Learning Collaborative WrapCT.org Mary Jo Meyers-2011 [email protected] WrapCT PRESENTS:...

Learning CollaborativeWrapCT.org

Mary Jo Meyers-2011 [email protected]

WrapCT PRESENTS:

PLANNING AND MANAGING TRANSITIONS



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



TRANSITION PLANNING BEST PRACTICES CONT’• Instills hope for a better future

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

• Community resources and available supports are explored well before ending

• Success is celebrated soon and often

• Empowers the Youth and Family 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

• Encouragement and support are provided to the family in a genuine manner

• The ability to be introspective about who’s needs are being met and who’s really having abandonment issues

• The ability to be understood and plan around underlying needs

• Outcome oriented



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

• Let the family acquire its own sense of agency and urgency

• There will be set backs – look for the learning opportunity

• Celebrate transitions the family’s way



THE FOUR PHASES OF THE WRAPAROUND PROCESS – TRANSITION FOCUSED1. Engagement – Learning about the family’s

support system

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.



TEAMS & TRANSITION• Assumptions & Values

• People working together can generate more solutions

• People working together can generate more creative solutions

• People/Families who are hurting deserve all of the people in their lives to be on the same page

• The best teams combine the expertise of the system with the compassion of the family’s people

• In order to have full participation of informal/natural supports, system people will need to accommodate & invite

• Wraparound teams should be learning & doing groups

• Healing comes from acting together



CONNECTIONS AND SUPPORT MAP

Self

Friends Family

Community Work/School



FIRST PHASE OF WRAPAROUND:TEAM DEVELOPMENT• Meet with family & stakeholders

• Get the story

• Gather perspectives on strengths & needs

• Assess for safety & rest

• Provide or arranges stabilization response if safety is compromised

• Explain the Wraparound process

• Identify, invites & orients Child & Family Team members

• Complete strengths summaries & inventories

• Arrange initial Wraparound team planning meeting



SECOND PHASE: PLAN DEVELOPMENT• Hold an initial (or 2) Child & Family Team Plan

Development Meeting• Introduce process & team members• Present strengths & distribute strength summary• Solicit additional strength information from gathered group• Lead team in creating a mission/vision• Introduce needs statements & solicits additional

perspectives on needs from team• Create a way for team to prioritize those needs that will

accomplish mission/vision• Lead the team in generating brainstormed methods to

meet needs• Solicit or assigns volunteers• Document & distribute the plan to team members



RESPONSIVE CRISIS PLANS:• Tells team members how to react

immediately and responsively to the events at hand

• Are practical and realistic

• Builds on functional strengths of the team and community

• Include as many natural and informal supports as possible

• Keeps everybody involved safe



PROACTIVE SAFETY PLANS:

• Aim is to prevent crisis

• Focuses on what to do instead of what not to do

• Is based on needs identified in the plan of care

• Works towards uncovering underlying needs



EFFECTIVE CRISIS/SAFETY PLANS:

• Describe specifically the unsafe behavior

• Analyze function (unmet need) of the unsafe behaviors

• Take the physical aspects of the setting into account

• Describe specifically safe alternative behaviors

• New strategies reflect functional strengths, culture and choices of those involved

• Steps are specific and written in order of use, least restrictive to most



HELPFUL HINTS:

• Keep the plan focused

• Include rules of household, school or community

• Discuss rewards and consequences for safe vs. unsafe behavior

• Consult with people who specialize in needed area of concern

• Watch and plan for regression during stressful times



FAMILY VISION: A DEFINITION• Definition: The family’s vision represents

their goals, hopes & dreams for their own family

• What are the benefits of identifying a family vision?• It helps families recognize the legitimacy of

their own perspective & voice• It creates meaning & purpose for families • It helps professionals validate the right to

the family to have their own perspective• It helps professionals understand the

family’s sense of themselves beyond services & systems.



REMEMBER

• Systems have no obligation to accomplish a family vision.

• Systems create joint goal or mission statements with families but families have a right to “own” their vision even if professionals disagree.



STRENGTHS DISCOVERY

• Look for functional. A list of attributes does not allow you to plan

• Are the key to any transition

• Lead to sustainable plans



NEEDS

• Check first to see if the needs identified when met will lead to the family’s vision

• Uncovering underlying needs leads to a more precise fit of strategies

• Families deserve to have their real concerns addressed



STRATEGIES

• Look to functional strengths first

• Should be written in a manner in which all team members know what their job is

• Should be reviewed for progress at least monthly



THIRD PHASE: MANAGING ONGOING PLAN OF CARE MEETINGS1. Accomplishments – Check with family first

2. Assess progress – Check for needs met not just services delivered

3. Adjust the plan – Remember you are planning for transition

4. Assign new tasks – Use the team!



ESTABLISH YOUR ANCHORS

• Anchors may be

• Goals

• Results

• Outcomes

• Define what life would like if the identified need were met

• Allows you and the team to define the destination



TIPS FOR ESTABLISHING YOUR ANCHORS• Create a view

• Future view of a household• “Normalized” view of a typical situation

• Create easy “counts”• Avoid anything that makes too much work• Percentages work/impression counts

• Identify the frequency of summary• Weekly, monthly, at least quarterly

• Ask the team to review the “facts”• Summarize the details• Graphs or Charts

• Bring a summary to the meeting



TIPS FOR CREATING YOUR ANCHORS• Avoid the control and compliance view

• Rather than he must go to school it should be he will attend school because …

• Keep teams from going off track

• Avoid over complicating

• Limit your indicators to no more than five

• Impressions count, ask the family to give you a report

• Use your outcomes to guide the team

• Bring your summary, discuss it rather than falling into the detail trap



FOURTH PHASE OF WRAPAROUND:PLAN COMPLETION & TRANSITION• Hold meetings

• Solicit all team members sense of progress• Chart sense of met need• Has team discuss what life would be like after

Wraparound• Review underlying context/conditions that brought

family to the system in the first place to determine if situation has changed

• Discuss the what if?• Facilitate approach of “post-system” Wraparound

resource people• Formalize structured follow-up if needed• Record accomplishments; what worked, didn’t work• Create a commencement ritual appropriate to family &

team



FOURTH PHASE OF WRAPAROUND:PLAN COMPLETION & TRANSITION• Completed Products

• Written Transition Plan that details how to access ongoing services/supports if necessary

• Written crisis plan that details who & how to contact individuals

• Follow up phone numbers for team members

• Formal Discharge Plan detailing strengths & interventions that were successful & those that weren’t

• Written letters of introduction for anticipated next formal service access



ELEMENTS OF GOOD TRANSITION WHEN COMPLETING THE FORMAL WRAPAROUND PROCESS

• Families have some sense of what comes next

• Families have increased confidence in their own abilities to make their own vision real

• Families have a sense of connection to various team and community members

• Families know what to do if things go wrong

• Families are able to chart & recognize their sense of progress since the beginning of formal Wraparound



TRANSITION PORTFOLIO• Transition portfolio contains the plan including a

crisis/safety plan and all supporting documentation

• It has multiple purposes:

• Help the family see what they have accomplished

• Remind the family of effective recovery strategies they can use

• Help other agencies down the line know what worked, what didn’t and who to call

• Help the family know who to call



EFFECTIVE TRANSITION PLANS• Begin early in the Wraparound Process

• Build on what has been accomplished

• Shift the balance of activity from the system to the community

• Assure needs and outcomes have been met

• Answers the questions of what will it take for the child to do well at home, in school and in the community

• Support rather than abandon the family



FOUR BAD REASONS FORTRANSITIONING OUT OF WRAPAROUND

• Team is out of money

• Team is out of ideas

• Team is out of hope

• Team is out of patience



TRANSITION:

CHALLENGES AND SOLUTIONS ACTIVITY



WrapCTLEARNING COLLABORATIVE

Our vision as a statewide learning collaborative is that all children, youth, and families are able and capable of achieving optimal levels of

functioning at home, in the community, at school and/or work.

WrapCT Steering Team

• Jan Bendall, Rushford; Ray Bieber, Child & Family Guidance; Tim Bowles, SEMHSOC; Jill Coffin , U CF S; Dorothy Contrastano, FAVOR; Tim Cunningham, Wellpath; Paloma Dee, NAMI, CT; Nicole DeRobertis, MFCGC; Hal Gibber, FAVOR; Victor Gonzalez, Wheeler Clinic-Hrtfd; Gabrielle Hall, Clifford Beers; Mary Held, Waterbury FFP; Katy Keegan, West Haven – Bridges; Virginia Lopez, Child & Family Guidance; Tim Marshall, DCF; Tabor Napiello, Wheeler Clinic-Plainville; Kristen Penta, Bridgeport Schools; Mark Plourd, Wheeler Clinic-Hrtfd, Cheryl Tedesco, Child & Family Guidance; Paige Trevethan, Bridges; National Consultants: Verneesha Banks, Wraparound Milwaukee; Mark Horwitz, Westfield State Univ.; Mary Jo Meyers, Wraparound Milwaukee

Contact information for WrapCT: Tim Marshall 860-550-6531; [email protected]

Contact for training material: Mary Jo Meyers 414-251-7521; [email protected]

Learning Collaborative WrapCT.org Mary Jo Meyers-2011 [email protected] WrapCT PRESENTS:...

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