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What Are Wraparound Services?

By: Protection & Advocacy Inc.

"Wraparound" may sound like a new concept, but it is not. The term "wraparound" came into use in 1986, in an article by Lenore Behar*. She defined "wraparound" as a way to "surround multi-problem youngsters and families with services rather than with institutional walls, and to customize these services." Also called "holistic," "strengths based" or "individualized," the "wraparound" approach is more a process than a service. Children who qualify for Medi-Cal qualify for wraparound services.

In California, children who qualify for Medi-Cal also qualify for wraparound services through Medi-Cal's EPSDT (Early and Periodic Screening, Diagnosis and Treatment) program.

To see how wraparound works, take a hypothetical child named "Gretchen." Wraparound is the process of:

  • Getting to know Gretchen and her family;
  • Working with them to identify their needs; and
  • Finding (or creating), securing and monitoring all of the services necessary to avoid placing Gretchen in an institution.

The actual services must:

  • Focus on Gretchen and her family;
  • Be home- or community-based;
  • Work with all the systems in Gretchen's life;
  • Respect the family's culture and religious beliefs; and
  • Be the least restrictive or least intrusive possible.

Strengths come first.

Each child is unique. Every family has its own structure and resources. Getting to know Gretchen in every aspect of her own world is the first step. What does she do well? What are her interests? What are her dreams and goals for the future? Where can she turn for support? What are her family's cultural and religious beliefs? How does her family feel about mental health treatment? Does she have extended family, close friends, helpful neighbors, a caring teacher?

After exploring Gretchen's and her family's strengths, her doctor turns to the difficulties she is having. Then, working from a base of strength and competence, Gretchen, her family, and members of her planning team look for ways to solve those problems together.

Power sharing, collaboration keys to success

The planning team includes Gretchen, her parents, community resource people, teachers, professionals (health, mental health, school, special education, probation) and anyone else the family invites. With the whole team at the table, everyone involved can see just how complex Gretchen's needs and solutions may be. The team looks at how Gretchen functions in all aspects of her life. They try to see what Gretchen needs -- at home, in the community, and at school.

Creativity follows

There are no rules. The team may find services that meet Gretchen's needs anywhere. Some already exist as standard treatment. Others, they will need to invent. Still others are as close as a coach or a grandparent. Gretchen's treatment plan is an action plan. Her team looks at each need in context and finds or invents a service to meet that need. The team watches the results and makes changes when necessary. They take care that each service:

  • Benefits both Gretchen and her family;
  • Targets clearly established needs;
  • Is part of a coherent treatment approach; and
  • Goes into place effectively.

Obviously, wraparound requires commitment and cooperation from everyone concerned. Agencies must collaborate with each other and with families. Their sole goal must be to help children like Gretchen live successfully in the community.

This module, which originally appeared as an article in Issue No. 64, Summer 1998 of the Newsletter published by Protection & Advocacy, Inc. (PAI), is reprinted with permission of the publisher. Protection & Advocacy Inc., 100 Howe Ave., Suite 185-N, Sacramento, CA 95825-9968, (800) 776-5746