Quality
and Fidelity in Children’s Mental Health Interventions
The current issue of Focal Point
highlights some of the challenges associated with ensuring high
quality programs and practice in Wraparound (also known as Individualized
Service/Support Planning or ISP). Wraparound has become one of the
most popular mechanisms for planning and delivering services and
supports for children with emotional and behavioral disorders and
their families. However, achieving high quality in Wraparound programs
and practice appears to be quite difficult. Challenges arise because
successful implementation of Wraparound requires that many people
learn to do things differently. For example, Wraparound requires
that
- Service providers acquire the skills and techniques that enable
them to carry out high quality practice;
- Service providers partner with family members and collaborate
with members of families’ informal and community support
network;
- Service providers collaborate with each other across agency
boundaries; and
- Managers and administrators in agencies and larger systems work
together to support their workers’ collaboration, and to
provide access to flexible funds and an array of appropriate,
community-based services.
These kinds of challenges are not unique to Wraparound. Successful
implementation of practice and program innovations in children’s
mental health almost always requires focused, sustained efforts
at the practice level, the supervisory level, and the managerial/administrative
level. Successful implementation requires know-how, commitment,
resources, and patience across all of these different levels. Where
these are present, there is potential for significant improvements
not only in client outcomes but also in provider morale. Yet all
too often, one or more of these key ingredients is missing, and
a promising approach becomes instead the latest example of a service
fad that didn’t work.
The Fall Focal Point
issue focuses on what we have learned about “what it takes”
to do Wraparound right. Here, we would like to expand the discussion
by inviting your comments on implementing high quality practices
and programs in children’s mental health. We are interested
in hearing from you about
- Your thoughts or reactions to any of the articles in the current
Focal Point issue;
- Your experiences with successful or unsuccessful implementation
of a new practice or program;
- Your recommendations regarding models, resources, strategies,
or supports that can help guide or inform implementation efforts;
or
- Your anecdotes, ideas, or opinions related to this theme.
As always, we look forward to hearing from you.
We value your responses!
Janet S. Walker,
Web editor
Your
thoughts…
Comments:
 In my experience I have found that the most difficult barrier to overcome in attempting to deliver wrap-around services is in dealing with systems more interested in perpetuating on-going programs than in developing services specific to meet the needs of an identified child/family. I would truly appreciate any advice on getting systems (e.g. mental health, juvenile justice, Drug and Alcohol,education,Children Services, etc) to work cooperatively to develop programming committed to providing what is needed in order to maintain children within their homes and communities. As a provider we seem to be preaching to deaf ears as most systems (and providers as well)in our community focus on sustaining services through grants, and attempting to fit children into programs as opposed to designing services for the target family. "Turf" issues seem to be more salient than the needs of service receipiants.Any recommendations would be appreciated. Meanwhile, keep up the good work. Posted Monday, November 24, 2003 by Harvey Kayne, Ph.D. at 01:14 PM
I have read the articles in Focal Point and become aware of the need to define practice and then measure fidelity to it. I look forward to reading about further developments. Posted Sunday, October 26, 2003 at 08:52 AM
I thought the articles in Focal Point were great, and they gave me a lot to think about. As someone who facilitates team meetings, it was really important to me to hear people saying that it really is hard, and offering some ideas for how to do it better. Thanks. Posted Wednesday, October 22, 2003 at 08:33 AM
In education, there is discussion of "communities of practice" which, if I have it right, refers to the idea that people who want to make changes in their teaching need to have continual discussion and interaction about what they are trying to do, why they are trying to do it, and how they can make it happen. I believe the idea is to recognize that changing practice is difficult and that people need to go through a deep/long developmental process if they are going to get to a level of expertise that will make a difference to the children they teach and their outcomes. This seems like an idea that applies equally well to practice with clients or consumers of services-- the previous posts have pointed out that mostly there doesn't seem to be a real appreciation of how much effort and support it takes to make change happen or to learn something new. I would agree with this. In our rush to do everything quickly, we seem to always be trying the next thing without taking the time or providing the support to really do something right. This is very stressful and probably contributes to burnout. Posted Tuesday, October 21, 2003 at 04:06 PM
Learning to do something new in practice or skill is a strange process. I think you can't really understand something until you actually are able to do it. Then you have the AHA! that you "get it." If you are really going to learn how to do something new you need support (from co-workers, supervisors, etc) and a kind of constant pushing until you get to that point. Otherwise I think you just basically go about things the way you always have. Also often there is no commitment from the people who are telling you you need to do this new technique or skill or approach. They say "we're doing this new thing" but then don't give the time or money or training you really need to learn or practice or do the paperwork or the extra activity that is associated with the new thing. Because of these and other difficulties, I think many people who are supposed to be doing the new thing just assume that it will come and go and the easiest thing is just to sort of pretend to do it for a while until nobody cares any more. Posted Tuesday, October 21, 2003 at 03:47 PM
My experience is often that "implementation" of a new technique or skill set is done exclusively through a small number of training sessions. There rarely seems to be much followup to see if anyone is actually trying to do what was taught. We might discuss in group or individual supervision some things that we have been taught but doing things in a new way usually seems to take back seat to the ongoing challenges and difficulties. Posted Tuesday, October 21, 2003 at 02:56 PM
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