Wraparound Care: Like a Big Hug

Tina: Hey everyone, I'm Tina.

Serena: And I'm Serena, and we are the Mental Health Mamas.

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Tina: Welcome to No Need to Explain. We are so glad you're here.

Serena: First, as always, a quick disclaimer.

Tina: We come to not as mental health professionals or experts in the field, but rather as parents with lived experience who are on a mission to normalize the conversation around mental health.

Serena: If you or someone you love is experiencing a mental health crisis, please seek professional support. You'll find a variety of resources in our show notes and on our website, noneedtoexplainpodcast.com.

Tina: This time of year is particularly difficult for those of us who struggle with our mental health in one way or another, and even perhaps for those of us who don't. The time change, the getting dark early, the, this is an issue, lighter earlier for those who like to sleep, right? As well as other factors like holiday prep, midterm exams, if you're a student, more time out of our routine, and the list goes on.

Serena: Yeah, I was certainly feeling this. This past weekend. So, yeah, big breath. So, yeah, everyone in my house struggles during these months, and it's definitely real, and it's getting colder. It was, yeah, below freezing this morning, and it will get colder, and so that's hard too. So, as we contemplate our tools in our proverbial toolbox, it's important to kind of open that toolbox and dig around, see what's at the bottom, see what you have, and figure out how to access them.

Tina: Yeah, so very important, and we can't say enough about the importance of feeling empowered to know what's out there, and how those resources and tools will best serve your family. And just to be clear, we're gonna talk about a type of, a very specific type of care today, specialized, and really intended for children and families who run into serious behavioral and mental health struggles, and really those that threaten to take that child away from the family and out of the community.

Serena: So, it'll be very specific around that, but we would like you to consider, as we kind of throw a lot of information at you, how this model might otherwise be used. We think it's an amazing model, and that's why we're talking about it. So, just consider that as we go through. So, today, we're going to explore a type of care called wraparound. We've heard lots of successful stories, the families receiving this type of care, allowing them to feel supported and gain resilience.

Tina: Yeah, so wraparound care is a several decades-old concept that I was first introduced to at a conference about nine or 10 years ago. This particular program, which was called a Wraparound Milwaukee in Milwaukee, Wisconsin, has been around since 1995. So, let's back up and talk about this very specific model of care. We're going to define it who's eligible and kind of where it exists in the country.

Serena: According to the National Wraparound Initiative, wraparound care, quote, differs from many delivery strategies and that it provides a comprehensive, holistic youth and family-driven way of responding when children and youth experience serious mental health or behavioral challenges. Wraparound puts the child or youth and family in the center. It continues by saying, the young person and their family members work with Wraparound facilitators to build their Wraparound team, which can include the families, friends and people from the wider community as well as providers of services and supports. So, I want to pause here a moment and I want to talk about that term family-driven. Tina, you've described this before and I like how you describe it.

Tina: Yeah, so I always think about it like a van or a bus, right? And the family is literally in the driver's seat and as they're going down the road, they pick up support and those people, those tools come into the bus or the van. We had a van, so I like to just say a van, right? To be in there, so the family really is in control and it has the ability to invite people in. So, that's just a good image, I think, of that.

Serena: Love that.

Tina: Yeah. So, this wraparound concept was really response to what was not working well for children and families which we love because that's part of what I think the world should be listening to, right? Like, there should not be people sitting in a room designing things who've not experienced this. This is where our lived experience matters, right? So, before the wraparound concept, care either was not widely available for families or even when the services were available, they were often focused on what the providers wanted for the families and I think of this like school, like teachers say, here are the things that we want from your child. We want to have them behaving in school, we want them to whatever. And we were partners with the school and certainly not school is a hard place, it's a hard place to teach, it's a hard place to be. And I think of that partnership as being so important, right? It isn't about what one side or the other side wants. We all want the same thing which is for our children to be well and successful. So, the other important aspect of wraparound is for those children to stay close, right? To stay close to those families, to stay close to the community they're familiar with and really receive those supports within that community and within that family unit.

Serena: Yeah, and so, just to emphasize that point in communities where this care doesn't exist, that often means that a youth is an hour, two hours away from their family, trying to make progress and heal and that's really, that's really hard to do. So, it's a burden on families too.

Tina: And expensive, right?

Serena: And expensive. Yeah, yeah. So, there are four phases of wraparound care, engagement, initial plan development, plan implementation and transition. Before we get into what these phases look like, let's take a look at the 10 guiding principles we have taken these from a program out of Camden, New Jersey, called the Camden County Partnership for Children.

Tina: Yes, so these principles are crucial to the process of getting this type of support and really implementing it with the greatest success. And I would say as we talked about a little bit at the beginning of this episode, these really can be applied wherever we are, right? So, the first is family voice and choice. And Serena and I cannot say enough about this. We learned how to use our voice together a while back. And we haven't stopped since. And they're crucial to all the phases in this process that that family voice and choice. Planning is grounded in family members' perspectives. And the team, important word, strives to provide options and choices so that the plan can reflect the family's values and the family preferences.

Serena: Just keep thinking of that family in the driver's place there. That's driving the bus. Second, team-based. The wraparound team consists of individuals agreed upon by the family. And so nobody's joining that isn't invited and committed to them through informal, formal, and community support and services relationships.

Tina: And then the third is natural supports. The team actively seeks out and encourages the full participation of team members. It draws really from the family network, as well as typical service people, right? So that might look like pastors. It might look like neighbors. It might look like grandparents. Whatever that looks like for the family. The wraparound plan reflects activities and interventions that draw on the sources of natural support.

Serena: Next, we have collaboration. Team members work together and share responsibility for developing, implementing, monitoring, and evaluating a single wraparound plan. The plan reflects a blending of team members' perspectives, mandates, and resources. The plan guides and coordinates each team members' work towards meeting the team's goals.

Tina: Number five is community-based. The wraparound team implements services and support strategies that take place in the most inclusive, most responsive, most accessible, and least restrictive settings possible. And that promote the safety of the child and the family integrating into the home and to community life.

Serena: Yeah, so just a note, one more note about the community based is we think about these kids who are now two hours away from home. They're not in their same school, obviously, anymore, either. So that's a really big transition point as well. So next step is culturally competent. The wraparound process demonstrates respect for and builds on the values, preferences, beliefs, culture, and identity of the child, youth, and family, and their community.

Tina: And sometimes I'll just comment. We, being competent, is quite a bar, very high bar. So sometimes we would say culturally sensitive and looking at things with a cultural lens, right? So we don't have to be perfect with this, but we need to be upfront about being sensitive about it.

Serena: Or even culturally responsive.

Tina: Responsive, correct, yes. So number seven would be individualized to achieve the goals laid out in the wraparound plan and the team develops and implements a customized set of strategies and supports and services individual to that child and family.

Serena: Number eight is strength-based. The wraparound process and the wraparound plan identify, build on, and enhance the capabilities, knowledge, skills, and assets of the child and family, their community, and other team members. In other words, we are looking at what's good, what's going well, what are the strengths as opposed to the deficits?

Tina: Important. And then number nine is persistence, despite all the challenges, the team together persists and works toward the goals included in the wraparound plan. Until the team agrees that the formal wraparound process is no longer required.

Serena: And finally, number 10, we have outcome-based. The team ties the goals and strategies of the wraparound plan to observable or measurable indicators of success. Monitors progress in terms of these indicators and revises the plan accordingly. So there's always a goal, we're always moving towards that goal.

Tina: And it's a shared goal, right?

Serena: Yes, absolutely. It's a shared goal, yes.

Tina: So we will include all of the links to these principles as well as the parents guide, which I cannot say enough about, it was revised in 2019, which sounds old, but this is an old concept, right? So the idea that it's a very step-by-step guide, I can't say enough about it.

Serena: So, okay. So taking these principles, we can look, we can take a look at what this process looks like. So again, you'll find all this in the parents guide. And like Tina said, we'll include it in our notes. So remember, there are four phases for implementation. The first starts with the family meeting with the care coordinator. So again, I just wanna point this out, right? Sometimes when plans are created, the family is not present at the beginning. So this is different, right? The family always needs to be there. So really, we're taking a look at what the families, hopes and dreams are and how they want to proceed. Another important step in this phase is exploring who will support the family and who will attend the meetings.

Tina: And the second phase is initial planning. This will look like attending a team meeting with people who are not only providing services, but those who have also been invited by the family and connected to that family in a supportive role together. And again, that is a super important word. Together, the team, including the family, comes up with the mission statement about what they'll all be working on, look at the family's needs, together come up with several different ways to meet those needs. And then, an important thing, and Serena and I have experienced this in some team meetings we've been in, it is not about the family doing all the tasks, right? It's about every person in that room who supports that family taking on something, right? Helping to move the needle in a direction that's positive. So really kind of divvying up those tasks.

Serena: Yeah, and so then phase three is the implementation when everyone hopefully does their tasks, right? Because everyone has them. And so what happens is meetings will occur to check on and assess what's going well, what might need adjustment and who might assist in carrying out new or continuing tasks.

Tina: Right, and the final phase is hopeful, it is transition. The hope of the process is that people could graduate, the child and the family from this intensive care, and kind of make plans in case there's a need in the future, right? Need the future to circle back.

Serena: So as we said before, there's so many things we appreciate as family members about this process and it's principles. So the question is, where is this available? And how can we access this kind of care when we know that care is super hard to come by these days?

Tina: And so I didn't find a lot of great data on this that's new. In 2013 I found a study that said that 49 of the states surveyed all had some type of wraparound care. I do have a link to that survey. Yeah, so I would say as we talked about the beginning, wraparound care in a formal way, might not be everywhere, but there can be pieces, right, Serena?

Serena: Yeah, so again, that's why we're sharing all of this with you. We want to emphasize, in case we haven't said it already, the focus of family voice and choice of this model. When I think about wraparound and I thought about it in the past and I think about the whole model, I've always thought of this big hug, right? Where somebody is sort of reaching around the family and the youth and coming together around them and making a circle around them and that's kind of the whole idea of wraparound. And we want to encourage you to think about how you might use this kind of model with family voice and choice and maybe you can take a piece of this to a provider, maybe you are a provider and you might consider how you might incorporate this into your process to use with families. So again, we've shared a lot of information and our hope is that although this time of year can be challenging for many families that you and yours are not in crisis. But if you are, as we always say, seek professional support and with hope, we will leave you with a few final thoughts.

Tina: The first is that you're never alone. All of us have mental health, are you well? Or do you need support? And know that if you need support, that is totally normal, be proactive.

Serena: Yeah. And if you don't know if there's wraparound in your area, ask, you might have it and you don't know. When we know better, we can work better together.

Tina: Absolutely. And on that note, know that you always have a voice in your journey, always. Know your strengths and what your hopes and dreams are because people might ask you that and it's good to know them. Ask questions, seek answers, something I've never been afraid to do.

Serena: That?s right. And we've said it more than once and we'll say it again. And again, find your champions, find those people that support you and want to help you. You can imagine many of you listening, find joy and helping others. So what other people have that joy as well? Let them help and support you. Let them in, you are never alone.

Tina: And as we have said, we will include all the links so you can read up on this and adopt some of those principles in your in your own life and the more you know, the more we can certainly help our people.

Serena: And so podcast friends, we are as always grateful for all of you listening and supporting us. You can help us out by visiting Apple Podcasts, leave us a review, subscribe, and please share with others. You'll find lots more content on our website, noneedtoexplainpodcast.com. You can connect with us on Facebook, Instagram, and Twitter. You can call and leave us a voice message. You'll find the number in our show notes. Tell us a bit of your story. Tell us what you think of the podcast or just call to say hi.

Tina: And this is your gentle reminder to take good care of yourself while you are also taking care of your people.

Serena: Thanks for listening.

Tina: Bye.

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