Wraparound Services

Wraparound services can include many different programs. They often incorporate individuals’ natural support systems and community representatives. They received their name, wraparound services, because they were designed to wrap around people and provide comprehensive support and care for individuals and families with complex needs. In this article, we’ll discuss wraparound services, the wraparound process, why wraparound services are important, and the challenges faced by wraparound services.

What Are Wraparound Services?

Wraparound services include care for children and young adults experiencing mental health or behavioral issues. They also help reduce homelessness and assist people with intellectual or developmental disabilities.

Wraparound services provide a holistic, comprehensive, home and community-based way of responding, prioritizing the child or young adult and their family members’ perspectives. People receive support from a team of professionals and natural supports, and a wraparound facilitator helps build their wraparound team. This can include family members, friends, people from the community, and providers of services and supports.

Team members help the young person and their family decide on a plan, put it into action, monitor it, and make changes as needed to achieve its goals. Wraparound services are different from traditional case management programs and other types of traditional social services. Conventional case management programs provide young people with individual case managers who guide them through existing social services or the juvenile justice system. These case management programs don’t operate in the same highly structured and integrated services environment as true wraparound initiatives.

The wraparound process is closely tied with the system-of-care (SOC) framework, and the Child and Adolescent Service System Program (CASSP) developed the SOC framework after Congress started it in 1984. The SOC framework is a comprehensive range of mental health and other services and supports. It has a coordinated network to meet the changing, diverse needs of children and young adults with severe mental health issues and their families.

Wraparound services provide people with customized, comprehensive services within a SOC. They align with the basic principles of the SOC framework, and many people think of them interchangeably. However, researchers needed more evidence to compare wraparound and SOC and decide which method is best in which circumstances. The wraparound approach is based on 10 key principles:

• Voice and choice: The young person and their family must be full, active partners at every level of the wraparound process and in every activity. In wraparound, family members are viewed as fully empowered, essential contributors to the solutions the young person needs.
• Youth and family team: Wraparound services are team-driven, and they involve family members, the child, natural supports, and community services. The family decides who will be on the team, and everyone works together to develop, implement, and evaluate an individualized plan for the child or young adult.
• Community-based services: Wraparound services happen in a mixture of community, residential, and school settings. Interventions to change behavior should take place in natural settings whenever possible, and the wraparound team provides healthy activities and positive reinforcement for the young person.
• Cultural competence: People who are members of different cultures can have differing beliefs, modes of communication, values, behaviors, and customs. People on wraparound teams should be aware of cultural differences.
• Individualized and strength-based services: Services must be individualized and based on the family’s needs and strengths, and well-written plans document the services and supports offered. To determine their needs and strengths, the child and family members receive careful assessments that can involve a variety of formal and informal procedures.
• Natural supports: Wraparound plans must include a balance of formal services and informal community and family supports. These individuals can help by offering a unique perspective on problem-solving and providing child care, recreation, or transportation.
• Continuation of care: With wraparound services, there should be an unconditional commitment to serve kids and their family members. Team members should maintain a child-centered approach and avoid blaming the young person for their mental health issues.
• Collaboration: Collaboration and clear communication between family members, the child, and other members of the wraparound team are essential.
• Flexible resources: Wraparound teams need flexible approaches and adequate, flexible funding. Since they’re natural parts of many families’ lives, the supports that flexible funds can make possible often stay in place after formal services expire, continuing to help young people achieve their goals.
• Outcome-based services: The final element of the process is to ensure data is used for further decision-making. Outcomes should be measured and determined for the system, the program, the individual, and their family. This helps the wraparound team make sure that they’re progressing toward the desired goals.

Wraparound programs can contain many elements, including:

• Mental health services.
• Educational or special education services.
• Tutoring.
• Health care services.
• Family support services.
• Community support services.
• Case management or service coordination.
• Individual, group, family, vocational, and youth counseling.
• Crisis care and outreach.
• Self-help or support groups.
• independent living supports.
• Psychiatric consultations.
• Community-based psychiatric care.
• Legal services, protection, and advocacy.
• Recreational therapy.
• Residential treatment and respite care.
• Therapeutic group care or foster care.
• Transportation.

Wraparound services help promote community-based care, building positive relationships with individuals and their family members. Along with relatives, natural supports can include caregivers, teachers, physicians, and many others.

What Is the Wraparound Process?

Care coordinators often lead the wraparound process, and they often use care coordination software to monitor all wraparound services. They collaborate with family members and professionals, including in-home behavioral support specialists, clinicians, resource coordinators, and others. Care coordinators are health care workers who can provide a range of services. They can help address barriers related to language, culture, transportation, communication, bias, and fear. Care coordinators can also help people transition between health care providers and settings. The wraparound process usually progresses through four phases:

Engagement and Team Preparation

This phase helps the young person and their family members learn more about the wraparound program. The care coordinator addresses any legal or ethical issues, stabilizes any immediate crises, facilitates conversations between the child and their family members, and engages with other wraparound team members.

Initial Plan Development

Initial plan development involves creating an initial plan of care and a crisis or safety plan for the individual. The care coordinator will also complete necessary documentation and address logistical issues like scheduling appointments with psychiatrists and other health care professionals. People usually complete these tasks during one or two meetings that happen over the course of one to two weeks. The care coordinator and other staff members also use these meetings to build trust and mutual respect between the child, their family, and the wraparound team.

Implementation

The implementation phase focuses on completing the actions or steps laid out during the previous phase, initial plan development. Care coordinators and other team members also monitor and evaluate the initial plan of care. When needed, they revise the plan to address issues of concern. When the team achieves its goals and the child doesn’t need formal wraparound services any longer, this phase can conclude.

Transition, Monitoring, and Evaluation

During the final transition phase, the wraparound team develops a plan to facilitate a transition out of a formal wraparound program. Many people move to a mix of formal and natural supports in their communities. Care coordinators and other wraparound team members continue monitoring individuals, even while they transition away from wraparound services. A wraparound facilitator guides the wraparound process, and each step is important. Care coordinators and wraparound facilitators help tailor the process to meet the needs of many different individuals.

Why Are Wraparound Services Important?

Wraparound services provide comprehensive support and care for individuals and families with complex needs. These programs emphasize community-based care, and they help build positive relationships between individuals and their family members. They also provide long-term support and care to prevent relapses and improve outcomes over time.

Wraparound Services Make Mental Health Care More Effective

Mental health professionals often experience difficulties associated with providing services, obtaining resources for people, and getting adequate support from staff or team members. Traditional mental health services and support systems often work in isolation. They each offer something unique to clients, but they don’t work together or coordinate their actions with each other often. As mental health services and systems become more specialized, the referral criteria for admission get shorter while the exclusion criteria become longer.

Wraparound care was developed in the 1980s to help prevent this issue and make mental health services more effective. A research article from the Journal of the American Academy of Child and Adolescent Psychiatry found that wraparound services were more effective than traditional social services. People who received the best outcomes got high-quality care that followed wraparound principles. Letting families make more choices can also reduce discrimination and disparities for people of color.

Wraparound Services in Schools Can Help Students

Implementing wraparound services in schools can help improve the emotional, social, behavioral, and academic functioning of students. These programs can be part of special education or general education. They often use a proactive approach to discipline called Positive Behavior Interventions in the Schools (PBIS).

It’s based on the assumption that when educators actively teach, expect, and acknowledge good behavior, the number of students with serious behavior or mental health problems decreases and the school’s overall atmosphere improves. This is more effective than suspending students and allowing them to miss classes. For some students, a suspension could act more as a reward than a punishment, encouraging disruptive behavior. People who receive frequent suspensions, detentions, and other penalties are more likely to drop out of school.

Students receiving wraparound services usually make up about 3% to 5% of school populations. Wraparound services can identify students who need tutoring, counseling, transportation, and other types of help and get them the assistance they need. Students need individualized services to determine why they have behavioral problems and correct them. People with poor academic performance can be more likely to become frustrated from a lack of positive enforcement and act out in school.

Helping these students catch up can improve their behavior and prevent future problems. It can make them more likely to graduate high school and then find employment or attend college.

Functional Behavioral Assessments (FBAs)

Members of the wraparound team often use Functional Behavioral Assessments (FBAs) to understand the causes of a behavior and how to correct it. For example, a student could become disruptive in class to gain positive attention from peers.

After the wraparound team determines the person’s motivation, they create a behavior support plan to replace the problem behavior with a more positive behavior that accomplishes similar goals. For example, a student could get positive attention from classmates by participating in a sports team or another extracurricular activity. Along with schools, people often use wraparound services as part of the juvenile justice system, the foster care system, and mental health services.

Challenges Often Faced With Wraparound Services

The main limitation or challenge associated with wraparound services involves communicating and coordinating with other team members successfully. Recognizing and valuing the strengths of each member of the wraparound team is important, and a good care coordinator or case manager can help facilitate this. Identifying natural supports can be challenging as well, and it’s a good idea to build a trusting relationship with the young person and their family members before asking about supports. If a family doesn’t have natural supports, care coordinators can recruit surrogate supports such as church members, coaches, or volunteer groups.

Other challenges can include a lack of funding and a shortage of trained professionals like child psychiatrists. Wraparound teams also need access to flexible resources and a variety of services and supports in the community.

Wraparound services are customized, and there are no nationally recognized manual or program standards. This can make assessing the success of wraparound services difficult. It also means that care coordinators and other members of the wraparound team have no clear expectations for practice. State and local organizations must develop their own training plans. These plans can sometimes be more appropriate for a particular region, but they can also lead to poor or inadequate training.

Despite some challenges, wraparound services can provide comprehensive care and support for individuals and family members with complex needs. Wraparound services can help people in a variety of settings, and young people get individualized help according to their strengths and needs. This helps them achieve their goals.