What is Wraparound?
Wraparound differs from many service delivery strategies, in that it provides a comprehensive, holistic, youth and family-driven way of responding when children or youth experience serious mental health or behavioral challenges. Wraparound puts the child or youth and family at the center. With support from a team of professionals and natural supports, the family’s ideas and perspectives about what they need and what will be helpful drive all of the work in Wraparound.
The young person and their family members work with a Wraparound facilitator to build their Wraparound team, which can include the family’s friends and people from the wider community, as well as providers of services and supports.
With the help of the team, the family and young person take the lead in deciding team vision and goals, and in developing creative and individualized services and supports that will help them achieve the goals and vision. Team members work together to put the plan into action, monitor how well it’s working, and change it as needed.
The National Wraparound Initiative and the National Wraparound Implementation Center (NWIC) have developed a variety of resources designed to help families, researchers, practitioners and policy makers understand Wraparound.
- Principles of Wraparound
- The Wraparound Process User’s Guide – A Handbook for Families
- Consultation and Training
Wraparound – before it was even called Wraparound – got started several decades ago as a response to what was obviously *not* working well for children and youth with serious mental health or behavioral challenges, and their families.
Back then, the kinds of intensive and helpful services and supports that children and families needed were often simply not available in their communities. And as for the services that were available, they were often focused on what the systems or providers wanted families and children to do, and not focused on what children and families needed in order to thrive. This meant that children and families would be involved with multiple systems and providers, with each one developing a separate plan telling the child and family what to do.
Not surprisingly, outcomes from this situation were not good. Many children ended up placed in residential treatment far away from their families and communities, often for very long periods of time. After being out of home, it was hard for children to come back and do well in their home communities and schools.
In contrast, Wraparound programs are able to keep children in their communities, producing better outcomes at lower cost.
There is now strong evidence that, when Wraparound is done well (i.e., with “fidelity”), young people with complex needs are more likely to be able to stay in their homes and communities, or, should a crisis occur, to be in out-of-home placements only for short periods of time.
Young people in Wraparound tend to have better outcomes than similar young people who don’t receive Wraparound, across different areas of their lives including mental health, and functioning in their homes, schools and communities. And all of this saves money by minimizing the time that young people spend in out-of-home facilities like residential treatment centers or psychiatric hospitals, which can cost $1000 – $3000 per day.
For a quick review of the research on Wraparound’s effectiveness in promoting outcomes, see this 2017 summary of rigorous research, or for a more in-depth discussion, see the full-text comprehensive review of Wraparound research. Further information is also available about cost savings and fidelity. The National Wraparound Initiative works closely with the National Wraparound Implementation Center (NWIC), which provides training and consultation to states and communities seeking to implement Wraparound with fidelity.
What takes place during the Wraparound process?
Wraparound is commonly described as taking place across four phases of effort: Engagement and team preparation, Initial plan development, Implementation, and Transition. During the Wraparound process, a team of people who are relevant to the life of the child or youth (e.g., family members, members of the family’s social support network, service providers, and agency representatives) collaboratively develop an individualized plan of care, implement this plan, monitor the efficacy of the plan, and work towards success over time. A hallmark of the Wraparound process is that it is driven by the perspectives of the family and the child or youth. The plan should reflect their goals and their ideas about what sorts of service and support strategies are most likely to be helpful to them in reaching their goals. The Wraparound plan typically includes formal services – including research-based interventions as appropriate to build skills and meet youth and family needs – together with community services and interpersonal support and assistance provided by friends, kin, and other people drawn from the family’s social networks. After the initial plan is developed, the team continues to meet often enough to monitor progress, which it does by measuring the plan’s components against the indicators of success selected by the team. Plan components, interventions and strategies are revised when the team determines that they are not working, i.e., when the relevant indicators of success are not being achieved.
For more information, see the NWI document that describes the phases and activities of Wraparound, or the User’s Guide to Wraparound, which presents a description of the process in simple terms for families or system partners.
What are the implementation requirements for Wraparound?
High quality implementation of Wraparound requires a supportive organizational context as well as a hospitable system context. A supportive organization ensures that a variety of conditions are in place to support high quality practice. For example, ensuring that staff acquire the skills and competencies they need to carry out their roles in Wraparound; ensuring that caseloads are reasonable and compensation is adequate; and ensuring that data is collected and analyzed so that the organization can monitor practice quality and program outcomes.
Providing comprehensive care through the Wraparound process also requires a high degree of collaboration and coordination among the child- and family-serving agencies and organizations that make up the system context of a Wraparound program. These agencies and organizations need to work together to provide access to flexible resources and a well-developed array of services and supports in the community. In addition other community- or system-level supports are necessary for Wraparound to be successfully implemented and sustained. Research on Wraparound implementation has defined these essential community and system supports for Wraparound, and grouped them into six themes:
- Community partnership: Representatives of key stakeholder groups, including families, young people, agencies, providers, and community representatives have joined together in a collaborative effort to plan, implement and oversee Wraparound as a community process.
- Collaborative action: Stakeholders involved in the Wraparound effort work together to take steps to translate the Wraparound philosophy into concrete policies, practices and achievements that work across systems.
- Fiscal policies and sustainability: The community has developed fiscal strategies to support and sustain Wraparound and to better meet the needs of children and youth participating in Wraparound.
- Access to needed supports and services: The community has developed mechanisms for ensuring access to the Wraparound process as well as to the services and supports that Wraparound teams need to fully implement their plans, including evidence-based interventions.
- Human resource development and support: The system supports Wraparound staff and partner agency staff to fully implement the Wraparound model and to provide relevant and transparent information to families and their extended networks about effective participation in Wraparound.
- Accountability. The community implements mechanisms to ensure the right children and youth are enrolled in Wraparound; to monitor Wraparound fidelity, service quality, and outcomes; and to oversee the quality and development of the overall Wraparound effort.
For more detail on implementation, see NWI resources, including the Implementation and Practice Quality Standards and the Implementation Guide. Contact the National Wraparound Implementation Center (NWIC) for assistance with your implementation questions.
What specialized staff roles are needed for the Wraparound process with families?
Wraparound is intended to be a way of supporting individuals with a range of complex needs in any community. In addition, Wraparound is individualized to meet the needs of each youth and family who participates. Thus, across Wraparound programs, people in a variety of different roles – both professional and non-professional – play important roles in carrying out the Wraparound process with families and their children. Most typically, implementing a Wraparound project requires a cadre of individuals who are trained and supported to effectively lead the process. These individuals most commonly include Wraparound facilitators (or care coordinators), family support partners, and youth support partners. In addition, other types of professionals may play important roles in carrying out the Wraparound process in a community. These professionals include clinicians trained on research-based practices to address psychosocial needs, in-home behavioral support specialists, resource coordinators, and others.
The NWI’s resource library has detailed information about various staff roles for Wraparound. (Click on “Human Resource Development” and then “Roles for Wraparound.”)
What about training and support for staff? What is required?
Wraparound is a complex process involving many different skill sets. People with key roles for carrying out the Wraparound process therefore require substantial training, as well as ongoing coaching and supervision, to ensure that they have the knowledge and skills they need. Not only do Wraparound facilitators (or care coordinators) and parent and youth support partners require training and coaching to criteria for skillful practice, but also providers in the service array need to be trained and supported to use evidence-based strategies and interventions. Most Wraparound projects, at least in their early stages of development, rely to some extent on outside people for training and for consultation on how to set up ongoing procedures for staff development and quality assurance. Finding a consultant or trainer has not always been easy, however, since Wraparound is not a proprietary model. To address this issue, the NWI launched the National Wraparound Implementation Center, which provides training, coaching, and a method that facilitates development of local expertise and sustainability. Regardless of who provides Wraparound training and staff skill development, the NWI urges sites and states to follow the guidance described in its comprehensive Guidelines for Training, Coaching and Supervision for Wraparound Facilitators.
The information on this page has been peer reviewed through the NWI.