History of Wraparound

By the 1970s, mental health services for children and youth with complex behavioral needs and their families were at a crossroads.  A general surge of a need for deinstitutionalization brought funding and service changes.  At the same time, there were few good options for providing the kind of holistic, comprehensive services required for the children and families to succeed.  Before wraparound, most children with complex behavioral health needs were being put into long-term placements outside their homes or secluded in their homes. Wraparound grew out of the continuing movement to improve behavioral health services for children and youth. Prior to the advent of wraparound, two-thirds of all children with severe emotional disturbances were not receiving appropriate services (Knitzer, 1982). These children were “unclaimed” by the public agencies responsible to serve them, and there was little coordination among the various child-serving systems.

To address this need, Congress appropriated funds in 1984 for the Child and Adolescent Service System Program (CASSP) through the National Institute of Mental Health. It was envisioned as a ten year program to build comprehensive mental health system of care for children, adolescents and their families. Ongoing Federal grants supported the development of wraparound practice and systems of care across the country. Wraparound as a field has been developing since the early 1980s, and many of the early programs directly targeted keeping youth and children in their homes. States such as Alaska, Michigan, Maine, Wisconsin, Vermont and Kansas used the process to reduce the potentially harmful impact of long –term institutional placements and serve children and youth in their homes. These early pilot programs were based primarily on the key principles of individualization, unconditional care, strengths-based planning, and increasing family voice and choice. The first project named Wraparound was grounded in creative agency­ based individualized planning being done at the Kaleidoscope Agency in Chicago (Kendziora, 1999). The Kaleidoscope Agency’s practices grew from research on de-institutionalization and normalization efforts from Canada. At these early stages, there was little to no standardization of the wraparound process.

By 1988, many communities had created programs they called ‘‘wraparound.” These programs varied wildly in quality and in scope. Local implementation was shaped through local innovations and policy and funding constraints.  By the mid 1990’s, efforts in several states to implement ”wraparound” had been identified as failures by implementers, evaluators, and funders. Close examination of these efforts revealed that what was called wraparound more closely resembled children’s case management with no real individualization, limited family voice and choice, no integration of services, and a focus on deficit-based services.  These failed variations posed a serious threat to the continued funding of wraparound everywhere. To address this, a meeting was held at Duke University. This meeting marked the first major organized effort to provide consistency to the definition of the wraparound process (Burns and Goldman, 1998).  This meeting helped to clarify the principles, but had little direct effect on the process variation.

In 2001 a larger group of early innovators, providers, and family members came together to continue the process of defining and standardizing wraparound.   This group grew into the National Wraparound Initiative (NWI) and developed standardized principles, and described the process of wraparound through standard phases and activities (Walker and Bruns 2006).  A part of NWI -the Wraparound Evaluation and Research Team (WERT) – developed standardized fidelity measures based on pre NWI tools (Rast and Burchard, 1996) and the principles of the process (Bruns, 2007). The founding partners of VVDB, Jim Rast and John VanDenBerg, were initial core members of the small work group of NWI that built the principles and phases and activities from the then current strengths in the field .   Many states and provinces have accepted the standardized principles and the phases and activities of the NWI as the definition of the wraparound process, and the field is becoming more consistent.

The NWI principles, phases, and activities created a strong basis for standardizing wraparound practices. However, there was still more work to be done.  Based on continual implementation of the NWI principles and phases and activities, VVDB has extended the work of NWI to define the roles of the Wraparound Facilitator and Family and Youth Support Partners through functions, action steps, and certification processes.  In addition, VVDB has defined a theory of change that explains why wraparound works which guides staff to individualize the process they use to do wraparound with individual families and provide a fidelity-based process for coaching and supervision.  VVDB has continually addressed challenges to engaging families in wraparound that understanding that success in wraparound must focus more with the youth and family than with the team.

A major focus and goal of wraparound is to prepare youth and families to get their own needs met and manage their own crisis after wraparound.  VVDB teaches that wraparound is equally about addressing current needs and preparing the family for the future. VVDB also recognizes that most people have “teams” of people who support them, but that the “teams” or “go to people” vary with different needs and few supports are involved with even most of the family’s needs. In addition, families have many different ways they prefer to ask for and coordinate services and supports.  Most do not choose to have team meetings.  Managing wraparound throughout the implementation phase through team meetings does not prepare families to sustain progress after wraparound. Explanations of wraparound that focus more on the team than the family miss this major element of successful wraparound.

VVDB has developed competency-based training for all wraparound staff and defined roles for trainers, coaches, supervisors and wraparound process mentors (consultants and coach trainers).  VVDB has developed certification processes for each of these positions.  VVDB has also developed and continues to develop advanced training and coaching materials.

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