High Fidelity Wraparound (HFW)
Center of Excellence: Resource Center for Family-Focused Practice (RCFFP) at UC Davis Human Services
Summary
High Fidelity Wraparound (HFW) is a team-based, family-centered service for children and youth living with complex mental health or behavioral challenges. HFW is an intervention designed to help the youth stay at home with their families/caregivers, in school, and in the community. HFW is also designed to help the youth’s family, caregivers, and natural supports understand the youth’s needs and learn how to support them in navigating complex mental health and/or behavioral challenges. HFW is not a prescribed set of services but instead organizes a collaborative planning process that brings together the youth and family/caregivers, natural supports, and involved providers to develop and carry out an individualized plan.
Pursuant to the Behavioral Health Services Act (BHSA), counties are required to implement HFW as part of their Full Service Partnership (FSP) component.
Clinical Appropriateness
Appropriate for: Children and youth living with complex mental or behavioral health challenges.
Child and Adolescent Needs and Strengths (CANS) Decision Support Criteria for Youth Ages 6-20: DHCS is establishing HFW Decision Support Criteria (DSC) using the CANS to support clinicians in determining clinical appropriateness of HFW for youth ages six to twenty in Medi-Cal and FSP. Clinicians will review the CANS domains for Behavioral Emotional Needs, Risk Behaviors and Caregiver Needs when determining when HFW is appropriate for a youth.
Please see the HFW Policy Manual for more details.
Age
- Youth ages 6 years and older.
- Transition Age Youth (TAY) ages 21-25 may receive HFW under BHSA FSP programs if determined clinically appropriate.
- Youth ages 0-5 may receive Medi-Cal covered HFW when the service is deemed medically necessary and recommended by a Licensed Mental Health Professional (LMHP) acting within their scope of practice and authorized to direct services under the California Medicaid State Plan.
Other Considerations
In limited circumstances, a licensed mental health practitioner (LMHP) may still recommend HFW as medically necessary and clinically appropriate even if a youth does not meet the HFW Decision Support Criteria. DHCS expects that these “edge cases” in which an LMHP identifies and recommends HFW as a SMHS intervention but the youth does not meet HFW DSC will be limited. Please see the HFW Policy Manual for more information and examples of these cases.
For youth for whom an LMHP determines HFW is not clinically appropriate, county behavioral health plans (BHP) must coordinate referrals for appropriate Specialty Mental Health Services (SMHS) and Non-Specialty Mental Health Services (NSMHS), consistent with current contractual requirements.
HFW is delivered in home- and other community-based settings, and, as necessary, to support continuity of care during transitional periods into and out of inpatient and residential settings. HFW is characterized by the following ten principles:
- Family Voice and Choice
- Strengths Based
- Individualized
- Natural Supports
- Community-Based
- Culturally Respectful and Relevant
- Team-Based
- Collaboration
- Outcome-Based
- Persistence
HFW includes four phases and associated key activities, with flexibility to align services and supports with youth and family-identified strengths and needs:
- Engagement and Team Preparation
- Plan Development
- Implementation
- Transition
HFW is a multidisciplinary, team-based service. Each youth receiving HFW will have a team that includes both paid supports (HFW provider) and natural supports (such as caregivers or others) selected by the youth and caregivers. The team should prioritize the youth and their caregiver(s)/family at the center of decision-making. For the Indian youth, the team should also include input from the youth’s Tribe.
The Medi-Cal HFW staff consists of paid supports staffed by the HFW provider that provide key HFW service activities (outlined below) to the youth. HFW team roles may include:
- Facilitator
- Caregiver/Parent Peer Partner
- Family Specialist
- Youth Peer Partner
- Supervisor
- Clinician
- Fidelity Coach
- Community Developer
HFW providers should work with each youth and family to individualize the HFW team based on youth and family choice. While some roles may not be needed for a youth based on their individualized plan of care, a HFW facilitator is required for all youth receiving HFW. Key functions required of HFW teams include:
- HFW Facilitation and Care Coordination, Care Planning and Documentation
- CANS Updates
- Crisis Support and Safety Planning
- Strength Based Psychoeducation and Psychosocial Skills Coaching for the Youth
- Parent/Caregiver Peer Support
- Youth Peer Support Referrals and Coordination
- Care Transition Support
HFW provider sites must collect data on member outcomes to ensure HFW is effective. The HFW COE will require every HFW provider site to use WrapStat. The WrapStat is used to collect member outcomes data, including data from the Document Assessment and Review Tool (DART), Wraparound Fidelity Index – Short Version (WFI-EZ), and additional questions within WrapStat.
Any member of the HFW team who has access to WrapStat can collect member outcomes data. To complement data collected by HFW provider sites, the COE will also engage with caregivers of youth receiving HFW to complete the WFI-EZ annually from a representative sample of youth enrolled for a certain timeframe (e.g., between 3 and 15 months).