers and youth
Part 2
Using the WFI-EZ for Quality Improvement
Importance of the WFI-EZ
• Family voice
• Fidelity monitoring vs. task management
• Opportunities for quality improvement
Quality Improvement
• Multiple levels of analysis
• Opportunities for celebration
• Common areas for improvement
• Site-specific strengths and needs
18
Total Caregiver Fidelity Score
High Fidelity (85% and above)Good Fidelity (75% - 84%)Adequate Fidelity (65% - 74%)
WFI Louisiana - October 2013
Wraparound Fidelity Principles
Outcomes Based
Teamwork Natural Supports
Needs Based Strength and family driven
WFI Total Score
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Wraparound
Adequate
Not Wraparound
Good
High
Strength and Family Driven
Wraparound
Adequate
Not Wraparound
Good
High
B1: Had
a majo
r role in
choosin
g team
B3: Fam
ily described
vision
B11: Celebrat
e succe
sses a
t each
mee
ting
B14: Stra
tegies ti
ed to
family
likes
B17*: Te
am m
embers
do not underst
and fa
mily
Strength
and family
driven
Overal
l0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Satisfaction
DC Indiana Louisiana Maryland Choices0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
I am satisfied with the wraparound process in which my family and I have participated.
% o
f Car
egiv
ers S
tron
gly
Agre
e or
Agr
ee
Outcomes
Cause stress or strain on family
Disrupt home life Interfer with success at school
Difficulty developing friendships
Difficulty participating in community activities
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Quality Improvement
• Multiple Levels– Agency– Programs – Teams
• Multiple Data Sources– Fidelity– Process measures– Outcomes
Conclusions
• Integrate WFI-EZ into practice
• Balance response rates and resources
• Quality improvement requires multiple types of data
• Ongoing assessment is important
Thank You!
Vicki Sprague Effland, Ph.D.Director, Outcomes and EvaluationChoices, Inc.4701 N. Keystone Ave., #150Indianapolis, IN 46205
(317) 205-8232