OAR 309-019-0163: Youth Wraparound Program Rules

(1) Wraparound providers shall: (a) Make eligibility criteria and referral processes available to the public. At a minimum, the following categories of youth shall be eligible: (A) Youth served in two or more child-serving systems and experiencing complex needs; (B) Youth who have been approved by the Wraparound Review Committee. (b) Obtain a mental health assessment within one year of Wraparound referral for youth being served under Medicaid; (c) Provide Wraparound to Medicaid Oregon Health Plan (OHP) members; (d) Implement peer delivered services in accordance with OAR chapter 410, division 180 for youth and families participating in Wraparound; (e) Ensure that youth have access to Wraparound if they are Medicaid-eligible and enrolled in any of the following: Secure Children's Inpatient Program, Secure Adolescent Inpatient Program, Psychiatric Residential Treatment Services, or the Commercial Sexually Exploited Children's residential program funded by the Division; (f) Ensure that program staff, contractors, volunteers, and interns providing Wraparound programs are trained in and familiar with strategies for delivery of trauma informed and culturally responsive treatment services. At a minimum, completion of an online foundational course for trauma informed care approved by the Division shall be required of program staff, contractors, volunteers and interns; (g) Ensure that Youth Partner and Family Partner services have been offered to the youth and family; (h) Ensure team members are selected with the youth and family’s direct involvement and approval; (i) Provide capacity to serve all eligible OHP members into Wraparound. (2) Wraparound providers may not: (a) Require Medicaid-eligible youth to receive services or supports prior to receiving Wraparound; (b) Place any youth on a waitlist. (3) Wraparound team meetings shall: (a) Be facilitated face-to-face or by two-way audio-visual conference or by telephone; (b) Be conducted in the preferred language of the youth and family. Professional interpretation services must be used, if requested by the youth and family; (c) Be scheduled with the youth and family's direct involvement and approval; (d) Ensure decisions are made with the youth and family’s direct involvement and approval. (4) The Wraparound team shall include a Wraparound Care Coordinator (WCC). The WCC shall: (a) Facilitate the Wraparound process to fidelity standards, in accordance with any procedures and standards established by the Authority; (b) Implement the Wraparound process in collaboration with Youth Partners, Family Partners, and other Wraparound team members; (c) Facilitate the Wraparound process for no more than 15 families at any time when in a full-time position; (d) Provide other service or support roles for youth on the Wraparound team they facilitate only when a variance has been approved; (e) Complete a Division-approved Wraparound foundational training within 90 days of the hire date; (f) Receive clinical supervision in accordance with OAR chapter 309, division 019; and (g) Receive orientation and shadowing opportunities, be observed, have documents reviewed, and be coached by a Wraparound Coach as defined in these rules and in accordance with any procedures and standards established by the Authority. (5) Family Partners shall meet the requirements for Family Support Specialists outlined in OAR 410-180-0305. They may receive support or technical assistance from a family organization and shall, at a minimum: (a) Complete a Division-approved Wraparound foundational training within 90 days of the hire date; (b) Receive peer supervision in accordance with OAR 309-019-0130; (c) Provide peer delivered services and supports to no more than 15 families at any time when in a full-time position; (d) Support family members and guardians to: (A) Navigate the child-, youth-, and family-serving systems; (B) Communicate effectively with family members, their support system, and agency representatives; and (C) Make informed decisions to direct the Wraparound process. (e) Provide individual and group support to enable and facilitate meaningful engagement with Wraparound team and service providers; and (f) Assist in connecting the family to resources within the community, support the family through barriers, help family members to acquire tools and strategies for success and advocate for the family's needs, interests, voice, and vision to be heard and thoughtfully considered. (6) Youth Partners shall meet the requirements outlined for Youth Support Specialists in OAR 410-180-0305. They may receive support or technical assistance from a youth organization, and shall, at a minimum: (a) Complete a Division-approved Wraparound foundational training within 90 days of the hire date; (b) Receive peer supervision in accordance with OAR 309-019-0130; (c) Provide peer delivered services and supports to no more than 15 youth at any time when in a full-time position; (d) Have at least one year of relevant lived experience, knowledge of the child- and youth-serving systems, and the ability to navigate the system; (e) Assist the youth to engage in the Wraparound process and support them in expressing themselves to members of their Wraparound team; (f) Assist the youth in identifying community resources, navigating barriers, acquiring tools and strategies for success and bridging the gap between the youth and the adults on the Wraparound team; and (g) Advocate for the youth's needs, interests, voice and vision to be heard. (7) The Wraparound provider shall, gather and compile a strengths and needs summary that is complemented by the Division-approved assessment tools for ages 0-5 and 6-20, as described below as a part of Fidelity Wraparound. Strengths and needs information to gather and compile shall include: (a) Conversations with the youth and family, which shall be conducted at a reasonable time and location chosen by the youth and family; (b) Conversations with team members including formal and natural supports; (c) A review of referral documentation; and (d) Consideration of each one of the following domains: family and relationships, home and a place to live, psychological and emotional, health and medical, crisis and safety, financial, educational and vocational, legal, cultural and spiritual, daily living, substance abuse and addictions, social and recreational. (8) The Wraparound provider shall conduct a strengths and needs assessment tool for each youth enrolled in Wraparound services and supports. The assessment tool shall: (a) Be started within 30 days of enrollment in Wraparound, and updated at least every 90 days thereafter and upon a change in clinical circumstances or other significant event; (b) Be a Division-approved strengths and needs assessment tool for ages 0-5 and 6-20; (c) Be completed by a Wraparound Care Coordinator, Family Partner, or Youth Partner certified in the Division-approved strengths and needs assessment tool; (d) Include strengths and needs of the youth; (e) Incorporate input from the youth, family, and all team members; and (f) Be used to develop a Wraparound plan of care. (9) Wraparound Crisis and Safety Plans shall at a minimum: (a) Be developed and approved by the youth and family in consultation with the Wraparound team; (b) Document the youth and family's definition of crisis; (c) Include within the initial crisis and safety plan at least one strategy to prevent a crisis situation and at least one strategy to use during a crisis situation; (d) Include a list of triggers, warning signs, and recommended de-escalation strategies and supports identified by the youth and family in consultation with the Wraparound Team; (e) Document strategies for risk prevention for existing or anticipated safety concerns; this shall include strategies developed through lethal means counseling to help individuals at risk for suicide and their families to reduce access to lethal means, including but not limited to firearms; (f) Include strength-based strategies for addressing the youth and family's needs when in crisis; (g) Document natural and formal supports approved by the youth and family for crisis response; (h) Be updated at the request of the youth or family, or when clinical circumstances change, including following any placement change, psychiatric crisis, overdose, suicide attempt, police involvement, or other situations identified by the youth or family; (i) Document safety requirements from other child-serving or legal systems; (j) Be culturally and linguistically responsive; (k) Include contact information for resources that the youth and family may use before or during a crisis event; (l) Be provided to the youth and family in a format chosen by the youth and family; and (m) Be available to Wraparound team members. (10) A Wraparound Plan of Care shall: (a) Include a family vision statement developed by the youth and family; (b) Include a team mission statement developed by the Wraparound team; (c) Include strengths and needs derived from the youth, family, the Child and Adolescent Strengths and Needs Assessment, and the strengths and needs summary; (d) Include goals(s) for each prioritized need; (e) Include strategies to achieve the desired outcomes; (f) Include action steps that team members will undertake to meet the needs identified by the youth and family; (g) Documented use of Wraparound flexible funding that supports the mission statement, needs and goals; (h) Be reviewed and updated at each team meeting; (i) Be culturally and linguistically responsive; (j) Be approved by the youth and family; (k) Be made available to the youth and family within five business days of the Wraparound team meeting in the format and language chosen by the youth and family; (l) If desired by the youth or family, include a blend of formal and informal supports; (m) Include a list of team members and contact information; and (n) Be present and discussed at each team meeting. (11) Peer Partner Coaches shall: (a) Be a certified Family Support Specialist or a certified Youth Support Specialist who has, at a minimum, two years of experience as a Traditional Health Worker as defined in OAR 410-180-0305; (b) Demonstrate understanding of the core elements of Fidelity Wraparound such as the ten Wraparound principles and the four phases of Wraparound; (c) Provide peer supervision in accordance with OAR 309-019-0130, including face to face individual and group coaching to Youth or Family Partners a minimum of one time per month; (d) Uphold Wraparound principles as evidenced by coaching notes; (e) Be rater certified in use of the Division-approved assessment tools for ages 0-5 and 6-20; (f) Ensure that Youth and Family Partners are delivering Wraparound to youth and families in a culturally and linguistically responsive manner; (g) Create documentation which demonstrates that coaching is responsive to diverse cultural beliefs, practices, languages, learning styles, and communication as evidenced by written feedback from Youth and Family Partners and Peer Delivered Service Supervisors; (h) be available to provide coaching in the language spoken by the family, when possible, to bilingual Youth and Family Partners and be able to observe meetings and perform document review in the family's primary language without impact on the youth, family or WCC; (i) seek out additional resources when the coach does not have lived experience to provide culturally specific coaching to the Youth or Family Partner; (j) Adapt caseload size to provide adequate time to complete tasks if a WCC is working with a youth or family that requires an interpreter, bilingual services, and other accessibility needs. (12) Wraparound Coaches shall: (a) Have at a minimum two years of experience as a Wraparound Care Coordinator; (b) Demonstrate understanding of the core elements of Fidelity Wraparound such as the ten Wraparound principles, the four phases of Wraparound, and the activities associated with each phase of Wraparound; (c) Complete a Division-approved Wraparound Coaches and Supervisors training within 90 days of the hire date; (d) Meet with the Wraparound Supervisor at least monthly; (e) Provide the following coaching to Wraparound Care Coordinators: (A) For WCCs with less than one year of Wraparound experience: (i) 20 hours of individual coaching, 10 hours of group coaching, and five hours of document review within one year of the WCC's hire date, using the coaching model approved by the Division; (ii) At least 5 of the 20 hours of individual coaching shall occur within the 90-day period before the WCC receives the Division approved foundational training; if the Division approved foundational training is not available or if the WCC is unable to attend during the first 90 days of employment, the WCC must receive biweekly individual coaching until the foundational training takes place; (iii) Within the first twelve months of the WCC beginning to work with youth and families, observe four Wraparound team meetings for each WCC, including one meeting representing each phase of the Wraparound process. (B) For WCCs with at least one year of Wraparound experience, provide 10 hours of individual coaching, 10 hours of group coaching and two to four Wraparound team meeting observations within one calendar year. (f) Utilize the coaching plan created with the Wraparound coach and document to include the names of the Coach and the WCC, the date, and the content of the coaching session; (g) Create documentation which demonstrates that coaching is responsive to diverse cultural beliefs, practices, languages, learning styles, and communication as evidenced by written feedback from WCC and Wraparound Supervisor; (h) Be available to provide coaching to bilingual WCCs inf the language spoken by the family and be able to observe meetings and perform document review in the family's primary language without impact on the youth, family; (i) Seek out additional resources when the Coach does not have shared lived experience to provide culturally responsive coaching to a WCC; and (j) Be rater-certified in the use of the Division-approved assessment tools for ages 0-5 and 6-20. (13) Wraparound Supervisors shall: (a) Demonstrate through experience the ability to understand and articulate core elements of Fidelity practice such as the ten Wraparound principles, the four Wraparound phases, and facilitation components associated with each phase of Wraparound; (b) Be informed of and implement their agency's Wraparound policies and procedures; (c) Complete a Division-approved Wraparound foundational training and Wraparound Coaches and Supervisors training within 90 days of the hire date; (d) Conduct or provide for clinical supervision, in accordance with OAR 309-019-0130, of Wraparound Care Coordinators, Wraparound Coaches, Family Partners, and Youth Partners, and uphold Wraparound principles as evidenced by notes in a supervision log that includes: name, date, and content of supervision; (e) Ensure coaching is provided by the Wraparound Coach and Peer Support Coach; (f) Ensure a coaching plan is written for each WCC, Family Partner, and Youth Partner per the Division-approved Coaches and Supervisor training; (g) Ensure that the provision of Wraparound is culturally and linguistically responsive to the needs of Wraparound Care Coordinators, Youth Partners, Family Partners, youth and families; (h) Adapt caseload size to provide adequate time to complete tasks if a WCC is working with a youth or family that requires an interpreter, bilingual services, or if there are other accessibility needs; (i) Ensure Wraparound Coaches implement coaching plans that are culturally and linguistically responsive; and (j) Be rater-certified in use of the Division-approved assessment tools for ages 0-5 and 6-20. (14) A Fidelity Monitoring Tool (FMT) approved by the Division shall be used to assess fidelity to Wraparound; (a) The FMT shall be offered to youth and caregivers no sooner than six months after a youth has been enrolled in Wraparound; (b) Any youth over the age of eleven may complete the FMT; (c) A parent, guardian, or legal caregiver who knows the youth best and has also participated in Wraparound may complete the FMT; (d) The youth and parent, guardian or legal caregiver shall complete the FMT without the team's Wraparound Care Coordinator present; (e) The FMT shall be offered to wraparound team members when approved of by the youth or family; (f) The FMT shall be administered electronically or in written form, as chosen by the youth and family; and (g) Other approved fidelity tools in addition to the FMT may be administered by the Division. (15) Transitions from Wraparound: (a) Upon completing the Wraparound team's mission statement, the team shall create a transition plan outlining the tasks required for Wraparound to be completed and shall implement the plan; (b) The Wraparound transition plan shall: (A) Outline the mix of formal and natural supports that the youth and family have chosen; and (B) Include a post-transition crisis management plan. (c) The WCC supports the team in creating a transition document that summarizes and highlights the youth and family's functional strengths, lessons learned and successfully used strategies; (d) The team conducts a culturally appropriate activity that acknowledges the end of formal Wraparound; (e) A young adult shall not be made to transition out of Wraparound solely due to attaining the age of 18. Young adults who reach the age of 18 while enrolled in Wraparound shall be offered the option to remain in Wraparound until their mission statement is achieved.