wraparound milwaukee: the family connection · 2016-03-08 · family connection. presented by:...

www.TheNationalCouncil.org

Wraparound Milwaukee: The Family Connection

Presented By:Bruce Kamradt, MSW

Director, Wraparound MilwaukeeWisconsin, USA


What is Wraparound Milwaukee

> It is a System of Care with a very comprehensive array of mental health and supportive services organized into a single coordinated network across all child serving systems including mental health, child welfare, juvenile justice and special education so that children with serious emotional and mental health needs and their families get all their mental health and supportive services from one place and one program –Wraparound Milwaukee

> 1200 children/families are enrolled in Wraparound Milwaukee, but you can design such a model for 25 or fewer families

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Who Are the Youth with Complex Mental Health, Emotional and Behavioral Needs We Serve?> DSM-IV Diagnosis with a condition/disability that has

persisted six months or more> Impairment in functioning at home, in school and/or

community> Involved in two or more child serving systems i.e.

Child Welfare, Juvenile/Criminal Justice, mental health and/or special education

> At risk of out of home placement or could be returned from an out of placement setting

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Background for Wraparound Milwaukee

> It was created in 1995 within the public mental health system in Milwaukee County

> Started with the “Twenty-Five Project”> In early to mid 1990’s, Milwaukee County Mental Health, Child

Welfare, & Juvenile Justice agencies were experiencing an overuse of institutional type placement of youth• Psychiatric inpatient care• Residential, group home and foster care placements treatment• Juvenile correctional placements

> The overuse was causing financial issues for Milwaukee County and the State of Wisconsin Medicaid Program

> Studies were showing poor outcomes for these youth following their discharge from those placements


Wraparound Milwaukee

> “We cannot solve our problems using the same thinking we used when we created them” Albert Einstein

> “Insanity: Doing the same thing over and over again expecting different results” Albert Einstein


What is the Value Base Wraparound Milwaukee is Built On?> Family Directed Care – “Families are the solution not the

problem”> Strength-Based Care versus focusing on deficits> Individualized Care versus categorical programs> Community-Based service delivery versus institutional care> Coordinated and Integrated Service Provision versus

fragmented care – “One Family with One Plan”> Respect and understanding for the cultural differences of the

persons we serve – “Culturally Competent Care”> Unconditional Response – “We Never Give Up”

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Wraparound puts system of care values and principles into practice for service planning and provision.

10 Principles of Wraparound


What Key Organizational Structures Make the System of Care Model Work So Well in Milwaukee?> Creation of a single “care management entity” (CME)

responsible to oversee the delivery of care for youth with complex mental health needs across child serving systems

> Blending of funds across all child serving systems to create a “flexible” and more adequate funding pool that benefits each partner (ex. Child Welfare, Juvenile Justice, mental health, etc.) through achieving better outcomes at reduced cost

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Why We Pool Funds?> Pooling funds across systems can create

“win-win” scenarios

Wraparound Milwaukee

Pooled Funding ModelJuvenile Justice

Alternative to detention,

incarceration of youth with mental health

issues, high cost/poor outcomes

Child WelfareAlternative to out-of-

home care or to stabilize & preserve

foster care placements

Mental HealthAlternative to IP/ER

costs, improve coordination between

primary care & behavioral care

EducationAlternative to

alternative school placement,

unnecessary school suspensions/expulsion

and poor school attendance


How We Incorporated the Values in a Delivery Model to “Connect” With Families

1. Child and family teams2. Mobile crisis services 3. Care coordinators4. Comprehensive provider network system with an array of

services and supports5. Information and data sharing across the system6. Family advocacy7. Emphasis on quality and measuring and achieving positive

outcomes

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1. Child and Family Teams

> Family creates their own vision> Family identifies strengths and resources> Team consists of people--chosen with the family and

connected to them through natural, community, and formal support relationships—who develop and implement the family’s plan

> Families learn to run their own team meetings

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Child and Family Teams, cont’d

> Family identifies child and family needs across life domains:

• Psychological• Educational• Living Situation• Family

> Strategies are developed to address needs incorporating strengths and use of formal/informal services and supports

> Plan is continually monitored and reviewed

• vocational• Medical• spiritual

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2. Mobile Crisis Services – Mobile Urgent Treatment Team (MUTT)> Provides 24/7 response to stabilize/resolve a

family crisis> Provide in-home, crisis 1:1 stabilizers for on-

going support to youth and family> Can provide short-term placement in a crisis

bed in designated community foster or group home to stabilize a youth


3. Care Coordinator

> Person trained to coordinate the wraparound process> One care coordinator per 8-9 families with weekly

face-to-face contact> Care Coordinator helps family identify and obtain

mental health and supportive services, both formal and informal

> Care Coordinator coordinates care across other child/adult serving systems-”One Care Coordinator & One Plan”


4. Comprehensive Service Array Through a Coordinated Network of Providers

> Over 70 different services and nearly 200 provider agencies organized into a single network

> Family choice of providers> Competition keeps quality and responsiveness high> All providers linked through one internet-based IT

system> Families have access to view information about

providers to make informed decision


4. Wraparound Milwaukee’s Comprehensive Service Array, cont’d

Behavioral & Clinical Services• Crisis intervention• Individual therapy• Intensive in-home therapy• Evaluation• Substance abuse therapy – individual and

group• Medication management• Day treatment• Special therapy i.e. behavioral

management teamPlacement Services

• Acute hospitalization• Foster home and treatment foster home• Group home care• Residential treatment• Crisis/residential, group care, treatment

foster care• Supported independent living

Other Supportive• Camps• After school• Suspension accountability• Transportation• Interpretive services• Equine therapy• Consultation with other professionals

Supportive Services• Mentors• Crisis 1:1 stabilizer• Tutor• Parent/family aide• Life coach – independent living• Employment preparation and placement• Job – internship• Other

Respite• Crisis/planned respite• Residential respite

Service Coordination• Care Coordination

Discretionary• Flex Funds• Clothing• Food/groceries• Housing assistance• Child care• Furniture, appliances• YMCA membership• Educational expenses


4. Provider Network Alternatives in More Rural Areas

> Informal Supports i.e. neighbors, friends, church, civic/volunteer groups

> Fiscal Intermediary Services – CME creates services utilizing the family who employ a relative, neighbor or friend to provide needed services the family cannot obtain on their own ex. Youth, mentor, transportation to a counselor

> Peer Specialists – youth/young adults who have experienced emotional mental health issues work with other youth

> Tele-psychiatry/medicine> Regional pooling of clinical expertise, crisis response resources

and other supports


5. Family Advocacy

> All families have access to a family advocate or “peer partner” who has had a child in the program

> Advocates are available to talk with families and participate as a support to them on the Child & Family Team

> Advocacy organization operates support groups and conduct family activities

> Family advocates and family members participate on all Wraparound committees, work groups and councils

> Educational advocates work with youth needing help with educational challenges particularly with access to special educational programming


6. Information Technology

> All providers on a single IT system> Single release of information across all child

serving systems> Automated electronic medical record with

care plans, progress notes, crisis plans, service authorizations, etc. entered easily

> Reports are easily accessible for system stakeholders


7. Outcomes for Wraparound> Financial – reduction in cost of care for youth who otherwise

would be placed in out-of-home care or stay in out-of-home care for longer periods without availability of Wraparound services

> Programmatically – reduction in the number of incarcerated youth and in length of stay of youth in detention

> Educationally – 60% increase in schools attendance and corresponding drop in school suspensions

> Clinically – improved functioning of youth at home and in school based on CBCL (Achenbach) administered at enrollment and discharge


Outcomes for Wraparound, cont’d> Recidivism – most recent study of 669 delinquent youth enrolled

in Wraparound Milwaukee for a period of 15 months showed a 15.2% rate of reoffending. Among 210 “high risk youth” i.e. juvenile sex offenders, etc. the rate was even lower at 6.7%

> Child Permanency – 85% of youth were discharged to a permanent setting with parent, relative, adoptive resource or subsidized guardianship

> Family Satisfaction – families consistently rate their experience in Wraparound Milwaukee as very good (4.7 on 5 point scale)


Does wraparound work?Evidence from Nine Published Controlled Studies is Positive

Study Target population Control Group Design N

1. Hyde et al. (1996)* Mental health Non-equivalent comparison 69

2. Clark et al. (1998)* Child welfare Randomized control 132

3. Evans et al. (1998)* Mental health Randomized control 42

4. Bickman et al. (2003)* Mental health Non-equivalent comparison 111

5. Carney et al. (2003)* Juvenile justice Randomized control 141

6. Pullman et al. (2006)* Juvenile justice Historical comparison 204

7. Rast et al. (2007)* Child welfare Matched comparison 67

8. Rauso et al. (2009) Child welfare Matched comparison 210

9. Mears et al. (2009) MH/Child welfare Matched comparison 121

*Included in 2009 meta-analysis (Suter & Bruns, 2009) 22


Wraparound Outomes(9 national studies)

> Better functioning and mental health outcomes

> Reduced recidivism and better juvenile justice outcomes

> Increased rate of case closure for child welfare involved youths

> Reduction in Residential tx.23


”Wraparound is “Evidenced-Based”

> Under review by SAMHSA National Registry of Effective Practices and Programs (NREPP)

> State of Oregon Inventory of EBPs> California Clearinghouse for Effective Child Welfare

Practices> Washington Institute for Public Policy: “Full fidelity

wraparound” is a research-based practice


“Never doubt that a small group of committed citizens can change the

world: indeed, it’s the only thing that ever does.”

Margaret Mead

wraparound milwaukee: the family connection · 2016-03-08 · family connection. presented by:...

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