Goals today• Define Systems of Care and Wraparound

• Learn how Systems of Care and Wraparound intersect

• Learn about Systems of Care and Wraparound implementation efforts at the state & local level through the Statewide Children’s Wraparound Initiative and at the local level through InterMountain ESD

Systems of Care

Systems of Care (SOC) defined:

The systems of care model is an organizational philosophy and framework that involves collaboration across agencies, families, and youth for the purpose of:

• improving services• improving access to services• expanding the array of coordinated, community-based

services and supports

…for children and youth with a serious emotionaldisorders and their families.

SOC Core Values:The systems of care philosophy is built upon core values1. Thecore values of the system of care philosophy specify that thesystem of care:

1. Should be child centered and family focused, with the needs of the child and family dictating the types and mix of services provided.

2. Should be community based, with the locus of services as well as management and decision-making responsibility resting at the community level.

3. Should be culturally competent, with agencies, programs, and services that are responsive to the cultural, racial, and ethnic differences of the populations they serve.

Traditional/Categorical Care

Child Welfare

Juvenile Justice

EducationMental Health

Family

Plan

Plan

Plan

Plan

Coordinated/Collaborative Care

Child Welfare

Juvenile Justice

EducationMental Health

Family

One Plan

System Reform Initiatives

Pires, S. (2002). Building systems of care: A primer. Washington, D.C.: Human Service Collaborative.

National Results

•Education: Children and youth perform better academically and act-out less; families are more engaged; and educators benefit from additional resources, fewer disciplinary problems, improved academic performance, and improved coordination/collaboration with families, MH professionals, and other partners.

Education Results (cont.)

•Fewer Disciplinary Problems- expulsions fell by more than 19%- suspensions fell by about 36%- detentions fell by about 34%

•Improved Academic Performance - 35% participants improved academic performance after 6 months- 42% improved after 30 months

Education Results (cont.)

•Positive Impact on School Attendance- 38% said child’s school attendance improved following onset of treatment

•Positive Effect on Chance of Suspension or Expulsion - before treatment, 18.5% of children 6 and up had been expelled or suspended in previous 365 days;- after treatment, only 11% of same population was expelled or suspended following onset of treatment

Wraparound

Wraparound

Education Child

Welfare

Mental Health

Juvenile Justice

HealthDevelopme

ntal Disabilities

Residential

Services

Community Based Services

Natural Support

s

Community

Wraparound is a Systems of Care Planning Model

Values & Principles

Systems of Care

Wraparound Principles

Team Based

Natural Supports

Collaboration

Community Based

Culturally CompetentIndividualized

Strengths Based

Unconditional

Outcome Based

Family Voiceand

Choice

Frontline Practice Shifts

Orrego, M. E. & Lazear, K. J. (1998). EQUIPO: Working as Partners to Strengthen Our Community. University of South Florida: Tampa, FL

What Does a WraparoundTeam Do?

1. Explore the family’s vision2. Assess strengths and needs3. Develop a team mission statement4. Prioritize needs5. Determine goals and outcomes6. Select strategies to meet needs7. Assign action steps8. Create a crisis & safety plan9. Implement action steps and track progress10. Evaluate progress and revise strategies11. Develop and implement a transition plan

Strengths and Needs Across Life Domains

• Psychological & Emotional

• Family & Relationships

• Home & A Place to live

• Social & Recreational

• Daily Living & Life Skills

• Substance Use & Addictions

• Educational & Vocational

• Legal

• Health & Medical

• Crisis & Safety

• Spiritual & Cultural

• Financial

Phases of Wraparound: What to Expect1.

Engagement & Team

Preparation

2. Plan Developm

ent

3. Plan Implement

ation

4. Transition

Roles within a Wraparound Team

System Partners, Providers,

Other Team

Members

Facilitator/Care

Coordinator

Youth & Family

The Wraparound TeamRoles and Responsibilities

Family and Youth

The guiding voice in Wraparound. They inform the team of their unique strengths and needs, and insure that the planning process reflects their preferences, values and culture.

The Wraparound TeamRoles and Responsibilities

Wraparound Facilitators/ Care Coordinators

Coordinate the overall care planning, inclusive of short and long-term goals of family and youth for achieving stability and permanency in the community.

The Wraparound TeamRoles and Responsibilities

Family/Youth Support Partner

Someone who has ‘walked in the family’s/youth’s shoes’.

Ensure that the youth and family voice is heard and is central in the team process and in all aspects of Wraparound implementation.

Help youth and families understand and navigate the complex systems they are involved in.

Systems of Care in Oregon2003: The Children’s Mental Health SystemChange Initiative (CSCI) •Established state and local interagency infrastructure to support SOC•Integrated the funding for high end services into the local or regional managed care environments•Created a uniform process to assess level of need (Level of Service Intensity Determination)

2005: Intensive Community-Based Treatment & Support Services (ICTS)•Established standards for care coordination and child & family team planning

Systems of Care in Oregon

2009 Statewide Wraparound Legislation

• House Bill 2144 passed the 2009 Legislative Session providing statutory direction for the Wraparound Initiative.

• DHS identified as the lead agency, among partner agencies including Department of Education, Oregon Youth Authority, Commission on Children and Families, and other appropriate agencies involved in the systems of care.

• Provides authority to combine resources into single funding pool, seek federal approval or waivers, and adopt rules.

• Phase 1 started in July 2010 to improve outcomes for children with high needs in the custody of child welfare by increasing access to care coordination and implementing wraparound to fidelity.

Washington County

Rogue ValleyJosephine County Jackson County

Mid-ValleyLinn CountyMarion CountyPolk CountyTillamook CountyYamhill County

Three Project Demonstration Sites

Common Goals

•Safety•Stabilization•Support•Improvement of symptoms and behaviors•Success at school and in the community

Value Added with Wraparound

•Planning is informed by comprehensive knowledge of family and youth

•Brings more talent to the table•Offers support and strategies not usually

possible within one system•Focus on creating conditions to sustain

academic achievement and therapeutic progress in the community

Working together

•Greater engagement of family and natural supports

•Improved understanding of respective systems

•Increased success in the community•Improved academic and family outcomes

Resources

•National Wraparound Initiative www.nwi.pdx.edu

•Statewide Children’s Wraparound Initiativewww.oregon.gov/OHA/mentalhealth/wraparound/main.shtml