Implementation
What are the implementation requirements for Wraparound?
High quality implementation of Wraparound requires a supportive organizational context as well as a hospitable system context. The NWI’s Implementation and Practice Quality Standards describe in detail the organizational and system features that are required for high quality implementation of Wraparound. An overview of these features is described below. Putting these organizational and system features into place is complex work, and thus many communities seek out consultation, such as technical assistance from the National Wraparound Implementation Center (NWIC), and evaluation and data support from the Wraparound Evaluation and Research Team (WERT).
Organization-level implementation support
A supportive organization ensures that necessary conditions are in place to promote high quality practice. For example, ensuring that staff acquire the skills and competencies they need to carry out their roles in Wraparound, caseloads are reasonable, compensation is adequate, and data is collected and analyzed so that the organization can monitor practice quality and program outcomes. NWIC has developed tools that outline all these program and system conditions in detail and uses resulting data to manage change at the program or organizational level.
System-level implementation support
Providing comprehensive Wraparound care also requires substantial effort at the system level, including financing strategies, data and accountability infrastructure, and collaboration among child- and family-serving agencies, state Medicaid entity, and others. Agencies and organizations need to work together to provide access to flexible resources and a well-developed array of services and supports in the community. In addition, other community- or system-level supports are necessary for Wraparound to be successfully implemented and sustained.
Research on Wraparound implementation has defined these essential community and system supports for Wraparound, and grouped them into six themes:
Community Partnership
Representatives of key stakeholder groups, including families, young people, agencies, providers, and community representatives join together in a collaborative effort to plan, implement, and oversee Wraparound as a community process.
Collaborative Action
Stakeholders involved in the Wraparound effort work together to take steps to translate the Wraparound philosophy into concrete policies, practices, and achievements that work across systems.
Fiscal Policies & Sustainability
Representatives of key stakeholder groups, including families, young people, agencies, providers, and community representatives join together in a collaborative effort to plan, implement, and oversee Wraparound as a community process.
Access to Needed Supports & Services
The community develops mechanisms for ensuring access to the Wraparound process, as well as to the services and supports that Wraparound teams need to fully implement their plans, including evidence-based interventions.
Human Resource Development & Support
The system supports staff, and partner agency staff to fully implement the Wraparound model and to provide relevant and transparent information to families and their extended networks about effective participation in Wraparound.
Accountability
The community implements mechanisms to ensure the appropriate populations of young people are enrolled in Wraparound; to monitor Wraparound fidelity, service, quality, and outcomes; and to oversee the quality and development of the overall Wraparound effort.
Comprehensive implementation support
High-quality Wraparound requires more than training practitioners. Implementation science emphasizes the importance of building aligned organizational and system conditions that support consistent, sustainable practice. These conditions include engaged leadership, a prepared and supported workforce, effective coaching and supervision, supportive policies and financing, clear accountability structures, and the ongoing use of data to guide quality improvement.
For more information, explore NWI’s Wraparound Implementation and Practice Quality Standards and Implementation Guide. Contact the National Wraparound Implementation Center (NWIC) for technical assistance with assessing readiness, developing implementation infrastructure, strengthening practice quality, and sustaining Wraparound over time. UW WERT can also provide guidance on evaluating fidelity, outcomes, and costs.
What specialized staff roles are needed for the Wraparound process with families?
Wraparound is an individualized process designed to meet the needs of each young person and family who are being served. Across Wraparound programs, people in a variety of different roles–both professional and non-professional–play important roles. Most typically, implementing a Wraparound project requires a cadre of individuals who are trained and supported to effectively lead the process. These individuals include Wraparound care coordinators (or facilitators), family support partners, and youth support partners. Additional professionals may play important roles in carrying out the Wraparound process in a community. These professionals include clinicians trained in research-based practices to address psychosocial needs, in-home behavioral support specialists, resource coordinators, and others.
What about training and support staff? What is required?
Professionals carrying out the Wraparound process require substantial training, as well as ongoing coaching and supervision, to build and maintain the knowledge and skills they need to best serve young people. This applies not only to the care coordinators managing the process, but also to the providers in the service array–all of whom need to be supported through training and coaching to use evidence-based strategies and interventions. Most Wraparound projects rely, to some extent, on outside partners for training and for consultation on best practices in staff development and quality assurance. The NWI launched the National Wraparound Implementation Center, which provides training, coaching, and systems-level supports that, when combined, facilitate the development of local expertise and sustainability. Regardless of who provides Wraparound training and staff skill development, the NWI urges sites and states to follow the guidance described in its comprehensive Guidelines for Training, Coaching and Supervision for Wraparound Facilitators.