# Document Assessment And Review Tool

Aaqib F. Azeez, CEP-Va
DART is the abbreviation for the Document Assessment And Review Tool, an assessment tool used in the overall evaluation of quality and management of the Wraparound process (also known as WFAS, or the Wraparound Fidelity Assessment System). The DART is used by supervisors and other external authoritative figures to make sure that the Wraparound program being implemented is in correspondance to the Wraparound guidelines outlined by the NWI (or the National Wraparound Initiative).
The DART contains...
* 9 main fidelity sections (fidelity refers to the measurement of adherence to the defined Wraparound model) with a total of 42 items.
* + 7-item clinical and functional outcomes
* + single global outcome question

### Purpose of the DART?

The DART was not designed to be an overly complicated, authoritative checklist - but rather a method to take in important aspects that are found in family records during the typical Wraparound process. This includes progress notes, contingent safety plans, assessment papework, plans of care, etc.
DARTs will be looking for plans of care that change as time passes and plans of care that are centered around the needs of the youth and their family, and the strategies needed to meet these needs.

### What makes up the DART?

DART is made up of the following sections:
* Section A - This section serves as a poster for the basics of the circumstances the document is reviewing, including the date, information about the reviewer, and time taken to complete the scoring.
* Section B - This section describes the specific case.
* Section C - This section names the youth enrolled in this Wraparound case.
The rest of the DART, passed Section A, B, and C, consist of...
* Timely Engagement (7 items): this section covers whether the care coordinator was vigilant in her management and engagement with the family, including if the care coordinator was punctual in their interactions with the family, completed all necessary paperwork within a month after referrals, and held monthly meeting with the child & family team.
* Wraparound Key Elements (25 items): this section evaluates the consistency of the attendance towards team meetings, including items E8 - E13, and to what level the documentations being analyzed adheres to the four key elements of the Wraparound practice. This is broken down in the following:
** Driven by Strengths and Families (E1 - E9).
** Natural & Community Supports (E6, E13, E14, E19-E21).
** Needs-Based (E15-E18).
** Outcomes-Based Process (E22-E25).
* Safety Planning (3 items): Is there a crisis plan available? If so, does it specify the triggers for such an incident and provide specific actions/interventions to mitigate the situation?
* Crisis Response (3 items): How many crisis events took place with the youth? If there were any, what actions were taken to combat this event?
* Transition Planning (5 items): This sections deals with the scenario where the family is in transition out of Wraparound - and some questions follow if this were to be the case.
* Outcomes (7 items): Did any extreme situations, such as juvenile detention or hospitalization, take place? Has the youth's mental state or community functioning shift?

### What are the evaluator's qualifications?

* An individual who has experience with evaluation research/quality assurance/data management should lead the local effort. This individual should set 2-3 sample records, in harmony with the group, as a "gold standard" to base off of.
* Experience with Wraparound.

### What are the sampling guidelines?

Pick a stratified random sample of 20-30% of the families each care coordinator is working with.
A family's record should only be reviewed using a DART as long as at least two CFTMS (Child and Family Team Meetings) have taken place and a plan of care has been developed.

### What are the preparations needed before we conduct DARTs?
#### What To Know

* IRB approval may be needed depending on local rules.
* Reviewers should not be directly involved in the services given out to the families (conflict of interest). Should have enough practice administrating DARTs prior. Supervisors and coaches may take on the role of being reviewers. Peer-coaching approach for much bigger samples. External reviewers may be implemented to show reliability of the scores.
* Wraparound care coordinators, including care coordinators, care managers, and team leaders, should be in assistance to the documentation that is going on with the DART reviews. Brings good feedback on how DART is being implemented.

#### Setting It Up!

* Access to family's records/documents.
* Printed DART forms
* Easy access to DART manual.

#### Completion of the DART

It usually takes 45-60 minutes to review one record of DART.

### Is there certain things that I should not include?

* NO names, use job titles or roles.
* Objective facts, NO opinions.

### What is the scoring criteria for DART?

For the 50 items in the DART (varies):
* 2 or Yes - sufficient evidence needed that item was fully met.
* 1 - sufficient evidence needed that this item was partially met.
* 0 or No - no evidence that an item was fully/partially met.
* N/A and missing are used when appropriate.

### How do we calculate the scores?

| TE (Timely Engagement) | NB (Needs-Based) |
| (A) # Yes (D1-D7) : | (A) E15 + E16 + E17 + E18 : |
| (B) 7 - (# Miss or N/A) : | (B) 4 - (# Miss or N/A) : |
| (C) A / B : | (C) B x 2 : |
| | (D) A / C : |
Multiply the numbers by 100 to get the percentage.
No "overall DART score" exists.