Finance and Sustainability
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 Fiscal Policies and Sustainability.
According to the Community Supports for Wraparound Inventory, success in the area of Fiscal Policies and Sustainability in Wraparound is defined this way: The community has developed fiscal strategies to meet the needs of children participating in Wraparound and methods to collect & use data on expenditures for Wraparound-eligible children.
Successful Wraparound projects require funding and fiscal policies that embrace Wraparound values. A key question is whether you can do Wraparound planning without funding. The answer to that is “it depends.” It first depends on how much capacity you want to build. If you are looking to set Wraparound in your system as an exception to basic care and use it sparingly you can probably garner enough staff resources to follow the process once in a while. Second, if you are in a system that has maximized flexibility so that every dollar is seen as flexible and is able to follow the child and family, then you don’t really need additional funding. If, however, you are looking to make Wraparound regularly available within the system, then you need to assign initial dollars while working to create flexible fiscal policies over time.
This section addresses some of the most important questions that typically arise when communities are developing strategies related to fiscal policies and sustainability. These questions include:
- How have communities used available funding streams to finance and sustain Wraparound ?
- What are key Wraparound capacities that we will need to fund?
- How do we know when to use flexible funds?
- What are the main pitfalls to avoid?
- What is the "take-home" message?
- Where can I find more resources on finance and sustainability?
The Resource Guide to Wraparound contains a number of chapters that focus on this important question. The chapters include:
- Developing, Financing, and Sustaining Wraparound: Models for Implementation
- Private Provider & Wraparound Flexibility
- The Wraparound Orange County Model
- Developing, Financing and Sustaining County-Driven Wraparound in Butler County, Ohio
- Funding Wraparound is Much More than Money
- EMQ Children & Family Services: Transformation from Residential Services to Wraparound
The NWI is continually adding to its collection of resources. You can search or browse for resources on finance.
There are a number of options that states can pursue to support and/or incentivize the development of local or county Wraparound efforts. Regardless of whether the funding strategies are implemented at the state or local level, it is local leaders who are responsible for creating capacities that are necessary and desired in their Wraparound project. This means that the local effort should be responsible for assuring the following capacities are met:
- Funds are available for the cost of doing Wraparound: Certain functions and responsibilities are implied in any Wraparound project. These functions include facilitation of teams, meetings and plans; care coordination including organizing, arranging and modifying services, supports and interventions; and infrastructure necessary for managing and supervising Wraparound. Most projects also include a capacity to provide peer-to-peer support to families as a key capacity for Wraparound implementation. These key capacities are generally budgeted in the personnel line associated with a Wraparound project and may take the form of FTEs in each of the named areas. Communities vary in terms of how the staff roles are structured and arranged but a local contract manager or program developer should ensure that there are sufficient fiscal resources for staffing roles so that that key Wraparound tasks can get done efficiently and effectively.
- Funds are accessible for needed supports and services: Contract managers should recognize that Wraparound is not a treatment or specific type of program. The Wraparound process cannot stand alone like other programs and services that may be funded. As a planning process, Wraparound seeks to coordinate and integrate a range of services and supports. This means that contract managers should think through how to ensure that funding is available to pay for services, interventions and supports that are needed to fulfill Wraparound plans.
- Funds are flexible enough to implement the strategies that teams choose for Wraparound plans. A key ingredient of Wraparound projects is the presence of funds that can be used to support and purchase a range of options for and with the family. Some communities manage this by creating a line item within a contract that is designated as a flexible fund category. Others will focus on braiding service dollars that are not necessarily flexible but finding a way to use these less than flexible funds to pay for the services and supports that are needed. This sort approach is used by Wraparound Milwaukee, which functions as the care management entity for children in the mental health system in Milwaukee, Wisconsin. Wraparound teams identify necessary services and supports. Results from those team meetings are identified in the management information system that allows individual providers to be paid by central administration. A range of existing funding streams have been pooled, allowing the project to match a funding source with the planned expenditure. In addition, the capacity to pay for services or interventions exists by always having an “other” category.
Wraparound managers are often faced with issues of adequate and appropriate management of flexible funds. In the early stages of Wraparound implementation, it is not unusual for flexible funds expenditures to be regarded as frivolous, and this can lead to a period of tightening down on flexible fund policies. Wraparound managers will do well to establish a clear logic for expending flexible funds. One example of such logic is listed below:
Does the intervention, planned interaction or expenditure…
- Build on family strengths?
- It’s helpful to check to make sure that the strengths are functional and real and were identified prior to the decision to pursue the service/support that requires funds, rather than having strengths filled in to justify a service, support or intervention.
- Add value to the stated mission?
- Does the intervention or planned action seem as if it will get the team and plan closer to the mission or outcome that is being pursued? This would presuppose that the team has developed a mission statement. The mission should be compatible with the conditions that brought the family to the attention of the system in the first place.
- Meet identified child and family needs?
- Does the intervention directly address a need that has been stated as unmet and targeted by the team? The team should be able to identify the action and state how it will address identified needs.
- Represent a culturally competent direction?
- Does the planned action or intervention fit well with the family? The action should be relevant to family members’ sense of their own identity and should fit with how they experience own community. This includes ethnicity, class, age, location, spirituality, nationality and tradition issues, among others. Interventions should be chosen which are compatible with the family’s self-definition.
- Build on community capacities?
- Does the intervention empower the community and those in it to care and support the child and family? For example, has the worker assured that a landlord is given a chance to help out rather than first requesting flexible funds to cover housing-related costs? Projects should check to make sure that system resources in terms of people, money and expertise are being used to create community caring.
- Represent a good deal for the investment?
- The planned action should be reviewed to ensure that it represents a good deal for the price. This is true for flexible fund expenditures, staff investment of time, referrals to categorical services and any other decision that a staff member could make. This process of finding the right price should also consider the results of the investment so that the bid that wins out won’t always be the lowest one, but rather the one that yields the best outcome for the investment.
- Over-reliance on any one funding stream. Administrators must recognize that Wraparound is a planning and organizing process that seeks to incorporate, integrate and create a range of supports in order to meet a family’s needs. Since Wraparound is an integrative model it stands to reason it requires an integrated funding stream. The question for funders is how much integration they need in order to construct a coherent funding platform. Integrating Medicaid funding to pay for medically necessary services and supports through a Wraparound planning process while using general fund services to pay for all or portion of staff time may be enough integration. Other sites may pool a wider range of funding streams. Successful Wraparound projects find a way to harness multiple funding streams to pay for services and project operation.
- The Medicaid trap. Medicaid is frequently used within Wraparound projects. Some functions within the Wraparound process itself may indeed be billable to Medicaid. Others are close but require staff and administrative time to make them fit. Still other Wraparound functions don’t line up with Medicaid rules and regulations. Billing Medicaid may seem like a good idea but good managers should identify whether the cost of making the proposed intervention fit within billing definitions outweighs the potential revenue. Likewise, funders should create opportunities for some staff time to be billed to other revenue sources so that the support activities of Wraparound can be integrated with the clinical activities. Maintaining the right balance between support and clinical intervention will ensure that the Wraparound project functions effectively.
- Over-managing flexible funds. Heightened sensitivity to public perception causes some sites to create so many rules and requirements that flexible funds fail to be used flexibly. This can often build resentment on the part of staff and families, who feel like rules are applied arbitrarily. Rules are fine but you should consider how rules can reinforce Wraparound practice and principles.
- Under-managing flexible funds. Some sites will under-manage flexible funds by providing no guidelines for their use. When this happens, family access to flexible funds may be random and projects face the risk of running out of the resource. When this happens, flexible funds no longer function as a tool but instead become a barrier that keeps families and those hired to help from having candid, honest conversations.
- Stopping at flexible funds rather than building flexibility in funding. Flexible fund pools can be a powerful tool in Wraparound. These pools are usually somewhat limited when compared to sources of inflexible funding. Wraparound is as much a system change strategy as a process for supporting children and families. Ultimately, Wraparound projects should work towards building as much flexibility in funding throughout the system as possible. This means that projects will have to rely less on the Wraparound flexible fund pool as the system adapts and becomes more flexible.
Funding and fiscal policies have to be addressed if Wraparound is to be sustained on a significant scale in your community. In addition to providing funding and ensuring flexibility, Wraparound projects need to have access to information about how much is being spent, on what services/supports, and for whom. Only with this kind of information can truly inform you about key facets of your implementation, including what is working (what’s not) and how it is working (how it isn’t). Effective and hands-on management of fiscal resources will help you create the needed match between family needs and services, supports and activities.
The NWI is continually adding to its collection of resources. You can search or browse for resources on finance.
The information on this page has been peer reviewed through the NWI.