Advocates have pressed hard in recent years to increase access to “Wraparound” for young people with significant behavioral health needs. A key strategy has been to encourage states to formally incorporate wraparound into the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) entitlement. These efforts have resulted in significant reforms in several states
[See Katie A. (California), J.K. (Arizona), & Rosie D. (Massachusetts)] that have improved access to individualized, comprehensive, and community-based services.
To help understand the purpose and impact of these efforts, it is helpful to understand the core concepts behind “wraparound,” as both an intervention approach or methodology and a behavioral health service array for children and youth.
What is “Wraparound”?
The term “wraparound” may be used to describe both a process for delivering mental health services as well as a range of direct services that are used as part of that process.
Wraparound is a method used to develop and deliver individualized behavioral health services and supports. These services are identified and implemented through a team-planning process that engages individuals who have stake in the well-being of the child, such as family members, service providers, and teachers. Through this process, the team creates intervention or treatment goals and an individualized, comprehensive, and coordinated plan of care, known as a wraparound plan, to achieve them. Wraparound plans are highly individualized and focus on home and community-based services that emphasize the child and family’s strengths.
Wraparound plans involve a range of therapeutic interventions—formal and informal—that may include in-home behavioral support services, crisis planning and intervention, parent coaching and education, individual, family and/or group therapy, medication management, and more. The wraparound services in a wraparound plan are distinguishable in that they are highly individualized, strengths and needs-based, intensive, provided in the home, school or community, may include informal providers or interventions, and are intended to support a child living in the most home-like setting possible.
Wraparound Services in Action:
Because wraparound services are highly individualized and may include informal services and supports, there is a certain “you know it when you see it” aspect to wraparound. An illustration by Karl Dennis, one of the nation’s leading experts on community-based care, may help our description.
In one community, Champaign, Illinois, a child and family team was assembled in response to the needs of a troubled 14-year-old young man. Everyone believed that he was certainly on his way to jail or an institution. His team included his father, his stepmother, and three friends who had learned of the wraparound process from listening to their parents. It was at their initiation that this process was begun. Each person had a specific role and purpose for being on the team. The direct service providers were primarily his peers, friends between the ages of 13 and 16. They tutored him, monitored his whereabouts and behaviors 24 hours a day, and even gave him advice on “appropriate” girlfriends. The young man checked in via telephone, particularly during crisis times. His peer team members accompanied him to his church as he sought support and refuge in new places and planned his weekend social agenda. When he began pulling away and returning to “old” behaviors, his team’s support intensified—they never gave up. In June, 1998, he graduated from the 8th grade. Between February and June, 1998, his behaviors and grades at school improved significantly; there were no incidents resulting in detentions, suspensions, or Saturday school consequences.1
How do wraparound services actually IMPROVE the lives of young people?
Studies have found that children who receive wraparound services rather than institutional care make substantial improvements including:
- Sustained improvements in social, emotional, and behavioral functioning;
- Decreased use of psychiatric hospitals, residential treatment and juvenile detention centers;
- Have improved outcomes in school including better grades and attendance;
- Fewer arrests; and
- Reduced suicide-related behaviors;
Implementation of wraparound services in California:
California is the most recent success in advocates’ efforts to increase young people’s access to wraparound services as part of their federal entitlement to mental health services under Medicaid’s EPSDT provisions. The state is set to roll out two broad wraparound services for youth involved in the state’s Child Welfare System over the next few months, including Intensive Care Coordination and Intensive Home-Based Services. For more information on these services, check out California’s Core Practice Model Guide.
 Burns, B.J., & Goldman, S.K. (Eds.) (1999). Promising practices in wraparound for children with Serious Emotional Disturbance and their families, Volume IV, Page 121.