Wraparound Across Systems An Introduction John VanDenBerg Ph.D. North Sound Systems of Care Training Institute

Marge and Tom Both age 37; three kids ages 8-16 Tom is unemployed due to his untreated alcohol addiction, Marge has diagnosis of major depression Oldest son has dropped out of school, has been charged with breaking and entering, has court date in May, is on house arrest Middle child has a dual diagnosis of mental retardation, attention deficit hyperactivity disorder and is in special education. Youngest child is very quiet, withdrawn Relatives in the area are “hands off” due to burn out of relationships; no family friends other than Tom’s drinking friends and one of Marge’s sisters who has been in a similar situation.

Typical Services for Marge and Tom Tom referred to Alcohol and Drug Treatment, AA; refuses to go to either because he does not think he is the problem in the family Marge has a therapist and is on meds. Oldest son has a probation officer and a therapist he refuses to go to; he is likely to enter detention for days, is at high risk for adult corrections Middle child has a different therapist, meds, is in special education Youngest child slips below the noise level yet her teachers have their eyes on her and are concerned

What are the predicted outcomes for this family? They are involved with at least mental health, drug and alcohol services, DD, education and special education, juvenile court, and adult services (6) and are at high risk for involvement with child welfare and welfare. Each of these systems can legally develop their own plans for the family, and each may see the family differently. Research shows that likely outcomes involve divorce, poverty, loss of housing, long term public support of parents and kids, school drop out, out-of-home care for children, and high potential of the cycle repeating in the next generation Five year cost to taxpayers often reaches $250,000 for Washington families like this one.

Wraparound for the Family Referral could be made by any system. In most Washington counties implementing wraparound, the family could self refer A Wraparound Facilitator who worked for all systems would be assigned if family agreed or court ordered involvement. Staff would engage the family, do a strengths discovery on what works in the family, and ask them what they see their needs as being, and prioritize these needs The family would choose a Wraparound Team to help get every system on the same page, to brainstorm options to meet needs, and help carry out options

Strengths of Family Tom has a father who has his best interest at heart, but is currently angry at Tom. Tom’s dad has a business. Marge’s sister belongs to a local church who has helped her with support, Marge would like to attend again but is embarrassed over her situation Marge and Tom have goals for their children and a vision for the future of grandchildren and the family being together The oldest son has mechanical ability and a grasp of math, he had a middle school math teacher he clicked with The middle child has a close friend at school and excels at activities that are fast paced and physical The youngest child wants friends but does not know how to develop friends, loves her parents, and loves going to school.

What Marge and Tom see as their top needs…. The family to stay together The oldest child to be crime free and not in jail The kids to finish high school and maybe go to technical school or college or have a vocation that fits Marge to get off meds or have happier days For their children to have healthy friends that they have fun with

The Wraparound Team for this Family The entire family Tom’s Dad Marge’s sister One of Tom’s drinking buddies who is the best dad One of the oldest child’s friends who is cool The therapists, the probation officer, and the school counselor, DD case manager

The Initial Wraparound Plan for the Family 1.The oldest son goes to court with a restitution plan (Restorative Justice) to compensate his victims. The plan involves a Mentor from a local Kiwanis who is a mechanic. The oldest son and the Mentor will maintain the vehicles of the victims for one year. 2.Marge will re-connect with her sister’s church for support from a women’s group 3.The middle child will get more involved with sports and activities like bike riding, with support from Tom’s father and Tom 4.Marge’s sister, Marge, and Marge’s therapist will help the youngest child learn the skills of making friends, starting with one of the child’s cousins

The eventual wrap plan… Focuses on Tom getting into AA, leveraging his desire for his family to be together Gets the oldest child back in school and on track for going to the Community College Gets the extended family back in the picture through improvement of relationships and a positive “buzz” Supports all children Includes informal fathering support from one of Tom’s sober friends whom he trusts As family stabilizes, either parent could be recruited to become Family Support Partners and give back to other families.

Why Does Wraparound Work? The family, not professionals, choose their needs and prioritize the needs The family accesses their own natural supports or uses surrogate supports until they get their own back The family learns to handle life on their own without professional help All systems involved with the family get on the same page.

Collaboration: Agencies are familiar with each other’s missions and roles, key staff work with each other at the child/family level, but often retain single system decision making power and planning. Integration: Agencies are familiar with each other’s missions and roles, key staff work with each other at the child/family level, sharing decision making in a team format that includes the family, producing a single plan that meets all system mandates and that is owned by the entire team. Copyright Vroon VanDenBerg Collaboration and Integration Definitions

Integration Could Marge and her Family have achieved outcomes without being in a process of integration (wraparound)?

Discussion Questions What is currently working in the area of integration in Washington State? What are the major barriers to achieving an Integrated System of Care?