The Centers for Disease Control and Prevention estimates that one in five children or youth may at some point have a serious emotional, mental, or behavioral disorder such as attention-deficit/hyperactivity disorder or conduct disorder. They may receive services from clinicians, social workers, and other mental health professionals. “Wraparound” is a comprehensive, team-based program providing individualized services to children and youth with serious mental health conditions and available in most states. Youth enrolled in Wraparound are usually involved with multiple service systems, such as foster care, juvenile justice, and state mental health systems. Wraparound teams typically consist of the youth, family members or caregivers, people from the family’s network of social support, professional service providers, and a care coordinator, who meet regularly to coordinate the youth’s treatment plan. Wraparound is intended to prioritize youths’ goals and preferences in their treatment plans. However, past research has shown that oftentimes youth do not actively participate in their Wraparound meetings. Youth may be hesitant to discuss their feelings openly with parents or other authority figures, and disagreements may arise between the youth and other team members regarding mental health treatment and other decisions. In a recent NIDILRR-funded study, researchers tested a brief coaching program called Achieve My Plan (AMP), in which youth were coached on how to be more involved in their Wraparound team meetings, while their care coordinators were also trained in basic strategies for making team meetings more hospitable to youth participation. The researchers wanted to see if this training and coaching package would help youth feel more involved in their treatment and whether it would improve the quality of the team meetings.
Researchers at the Rehabilitation Research and Training Center for Pathways to Positive Futures enrolled 55 youth in a study. All of the youth were 12-18 years old and receiving Wraparound services in Portland, OR. To qualify for Wraparound, these youth all had, or were at risk for, emotional, behavioral or substance use issues, and all were involved with at least two service systems at the same time, such as foster care and juvenile justice. The researchers divided the youth and their Wraparound teams into two groups: an experimental group who received the AMP coaching, and a comparison group who just participated in their usual Wraparound program.
The youth in the experimental group had three one-on-one coaching sessions with a trained social work student serving as coach. The coaching sessions were designed to help the youth prepare for their next regularly scheduled Wraparound team meeting. At the first session, each youth identified long-term life goals as well as short-term, concrete action steps they could take toward meeting those goals. In the second session, each youth worked on setting the agenda for the Wraparound team meeting and deciding which sections of the meeting to lead. During the third session, each youth practiced what he/she might say during the meeting and, with guidance from the coach, discussed how to handle unexpected problems that might come up at the meeting. The coach attended the next scheduled Wraparound meeting, where the youth drove the discussion, to provide support to the youth as needed, such as reminding the team to speak directly to the youth during the discussion instead of about them. After this “target” team meeting, the coach checked in briefly with the youth to review goals and actions and plan for the next Wraparound team meeting. The coach also attended this next meeting to lend support, then handed off coaching to the young person’s care coordinator thereafter.
To find out whether the coaching increased youth perceptions of involvement, the youth in both the experimental and comparison groups were interviewed before coaching started, after the target team meeting, and after two additional Wraparound meetings. At each interview, the youth answered questions about how prepared they felt before the meeting and how much their ideas were reflected in the treatment plans. They also answered questions about their perceptions of “working alliance” between themselves and members of the team, including their sense of bonding, team cohesion, and agreement on treatment goals and actions. The youth, care coordinator, and other team members also filled out a survey after each meeting where they rated how productive the meeting was, how much the youth’s ideas were reflected in the meeting, and how well the meeting went overall compared to prior meetings. The researchers then compared these ratings between the experimental and comparison groups. In addition, the researchers recorded video of the team meetings to directly review and analyze team interactions and processes.
The researchers found that youth in the experimental group, who received the coaching, felt more involved in their treatment and thought that their ideas were reflected more strongly after coaching, compared with the youth in the comparison group. This pattern held up for the target meeting as well as for the two subsequent meetings. After the coaching, the youth in the experimental group also described a stronger working alliance with their teams relative to the youth in the comparison group.
When the researchers looked at the post-meeting surveys, they found that both the youth and adult team members rated the meetings as more productive in the experimental than in the comparison group. The experimental group participants (both youth and adults) also rated the youth’s involvement as being more substantial compared the participants in the control group. About half of the youth and adult team members in the experimental group rated the target meeting as going “much better than usual” compared with only about one third of the youth and team members in the comparison group. Video recordings also showed more active and meaningful participation by the youths in the experimental group.
The authors noted that a brief self-advocacy coaching program can increase youth’s active involvement and leadership in planning their own mental health treatment. This can improve their sense of alliance with clinicians, allowing them to take charge of their own lives while also bonding with caring adults. Similar coaching could be useful to empower youth in other team-based systems, such as Individualized Education Plans (IEPs) or postsecondary transition plans. Future research may be helpful in understanding how this approach may be applied in these other settings. The coaching program developed in this study was effectively delivered at low cost, by social work students with six weeks of formal training. Educators and service providers may wish to implement similar self-advocacy coaching into their programs.
To Learn More
The Pathways RTC trains providers across the country in the AMP coaching process, and has developed several products and publications as part of the Achieve My Plan project including:
- “During Meetings I Can’t Stand It When…” A guide for facilitators and team members
- Tips for Your Team Meetings, a guide for youth
- Youth Participation in Planning: Why It Matters, a video of interviews with youth describing what it feels like not to have a say in their own treatment.
Research on Achieve My Plan continues at the Pathways RTC. AMP+ uses the coaching intervention to support youth with mental health conditions who are transitioning to employment. For further information about training or publications, contact Pathways RTC.
The RRTC on Learning and Working During the Transition to Adulthood also focuses on youth and young adults with mental health concerns. Learn more about their Youth Voice project and their tip sheet on self-advocacy.
To Learn More About this Study
Walker, J.S., Seibel, C.L., and Jackson, S. (2017) Increasing youths’ participation in team-based treatment planning: The Achieve My Plan enhancement for Wraparound. Journal of Child and Family Studies, 26(8), 2090-2100. This article is available from the NARIC collection under Accession Number J76685.
This project is also supported by the Substance Abuse and Mental Health Services Administration (SAMHSA).