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Components of Effective Wraparound Services:
Innovations and Best Practices
Kim Mcgrath Psy.D., Gihan Omar, Psy.D, Jesus Perez, Psy.D.Hialeah, FL
Wraparound should not be confused with:
W.R.A.P. (Wellness Recovery Action Plan) developed by Mary Ellen Copeland.
How’s it different? W.R.A.P. is a tool that can help people self
determine their own course of actions
Caveat:
Nationally, numerous reports documented “disorganized and fragmented systems”
4 Guiding Principles
1. Individualized care that recognizes strengths in the child, family and community and is tailored to the individual needs and preferences of the child and family.
2.Family inclusion at every level of the clinical process and system development.
3. Collaboration and coordination between and across service agencies for provision of culturally competent service.
4. Serving youth in their communities or the least restrictive setting using natural supports whenever possible.
Child and Adolescent Service System Program (CASSP)
Born out of the Willie M. Lawsuit
Wraparound term coined in the 1980’s by Dr. Lenore Behar in North Carolina for youth who presented with severe emotional and behavioral problems as an alternate to institutionalization.
History of Wraparound
It is not: a Specific Program or Service
It is not: synonymous with “in-home services”
It is not: time limited.
It is not: for children in Residential treatment but intended to be as an alternative to residential treatment.
“Is fundamentally not a clinical treatment but a team-based planning process that always needs to include clinical support.” (Winters & Metz 2009)
What Wraparound is NOT?
Child Welfare: Family Group Decision Making Juvenile Justice: Restorative Justice Teams Developmental Disabilities: Person Centered
Planning Education: Positive Behavioral Support
Teams Spirit and Healing Circles Integrated Systems: Wraparound
Team Based Planning Models
Winters, NC & Metz, W.P (2009)
Multi-Systemic Therapy Wraparound Planning Process Intensive Case Management Treatment Foster Care (Oregon MTFC model)
Community-Based Interventions
Wraparound is an intensive philosophical approach used to provide consumers with severe or complex needs individualized and unique treatment.
Wraparound is a definable planning process that results in a unique set of community services and natural supports that are individualized for a child and family to achieve a positive set of outcomes. (Burns & Goldman 2008)
What IS wraparound?
The community collaborative structure, with broad representation, manages the overall wraparound process and establishes the vision and mission.
A lead organization is designated to function under the community collaborative structure and manages the implementation of the wraparound process.
A referral mechanism is established to determine the children and families to be included in the wraparound process.
Resource coordinators are hired as specialists to facilitate the wraparound process, conducting strengths/needs assessments; facilitating the team planning process; and managing the implementation of the services/support plan.
Requirements for Practice
With the referred child and family, the resource coordinator conducts strengths and needs assessment.
The resource coordinator works with the child and family to form a child and family team.
The child and family team functions as a team with the child and family engaged in an interactive process to develop a collective vision, related goals, and an individualized plan that is family centered and team based.
The child and family team develops a crisis plan.
Within the service/support plan, each goal must have outcomes stated in measurable terms, and the progress on each monitored on a regular basis.
The community collaborative structure reviews the plans.
Requirements for Wraparoundcontinued…
Adaptive from the National Wraparound Initiative
Walker, J.S. & Bruns, E.J. (2008)
Engagement and team preparation Initial plan development Implementation Transition
Phases of Wraparound
Mobile Therapy Behavioral analysis Therapeutic Staff Supports Case management Crisis Outreach Family Support Tutoring Gym membership, extracurricular activities Church or religious involvement
Common Services Provided
Team-based approach aimed at serving children and adolescents in Miami-Dade County with severe mental health and behavioral problems aimed at preventing residential placement
Services that can be offered include: In home Therapy services Behavioral Analysis Case Management Life coaching Crisis Support
Citrus Health Network’sChildren’s Crisis Response Team
(CCRT)
The Alaska Youth Initiative: Trailblazer for other programs. Kept majority of youth out of residential placement. (Burchard, Burchard, Sewell & Vanderberg 1993).
The Milwaukee Model: Focused on children in the child welfare system. They were able to sustain its program after grant ended because 4 public agencies pooled funding. Serves 506 youth annually. (Kamradt & Gilbertson, 2005).
High Fidelity Models of Wraparound
Fidelity: The degree to which programs are implemented as it is intended by the program developer.
Wraparound Fidelity Index (WFI) developed by the National Wraparound Initiative Collects data from Youth, families and the wrap
facilitators E.g. “Were you given time to talk about your family
strengths, beliefs and traditions?”
Wraparound Observation Form (WOF; Epstein et al., 1998), measured adherence to wraparound principles as observed during team meetings.
Measures of Fidelity
Research Approach is characterized as promising Randomized trials The need for more standardized intervention
Evidence of Effectiveness
Ultimate goal is to help families with the most challenging children function more effectively in the community
Reduce the likelihood of Out Of Home Care and unnecessary restrictive placements
Improve Behavioral and Emotional Functioning (Lyons & Rawal, 2005)
Move towards replacing formal supports (e.g. therapists) with informal supports (e.g. extended family, religious community)
Goals of Wraparound
Strengths Population that it serves Adopted across multiple states as a system of
care Principles make sense to families
Limitations May result in an ‘any services will do’ approach Limited evidence about its effectiveness Not one unified model with standards of practice
and parameters Because the model is individualized the
wraparound group might have a mixture of effective and ineffective treatments contributing to less favorable outcomes
Strengths and Limitations
Family/Youth Level Families receiving the services have few, if any, social
supports Families find it hard to commit their time and energy or
adhere to the agreements previously made Getting Families and young people actively participate Lifestyles Skills/capacities
Staff/Administrative Level are required to participate in intensive ongoing training and
supervision Organizations have to be willing to adopt new ways of
funding. E.g. Having Flex funds
Challenges to ImplementingWraparound
Identify a more reliable method of assess fidelity of intervention
Policy makers to commit to interagency collaborations
GET FUNDING
Overcoming Challenges of Wraparound
Further research on high fidelity approach is needed
Validity Future expansion of services
Future Direction
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