Access to Supports and Services
For more in-depth information on this aspect of implementation:
- Refer to the NWI’s Implementation Guide
- For consultation and training related to Wraparound implementation, please visit the National Wraparound Implementation Center (NWIC).
As conceived by the National Wraparound Initiative, implementation of Wraparound requires attention to six types of community supports. One of these areas is Access to Needed Services and Supports.
According to the Community Supports for Wraparound Inventory, when a Wraparound initiative is fully supported in the area of Access to Needed Services and Supports, the community has developed mechanisms for ensuring access to the Wraparound process and the services and supports that Wraparound teams need to fully implement their plans.
The resources in this section provide an outline of key considerations, pitfalls and strategies related to developing and managing the services and supports that Wraparound teams will need for the plans they create. Questions addressed include:
- What sorts of services and supports will our families need?
- What are the key issues to consider as we work to ensure that children and families have access to the services and supports they need?
- What are some strategies that have worked for creating and managing an appropriate range of services and supports?
- What are some of the most common pitfalls we should avoid?
- What’s the take-home message here?
As you roll out your initial Wraparound effort, it is important to remember that it is based on a set of principles that are different than those that underlie many programs or projects. Wraparound is a planning process that is used to coordinate, create, tailor and individualize services and supports to fit the unique needs of the child and family while also building on their strengths. While many other programs are predicated on a defined program model, Wraparound is built on the notion of individualization. In other models, managers and funders may focus on uniformity in an attempt to ensure that families have access to the program as it is designed. In Wraparound , the organizing process should occur with consistency but the plans that are produced should vary considerably from family to family. This means that the system in which the Wraparound initiative is functioning must have a wide array of services and supports available, and that managers attached to Wraparound projects should be prepared to manage for creativity, flexibility and originality.
Wraparound is best implemented in the context of a community based system of care. This means that those involved must be able to see the entire community as a resource that can be deployed for families. Wraparound projects are also predicated on the notion that help is more than services. This means that leadership has to ensure that a wide array of supports and interventions are considered and developed in building Wraparound capacity. Wraparound projects should include a blend of services and supports including:
- Formal service drawn from the existing system, including “evidence-based” treatments that have been shown to be effective in achieving outcomes and/or meeting emotional and behavioral needs;
- Created interventions that are developed on a one youth/family at a time basis; and
- Purposeful support designed to help families get through system processes.
2. What are some key issues that communities need to consider as they work to ensure access to needed services and supports?
- Creativity. Managers, including providers involved in overseeing Wraparound, should be prepared to create structures that lend themselves to creativity. This might occur through the strategic use of flexible funds, deploying flexible staff resources or working out unique arrangements with other providers from within the system or community. Additionally, managers should be prepared to develop creative arrangements with system monitors, such as licensing authorities, to assure as much flexibility within program structures as possible. Managers should be prepared to partner with practitioners to ensure that the Wraparound program has an ongoing capacity for service creation for each child/youth and family at a time. This ability to individualize through service creation requires ongoing support from management either through creative arrangements with other organizations, flexible contracting, or the capacity to reassign staff roles to meet the needs of families.
- Wide range of options. Not all services or supports identified in a Wraparound plan will need to be created. Some will be existing services and supports, while some will closely resemble usual and customary services, though perhaps with some minor readjusting. What is important is that the Wraparound project creates alliances that allow the widest range of services possible for families. Wraparound projects should avoid assuming that certain services will be limited or not needed. In fact, when it works best, Wraparound serves to blend and integrate a range of services from traditional to nontraditional, from tried and true to never before attempted. Good Wraparound leadership creates a platform to arrange all of the possible services and interventions on behalf of children and families enrolled in the project.
- Ensure open doors. A key feature of necessary services and supports is that families are able to get to the right services when necessary and aren’t burdened with services that are not needed. Access often means that services can be tailored in terms of time and location, depending on the needs of the family. Wraparound staff should be expected to participate in creative resource development. On the other hand, Wraparound managers should monitor creative resource development to ensure that families are getting what they need with the right amount of effort. Access frequently plays out in two ways at the team level. The first is the ability of the team to work with the family in exercising choice about the provider of services. Families and teams should be able to leave service providers who are not working out and gain access to alternative providers. The second way is to ensure access during crisis periods. This access typically focuses on three features including developing an individualized on-call capacity, having the ability to respond wherever the crisis is occurring, and the capacity to link to other resources even during after-hours periods.
- Focus on just-in-time help. Pace and urgency are critical concepts within the Wraparound process. While working with children, there is not a lot of time to make mistakes as the clock is ticking on the young person’s childhood. Wraparound leadership has to be prepared to construct a range of “just-in-time” resources designed to assist families enrolled in the project. Expediting waiting lists, creating short term fill-in capacity and realigning resources to fit with demand are all activities that fit with the notion of timeliness. Another concept attached to timeliness within Wraparound centers around the capacity to shut off interventions as needed. Wraparound is designed to customize service responses according to unique individual needs. This means that when a service is no longer needed it can be shut off, even if that shut off will be temporary. This differentiates Wraparound from many other programs in which young people stay enrolled until a natural calendar break or until the anticipated discharge from service nears. Being able to shut off services that are providing less potent results is as important as granting access to a range of needed supports and services.
3. What are some strategies that have worked for creating and managing an appropriate range of services and supports?
Wraparound is not a standalone process. Effective project implementation requires that a range of services, supports and strategies be available between meetings. Leaders involved in implementing Wraparound must consider ways to ensure that those responsible for implementing the Wraparound planning process have a range of interventions that can be deployed through the planning process. Strategies that have been used in a variety of settings include:
- Creating a service provider network. This option entails creating and organizing a range of service providers that are available to individual Wraparound teams. This typically involves estimating a range of services that might be necessary and creating a structure for easy access for individual teams. Driven by contracts or memoranda of agreement, services are not accessed until needed, thereby starting with the family rather than the program. Typical provider networks don’t guarantee a minimum amount of utilization but instead let the demands of individual Wraparound teams drive the response. This approach works well when there is a centralized funding pool to pull from or when the funds available for Wraparound implementation are large enough to warrant a structure for purchase of services. The advantages of this strategy include fostering a wide range of partnerships in Wraparound rather than focusing on a single Wraparound organization and developing a knowledge base about family needs and service utilization. Good provider networks bridge community and system concerns. Balanced provider networks will include a range of providers from certified mental health professionals to neighborhood or community organizations or associations that can be connected to help out. Finally, effective provider networks have the capacity to certify and enroll individuals or organizations to provide services or supports for a single child or family involved in the process.
- Managing a resource directory. Some sites find that they don’t have the political or fiscal will to develop and manage a provider network. These sites find the less formal approach of creating a resource directory to be an effective alternative. This approach creates associations and agreements among a range of providers to work together to build flexible responses. Families can even rate their experiences with certain providers, which can be reviewed by teams as they develop the services and strategies for their plan. This approach works well for many things including crafting services and strategies that are tailored to individual situations. It is often more difficult, however, to get to individualized responses with this informal approach due to system barriers, contract limitations or rules and regulations.
- Contracting for flexibility. Another approach involves constructing flexible contracts. This entails developing or funding a certain amount of flexibility in the basic Wraparound project design. Examples include providing funding for a range of flexible staff that can provide immediate and creative responses to families, or providing significant amounts of flexible funds for use in purchase or arrangement of flexible services and supports. One way of achieving this is by funding well-designed direct support services. More information about this approach can be found in the Resource Guide to Wraparound chapter entitled Direct Support Services in Wraparound.
- Focusing solely on access and neglecting exit. Many Wraparound projects focus on making sure services are available but fail to create protocols for families to cease services they don’t find helpful.
- Over-focus on a particular type of service or support. Effective Wraparound projects ensure a balance between clinical intervention and community support. Some projects become so focused on clinical interventions that they neglect community participation and basic support while other projects will focus on basic support to the exclusion of clinical intervention. Leadership should plan and monitor for a balance between these two extremes to assure that families don’t have to sacrifice one or the other in order to participate in the process.
- Failing to individualize. Individualization means that services, supports and strategies can be constructed or created based on individual family needs. In addition to flexible timing and location of delivery, highly individualized responses can include the capacity to imagine and create a one-family-at-a-time service that has never been tried before. Some Wraparound projects are designed so that while facilitation is funded by the project, it is assumed that all services and supports will be paid for from existing funding streams. This will often lead to frustration with the lack of flexibility in programming that many of these funding streams represent, and to a lack of individualization, which negates the point of the Wraparound process. Effective leadership should anticipate this and create formal protocols to allow for one-time exceptions to policy in order to assure that responses are individualized.
- Focusing on crisis planning rather than crisis doing: While the Wraparound process identifies clear steps for developing a crisis plan, it is important that the project creates the capacity for immediate crisis response. This means that families enrolled in Wraparound should not have to manage the crisis on their own and that Wraparound has assured that a tailored and preferably individualized response is available when needed. Effective crisis programming in Wraparound should include after-hours coverage, up-front stabilization to help families feel supported and comfortable enough to effectively engage in Wraparound, and mobile response so that crisis coverage goes to where the family is rather than forcing the family to come to the project.
Creating and assuring access to a variety of “individualizable” services and supports requires as much effort as creating a sound capacity to facilitate Wraparound planning. Many communities will focus on Wraparound, the planning process, and overlook the fact that interventions that occur between team meetings are critical. Ensuring a range of responses that are individualized, tailored and flexible in terms of location and timing should be considered early on in Wraparound implementation.
The information on this page has been peer reviewed through the NWI.