Moving from Principles to Practice: Recommended Policy Changes to Promote Family-Centered Care

This paper emphasizes the value of family-centered care. Discussion highlights family-centered philosophies (e.g., Systems of Care [SOCs]) and practice models (i.e., wraparound) and identifies discrepancies between conceptualizations and actual practice. Data from multiple sources detail issues in fidelity to family-centered values and needs and risks experienced by siblings of children with severe emotional disturbance and their caregivers. This discussion provides a springboard for policy recommendations to strengthen family support programming and enhance family-centered care, from modifying funding streams such that systems extend their reach beyond children with full-blown, diagnosable problems (those meeting standards of "medical necessity), to supporting prevention and early intervention initiatives that address families as targets for intervention. Recommendations include ensuring that communities with SOC funding address the needs of families; broadening Medicaid rules and definitions; expanding the range of reimbursable activities and services; and increasing funding for evaluating family-centered care models and family support programming.     

The Impact of Child and Family Team Composition on Wraparound Fidelity: Examining Links Between Team Attendance Consistency and Functioning

Although a growing body of literature has examined wraparound implementation and fidelity, child and family team (CFT) members’ levels of participation and the consistency of their attendance have not been systematically examined. This study explored the relationship between CFT member attendance consistency and the fidelity of wraparound team level implementation processes in a System of Care (SOC). Specifically, utilizing Participant Rating Form (PRF) data collected from caregivers, facilitators, youth, supportive persons, and service providers, as well as meeting attendance records, the relationship between team attendance consistency and fidelity of wraparound implementation was explored. Records for 88 teams, with a total of 2,643 members’ ratings of CFT meetings between 2004 and 2009, were examined. Analyses indicate that the structural team factors of attendance consistency and mean team members present relate to CFT members’ ratings of team functioning and the degree to which meeting processes are consistent with the tenets of wraparound. Team attendance variables related to the views of meeting functioning by facilitators, service providers, and caregivers, the individuals most often responsible for implementation of the plan of care, but not ratings by youth or supportive persons. These findings have implications for policy and the successful implementation of wraparound, underscoring the relevance of attending to and tracking the composition of the CFT and more actively encouraging consistent meeting attendance. Results also highlight the need to measure structural variables that may have salience in fidelity and implementation assessments and, more globally, the effectiveness of SOCs.     

Practical Disadvantage,Socioeconomic Status,and Psychological Well-Being Within Families of Children with Severe Emotional Disturbance

Although socioeconomic status (SES) has been associated with a myriad of physical and psychological health indicators, it is arguably one of the most elusive constructs in the psychological literature. Most researchers agree that SES is complex and multidimensional; however, the majority of empirical studies that focus on SES do not measure (or attempt to measure) multiple components of the construct, instead focusing on one or two indicators of SES, most commonly household income and/or levels of education. This paper explores relationships among indicators of SES, disadvantage, and psychological well-being in two independent samples of families with children with severe emotional disturbances. In addition to utilizing two common SES indicators (parental education and income), we incorporated measures reflecting resource-related challenges of living, such as adequate food and housing. Based on analyses, we argue that such variables may better capture the challenges experienced by many families than traditional SES indicators. Findings also suggest that income and education relate to different aspects of family well-being, and solely using one or both of these variables may mask relevant relationships. Moreover, assessing practical, day-to-day challenges may permit a more nuanced picture of the relationships between factors associated with SES and indicators of well-being and adjustment.