WRAPAROUND MILWAUKEE “Never doubt that a small group of committed citizens can change the world: indeed, it’s the only thing that ever does.” Margaret Mead

Bruce Kamradt Project Director Operated by Milwaukee County Mental Health Division Child & Adolescent Services Branch Presented by:

What Has Been Achieved In Wraparound Milwaukee for Children with Severe Emotional Needs  Better Clinical Outcomes  Children & Families Function Better  Reduced Recidivism of Delinquent Youth Served  Improved School Attendance  Reduction in the Use of Residential Treatment & Psychiatric Hospitalization  Reduction in Cost of Care

Wraparound Approach for Children with Serious & Complex Mental Health Needs  Focus on Family and Children’s Strengths  One Family - One Plan Across Systems  Community-Based Care and Treatment  Needs Driven vs Categorical Services  Care for Children in Context of Families  Parent Choice in Provision of Services  Focus on Refinancing Strategies  Unconditional Care

What is Wraparound Milwaukee  Public Care Management Organization  Governance with Milwaukee County Behavioral Health Division  Manages the Care of Children with Serious Emotional & Mental Health Needs at Immediate Risk of Residential Treatment, Correctional Placement or Psychiatric Hospitalization  All referrals come through the Child Welfare or Juvenile Justice System  Pools $30 Million in Funds from  Child Welfare  Medicaid  Mental Health  Juvenile Justice

Key Components of Program  Fiscal & Operational Management  24 Hour Mobile Crisis Team  Care Coordination  Provider Network  80 Services  230 Agency and Individual Providers  Family Advocacy / Support Organization  Quality assurance / Program Evaluation  Clinical Support and Resource Teams  Extensive Use of Informal Supports ie. Boys & Girls Clubs, Churches, Civic Organizations, etc.

Demographics of Children & Families We Serve  70% Male  30 % Female  Average Ave years  Ethnicity  64% African American  27% Caucasian  7% Hispanic  2% Other  52% Delinquent - 48% Child Welfare  50% with Annual Family Income Under $15,000  40% Regular Education - No IEP Continued

Demographics of Children & Families We Serve  Diagnosis  65% Conduct Disorder  50% Depression / Oppositional Defiant  46% Attention Deficit  25% Substance Abuse  15% Adjustment Disorders  12% Cognitive / Developmental Disorders

What are Pooled Funds? CHILD WELFARE Funds thru Case Rate (Budget for Institutional Care for Chips Children) JUVENILE JUSTICE (Funds Budgeted for Residential Treatment for Delinquent Youth) MEDICAID CAPITATION (1557 per Month per Enrollee) MENTAL HEALTH CRISIS BILLING BLOCK GRANT HMO COMMERCIAL INSUR WRAPAROUND MILWAUKEE MANAGEMENT SERVICE ORGANIZATION (MSO) 30 M CHILD AND FAMILY TEAM PLAN OF CARE 9.5 M8.5 M10 M2.0 M CARE COORDINATION PROVIDER NETWORK 240 Providers 85 Services

Provider Network  80 Services  No Formal Contracting -- services purchased on a fee- for-service basis -- rates established by Wraparound Milwaukee  Extensive Quality Assurance/Quality Monitoring  Residential Treatment Vendors were asked to re- engineer institutional services to community-based services  Consumer Choice of Providers  All Providers & Care Managers linked through internet- based IT system for authorizations, plan submission, invoicing, etc.

Outcomes - Program  Average daily Residential Treatment population reduced from 375 placements to 60 placements  Psychiatric Inpatient Utilization reduced from 5000 days per year to under 200 days (ave. LOS of 2.8 days)  Reduction in Juvenile Correctional Commitments from 385 per year to 285

Outcomes - Financial  Wraparound Milwaukee average monthly costs is $4350 per child per month versus $7200 for residential treatment, $6000 monthly for a correctional placement or $600 per day for psychiatric inpatient care

Child Behavior Checklist (CBCL), N=219; Youth Self-Report (YSR), N=155; Child & Adolescent Functional Assessment Scale (CAFAS), N=374. Reductions are significant at the p<.001 level of significance using a repeated measures analysis of variance. CAREGIVER, CARE COORDINATOR, & YOUTH REPORTED IMPROVEMENT IN FUNCTIONING FOR CLIENTS Year 2001

N = 490 Year 2001 REDUCTION IN PERCENTAGE OF CLIENTS REFERRED FOR FELONIES & MISDEMEANORS WHILE ENROLLED & FOLLOWING DISCHARGE

N = 492 *OTHER OFFENSES CONSIST PRIMARILY OF DISORDERLY CONDUCT Year 2001 REDUCTION IN SPECIFIC OFFENSE TYPES PRIOR TO ENROLLMENT, DURING ENROLLMENT, AND AFTER DISENROLLMENT

Serving Children and Families with Complex Needs Operated by Milwaukee County Behavioral Health Division Child & Adolescent Services Branch

Operated by Milwaukee County Behavioral Health Division Child & Adolescent Services Branch