Rosie D.
Reforming the Mental Health System in Massachusetts

Understanding the Wraparound Process


Home-based treatment planning is based on the wraparound process that builds on children’s strengths, empowers their families, appreciates their cultures, and “wraps” services around their needs.  The following core values are the foundation for the wraparound process:


·         strength-based services

·         individualized services

·         child-centered services

·         family-focused services

·         community-based services

·         multi-system services

·         culturally-competent services


These values were originally identified by a consensus group convened by the federal government and are still known as the Child and Adolescent Services Planning Principles (CASPP).


For a detailed description of the wraparound process, read the Feature on Wraparound.

Some Model Wraparound Programs


Wraparound services have been part of service delivery networks in many States for nearly 20 years.  In the 1990s, the Robert Wood Johnson Foundation initiated Mental Health Services Program for Youth (MHSPY) which are based on the CASPP values and employ a wraparound, individualized, needs-based planning process for providing home-based services.  MHSPY programs, such as Wraparound Milwaukee and the Cambridge-based MA-MHSPY have become national models of integrated care. 


Wraparound Milwaukee was established in 1995 to address the rising number of children being placed in psychiatric hospitals and residential treatment facilities.  The project created comprehensive home-based alternatives for children with serious emotional disturbance. It has dramatically reduced residential treatment placements in Milwaukee County and the use of psychiatric inpatient care for SED youth. 


Wraparound Milwaukee emphasizes individualizing care, building on the strengths of a child, meeting the needs of children and families across life domains, and involving families as full and active partners in all treatment decisions. It utilizes a team-driven process involving the family, child, natural supports, clinical provider agencies, and other who know the child to develop, implement and evaluate the care plan.


A care coordinator/case manager facilitates the team process, helps the family to identify strengths and needs, and helps obtain the home-based services which the integrated planning team identifies as needed.  The team and case management functions are critical to the success of the program, both by ensuring that needed services are provided in a timely manner and by ensuring that all distinct services and providers are integrated into a coordinated service approach.  Instead of a single service, Wraparound Milwaukee care coordinators can directly access over 80 different covered services including individual and family therapy, substance abuse, in-home therapy and behavior management specialists, crisis stabilization workers, mentors, tutors, job specialists, transportation, and day treatment.


Wraparound Milwaukee also provides a 24-hour mobile crisis team that can intervene at the child’s home, at school, or wherever the child resides if he or she has a mental health crisis that threatens the child being removed from a community placement.


Besides significantly reducing the numbers of residential treatment, psychiatric hospital and correctional placements, clinical outcomes of enrolled youth have improved dramatically, and their school attendance has increased substantially. 


MA-MHSPY, which started in Cambridge, Massachusetts in 1998, integrates behavioral and physical care for children with SED.  It targets children at risk of out-of-home placement or those in an out-of-home placement determined to be ready to return to the community.  Length of stay can exceed a year or more depending on need.  Case managers have direct access to all behavioral health and medical services for children.  This means any child in MHSPY receives all needed medical services, including medication, hospitalization and treatment for any physical condition.  In addition, they receive all needed home-based mental health and substance abuse services through the program.


The MHSPY program can arrange and pay for non-traditional mental health services and supports, such as respite care for families, a tutor, a parent aide, transportation, a mentor, etc. It has great flexibility due to the fact that it receives funding from Medicaid as well as several state agencies, including the Departments of Education, Mental Health, Social Services and Youth Services, as well as by local school districts.  

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