Wraparound- based Transition Planning

Presented by:Mary Jo Meyers, M.S.

Transition Planning Best Practices:

Begins on day one Utilizes the family’s expertise in problem

solving Is discussed and planned for at each plan

of care meeting Requires exceptional crisis/safety planning Utilizes the Wraparound process in a

planful and concise manner Instills hope for a better future

Transition Planning Best Practices cont’

Utilizes a well balanced team consisting mostly of natural/informal supports

Providers coach and practice helpful and sustainable skills and techniques with families prior to transitioning out

Community resources and supports are explored well before ending

Success is celebrated soon and often The youth and family are able to mobilize

their own team as needed

Necessary Skills for Facilitators

The ability to communicate and behave with confidence and reassurance

Good planning and organizational skills A working understanding and use of the

components of the Wrap Process The ability to be introspective about

who’s needs are really being met The ability to uncover and plan around

underlying needs The ability to remain focused on

families’ desired outcomes

Families deserve to know they are transitioning to something rather than away from something

Tips for Transition Planning

Negotiate transition with the full team Allow Family Voice to be heard about

transition Plan for interventions to fade over time Set clear transition benchmarks Use life domains as a guide for system

exit

Tips for Transition Planning

Keep track of incremental progress – no matter how small the increments

Expect and plan for set backs – look for the learning opportunity

Celebrate success and transition the family’s way

Leave the family with a clear plan and real way to access help when needed

The Four Phases of the Wraparound Process – Transition Focused

1. Engagement– Learning about the family’s strengths, support system, and building hope for a better future

2. Planning– Bringing existing supports in and deciding how to build new supports

3. Implementation– Building bridges to the community, enhancing or enlarging competency, creating opportunities for a better life

4. Transition– Help is in place. Team is mobilized to act when needed.

Phase One- Engagement

If transition begins on day one then what does an effective first visit look like?

Facilitator allows time and space to really listen Facilitator clearly explains the Wraparound process

letting the family know there is an end point Facilitator meets immediate needs Facilitator begins exploring the family’s support

system Facilitator ends first visit by creating hope for the

future

Activity: In pairs or small groups discuss what else is needed for a first visit to set the stage for effective transition planning. Be prepared to report out.

Strengths and Transition Planning

For a strengths discovery to utilized for effective transition planning it must be:

Robust in nature Reflective of the family’s culture,

preferences and skills Well-rounded in that it reflects all family

members, their supports and community

Activity: Review the plan(s) you have in front of you and evaluate the strengths discovery for effective transition planning. Be prepared to report out on what you have found

Teams and Effective Transition Planning

Good Facilitation requires setting the stage in the first visit about what makes Wraparound unique

Normalize the process of bringing support to the table for planning purposes. Be prepared to give examples

Set a calendar of both visits and team meetings as soon as possible and establish a mechanism for team member invites/reminders

Establish roles and responsibilities early in the process to keep everyone on task and invested.

Utilize the family’s preferences and interests to add team members as needed

Remember the families who transition the earliest and with the most success have a support system in place to allow this to happen. It is our job to help them get there

Activity: Evaluate the team list on the plans you have brought. Is the mix of formal and natural/informal where it should be? Have you established a routine where teams know what is expected of them?

Family Vision and Transition Planning

• Provides a clear sense of what a better future would look like

• Is written in language that is meaningful to the family

• Reflects the whole family’s hopes and dreams• Provides the family with ownership of their

plan and sets the stage for them to think beyond system involvement

Activity: Evaluate the vision statement of the plan(s) you have to determine if the vision meets the above criteria.

Needs Statements in Effective Transition Plans

• Go beyond the surface of problems or behaviors and represent the underlying reasons or root causes

• Answer the question why?• Are enduring in nature and reflect cause

or meaningful desire rather than action• Are prioritized to deal with the “big stuff”• When met will lead families closer to

their vision

Will the “real need” stand up?

Sam needs help on his school work Tammy will stop cutting on herself The Smith family wants counseling Sarah deserves to be in a loving and safe home Billy wants help understanding his angry

outbursts Jason wants to be accepted for his choices in

partners

In pairs discuss and determine which need statement(s) could be utilized in an effective plan that would lead to transition? Be prepared to report out which need(s) you chose and why.

Benchmarks- The Key to good transition planning!

Benchmarks should: Represent what the team/family would see if a behavior

changed or diminished Be measurable in a realistic way (Scaling, counts, time

increments) Be attainable Reflect positive: more of what is wanted rather than not Represent steps that would get the family/team closer to

the need being met; answers the question, if this need were met the behavior we would see is________.

Activity: Using the plan(s) you have brought, review the need statements and corresponding benchmarks based on the criteria from this slide and the previous slide. Be prepared to report out on what you have learned.

Strategies and Effective Transition Planning

Do the strategies demonstrate a clear call to action by the team

Do team members have delineated tasks and responsibilities Are time frames in place Have meaningful strengths and preferences been included in

the strategies Do the strategies reflect more natural/informal supports

rather than formal systems or providers Do the strategies lead to benchmark accomplishment Have the formal team members contributed strategies that

reflect teaching and coaching of their skills and techniques? Is the family’s community reflective in the strategies?

Activity: Review the strategies on the plans you have brought based on the above criteria. What would you do to improve the strategies to promote a smoother transition for the family they apply to?

Crisis Plans and Transitioning

• Tell the family how to react immediately and responsively to the events at hand

• Need to be practical and realistic• Describe specifically safe alternative

behaviors• Contain steps that are written in order

of use, least restrictive to most• Have been rehearsed and are

accessible in times of need

Transition Crisis Plan Checklist

Crisis plan holds meaning to family Is not reliant on formal services List supports that are available when needed Steps are in place that are clear and are applicable

to the environment(s) in which the crisis may occur Tells the adult(s) in charge not only what to do but

how to do it calmly Is concise and accessible if/when needed

Activity: Using the plans you have brought, review the crisis plans using the criteria on the previous slide and this one. How would you improve the current plans to prepare the family for transition? Be prepared to report out on what you have found.

Tips to keep Teams on Track

Meet as least monthly Use the process to evaluate progress Add to the strengths list as you go Review the Vision for accuracy Continue to uncover and prioritize underlying needs Assess progress by checking the benchmarks; needs closer

to being met not just services delivered Provide the team with tangible evidence of progress Change the strategies as needed to meet the benchmarks Add natural/informal supports to the team and keep

everyone invested with a task or responsibility Celebrate success along the way Keep the process creative, fun and moving

Transition Portfolios

Contain the following: A copy of the final plan of care A crisis plan that has been tried or rehearsed by the

family Numbers to call for help if needed in the future A copy of any educational plan or evaluations that

have been done A letter of introduction or set of references for future

involvement with potential jobs, schooling, etc A certificate of accomplishments

Activity: In pairs or small groups, brainstorm other items that may be helpful to add to a transition portfolio. Be prepared to share your ideas with the large group.

Five Bad Reason for Transitioning out of Wraparound

1. The program mandates your ending time

2. The money has run out3. The team is out of ideas4. The team is out of patience5. The family, team or facilitator has lost

hope

Effective Transition Plans

Begin the process of transition early Build continuously on strengths and

accomplishments Shift the balance from system activity to

community activity Assure the prioritized needs have been met to the

point of the family being able to do it on their own Support rather than abandon the family Lets the family know they are able to call and run

their own team meetings when needed Gives the family the sense of connection and

support by those that love and care about them

For more information contact:

Mary Jo Meyers, Consultant and TrainerE-mail: consultmjm@hotmail.com