Wraparound Programs

Wraparound programs help coordinate services for children with complex healthcare needs — including behavioral health issues — and their families. The structure of wraparound programs can vary greatly; they often include intensive behavioral healthcare planning and case management for eligible individuals, including children, adolescents, and their families.

Wraparound programs are generally family-centric and provided in the home, school, or community setting in order to address a child or family's needs while allowing them to remain in their community. Wraparound services can be particularly important in rural settings, where individuals with complex care needs might otherwise require placement in an out-of-area group home or institutional setting. The Mental Health in Rural Communities Toolkit has additional information about wraparound services to deliver mental healthcare.

Care coordinators often lead the wraparound process in collaboration with family members and professionals, including clinicians, in-home behavioral support specialists, resource coordinators, and others. The National Wraparound Initiative describes the wraparound process as progressing through four phases:

1. Engagement and team preparation: This phase includes orienting the family and youth to the wraparound program, addressing legal and ethical issues, stabilizing any immediate crises, facilitating conversations with the family and child, and engaging other team members.
2. Initial plan development: This phase involves developing an initial plan of care and a crisis/safety plan, completing necessary documentation, and addressing logistics. It is generally completed during one or two meetings that take place over the course of one to two weeks. Program staff focus on building trust and mutual respect between the wraparound team, the child, and their family.
3. Implementation: This phase focuses on implementing the action steps laid out in the initial plan of care. Activities also include monitoring, evaluating, and revising the plan, including celebrating successes and addressing issues of concern. This phase concludes when the team achieves their initial goals and the child no longer requires formal wraparound services.
4. Transition: In this phase, the team develops a plan to facilitate a purposeful transition out of formal wraparound services to a mix of formal and natural supports in the community.

Services provided through wraparound programs can include:

• Case management (service coordination)
• Counseling (individual, family, group, youth, and vocational)
• Crisis care and outreach
• Education/special education services, tutoring
• Family support, independent living supports, self-help or support groups
• Psychiatric consultation, community-based inpatient psychiatric care
• Health services
• Legal services, protection, and advocacy
• Recreation therapy
• Residential treatment, respite care
• Small therapeutic group care, therapeutic foster care
• Transportation

Example of a Rural Wraparound Program

• The Montrose County Department of Health and Human Services (MCDHHS), located in rural Colorado, has developed a wraparound program to support at-risk youth and their families through the Colorado Collaborative Management Program (CMP). The CMP coordinating group united representatives from the county's government, schools, and community to improve the coordination of services for individuals who are entering or at risk of entering the child welfare system.
• Project ACTIVATE (Advancing Coordinated and Timely InterVentions, Awareness, Training, and Education) addresses behavioral health needs of students in rural North Carolina. At the most intensive intervention tier, the program provides wraparound services to provide integrated mental health support to students and their families.

Considerations for Implementation

Wraparound programs are collaborations between state or local government agencies and organizations that provide behavioral healthcare and management services. Providing wraparound services requires effective coordination and highly trained staff with sufficient time and resources to address complex cases. This can be a significant challenge in rural areas, where there may be a lack of staff and funding.

Resources to Learn More

Youth for Change: Adoption Wraparound Services
Website
Describes the wraparound program operating in partnership with local governments in rural and semi-rural counties in Northern California.
Organization(s): Youth for Change

Intensive Care Coordination Using High Fidelity Wraparound/High Fidelity Wraparound
Website
Provides evidence on the effectiveness of using individualized team-based wraparound models to improve outcomes among children and youth with emotional, mental or behavioral health needs.
Organization(s): Administration for Children and Families