Hope is the thing with feathers - That perches in the soul- And sings the tune without the words - And never stops - at all - Emily Dickinson Progress on Quality Assurance: Cuyahoga County Wraparound Jane Timmons-Mitchell, Ph.D. Targeted
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Presentation Transcript
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“Hope” is the thing with feathers - That perches in the soul- And sings the tune without the words - And never stops - at all - Emily Dickinson<br>
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Progress on Quality Assurance: Cuyahoga County Wraparound Jane Timmons-Mitchell, Ph.D. Targeted RECLAIM
Oct. 26, 2018<br>
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Fidelity Monitoring in Wraparound In Cuyahoga County, Wraparound Fidelity has been monitored for 6 agencies as part of a project with the Department of Children and Family Services
The Wraparound Fidelity Index v. 4, WFI-EZ, is a brief instrument completed by caregivers, facilitators, and youth enrolled 60 days or more.
The WFI-EZ contains four parts: fidelity, system level outcomes, functioning outcomes, and satisfaction.
In addition, recidivism outcomes for Wraparound involved youth were analyzed.<br>
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Wraparound Fidelity The WFI-EZ fidelity scoring is derived from endorsing 25 items using a 5 point Likert type scale which is scored from 0 to 4.
Items load into five domains, including Effective Teamwork, Natural Supports, Needs-based, Outcomes- based, and Strength and Family Driven.
Examples of items include:
Our wraparound team’s decisions are based on input from me and my family
At every team meeting, my wraparound team reviews progress that has been made toward meeting our needs.
At each team meeting, our wraparound team celebrates at least one success or positive event.
Members of our wraparound team sometimes do not do the tasks they are assigned.
Because of wraparound, when a crisis happens, my family and I know what to do.<br>
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Cuyahoga County WFI-EZ Scores Compared with National Mean<br>
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System Level Outcomes The outcomes domain is measured by yes/no questions for the system level outcomes; endorsement of these items can be interpreted as percents.<br>
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WFI-EZ System Level Outcomes<br>
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WFI-EZ System Level Outcomes<br>
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Functioning Outcomes Functioning outcomes are measured using a 4 point Likert type scale ranging from 0 through 3, and questions measuring satisfaction outcomes use a 5 point Likert type scale ranging from 0 through 4.<br>
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WFI-EZ Functioning Outcomes<br>
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WFI-EZ Functioning Outcomes<br>
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Caregiver Satisfaction Caregivers are asked to rate, from Strongly Agree to Strongly Disagree, how satisfied they are with Wraparound services based on the items.<br>
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WFI-EZ Satisfaction Item Level Means<br>
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WFI-EZ Satisfaction per Caregiver<br>
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Juvenile Justice Outcomes A total of 849 clients were included in this analysis, including 781 clients in the Wraparound and 68 in the comparison group (referred but not engaged)
compared on time from disenrollment to first recidivism using the log-rank test.
Kaplan-Meier and Cox proportional hazards regression were calculated.<br>
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Juvenile Justice Outcome The mean time from discharge to recidivism was 826 days (standard deviation: 22 days) in the Wraparound group and 534 days (standard deviation: 50 days) in the comparison group. Overall, the time from disenrollment to recidivism was statistically significantly longer (better) in the Wraparound group than in the comparison group
Of youth with new charges, 70% were misdemeanors and 30% were felonies<br>
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Beginning at 9 months after discharge, recidivism was significantly lower in the group that received High Fidelity Wraparound.
Log-rank test P-value = 0.0003,<br>
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Fidelity is often a good predictor of outcome
BUT it can take a long time to establish Outcomes.
By monitoring Fidelity, you can approximate outcomes that you will eventually be able to track.<br>
