Registration Form ‹ California Wraparound County Plan Approval and Provider Certification Portal

I am a *

County *

*The following is for informational purposes only. Answers will not be utilized to determine approval status.

County

Contact Person Name

Primary contact person for completion of this approval process.

Contact Person Phone

Contact Person Email

Is the county planning to contract with providers for Wraparound services?

Please identify current or planned contracted Providers.

Click "Add Provider" to enter current or planned provider information. For multiple providers, add additional providers as necessary.

Name of Agency

Contact Name

Contact Phone

Contact Email

Add Provider

County Wraparound Coordinator

Name

Phone

Add County Wraparound Coordinator

Which department manages the Wraparound contract?

How many youth are receiving Wraparound on average per month?

Which outcome, fidelity, and assessment tools are currently being used? (Check all that apply)

WrapStat
Wrap Fidelity Index (WFI/WFI-EZ)
Team Observation Measure (TOM)
Document Assessment Review Tool (DART)
Child Adolescent Needs and Strengths (CANS)
Youth Satisfaction Survey (YSS)
Other

Other

Please list the funding sources used to fund the county's Wraparound program?

How are Wraparound staff provided initial training? (Select the option that applies to your organization)

Wraparound staff are trained externally by attending the Statewide standardized Foundational Wraparound training through the UC Davis RCFFP.
Wraparound staff are trained internally by utilizing the Statewide standardized Foundational Wraparound curriculum delivered by internal staff who have completed the Foundational Wraparound training and Foundational Wraparound Training for Trainers, both available through UC Davis RCFFP.
Wraparound staff are trained internally by utilizing internal curriculum. Counties and providers who choose to utilize their own curriculum are required to submit their internal curriculum that aligns with the Statewide standardized Foundational Wraparound curriculum.

Permission to Share Materials

Help enhance Wraparound practices:

The Wraparound Standards Toolkit aims to provide counties and organizations with valuable resources and exemplary materials to inform and improve Wraparound practices statewide.  The RCFFP would like to share submitted materials, which we believe could serve as excellent examples for others in High Fidelity Wraparound practice. By sharing these materials, you would be contributing significantly to collective knowledge and helping to elevate High Fidelity Wraparound across California. Additionally, we will ensure that all contributions are appropriately attributed, highlighting your county/organization’s commitment to excellence in Wraparound.

Please be assured that any materials you provide will be used solely for the purpose of enhancing the Wraparound Standards Toolkit

Provider

*The following is for informational purposes only. Answers will not be utilized to determine approval status.

Agency Name *

Contact Person Name *

Primary contact person for completion of this approval process.

Contact Person Phone *

Contact Person Email *

What counties does the Provider currently have contracts with? *

Is the Provider anticipating contracting with any new counties within the next year? If yes, which ones? *

Please provide contact information for one point of contact in each county that you serve and please provide the number of youth currently being served in each county

Name

Phone

County

# of youth currently being served

Add County

How many youth are currently being served in each county?

Are Adoption Assistance Program (AAP) funds utilized in the Provider's Wraparound program? *

Which outcome, fidelity, and assessment tools are currently being used? (Check all that apply)

WrapStat
Wrap Fidelity Index (WFI/WFI-EZ)
Team Observation Measure (TOM)
Document Assessment Review Tool (DART)
Child Adolescent Needs and Strengths (CANS)
Youth Satisfaction Survey (YSS)
Other

Other

How are Wraparound staff provided initial training? (Select the option that applies to your organization) *

Wraparound staff are trained externally by attending the Statewide standardized Foundational Wraparound training through the UC Davis RCFFP.
Wraparound staff are trained internally by utilizing the Statewide standardized Foundational Wraparound curriculum delivered by internal staff who have completed the Foundational Wraparound training and Foundational Wraparound Training for Trainers, both available through UC Davis RCFFP.
Wraparound staff are trained internally by utilizing internal curriculum. Counties and providers who choose to utilize their own curriculum are required to submit their internal curriculum that aligns with the Statewide standardized Foundational Wraparound curriculum.

Permission to Share Materials

Help enhance Wraparound practices:

Please be assured that any materials you provide will be used solely for the purpose of enhancing the Wraparound Standards Toolkit

https://calwrapcertification.com

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