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. Hows 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 1980s 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

Multi-Systemic Therapy Wraparound Planning Process Intensive Case Management Treatment Foster Care (Oregon MTFC model) Community-Based Interventions Winters, NC & Metz, W.P (2009)

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 Wraparound continued…

Adaptive from the National Wraparound Initiative

Engagement and team preparation Initial plan development Implementation Transition Phases of Wraparound Walker, J.S. & Bruns, E.J. (2008)

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 Networks Childrens 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 Implementing Wraparound

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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