Many competing needs and goal went into creating the processes and procedures we follow when providing mental health services in this country. There are a variety of things we do to protect ourselves legally (like mandated reporting practices, forms we have to get signed, and when and how we meet our clients, to name a few). There are other things we do to make our jobs fit within convenient time frames and billable hours. There are a whole host of things we do to maintain our own privacy, and to reinforce the barrier between practitioner and patient.
When you are trying to make a process work that relies on securing engagement, it quickly becomes obvious that the modern mental health admittance and treatment process wasn’t created with engagement and client comfort in mind.
I have watched so many dedicated professionals struggle to do High Fidelity Wraparound in a system that hasn’t been adapted to support it. From big picture things like securing or adjusting funding to meet the needs of the process (instead of the other way around), to daily items like adjusting paperwork to reflect the process, there are a lot of potentially fidelity ruining barriers that agencies never examine.
Consider this: we went into an agency that, despite their sincere efforts, was unable to maintain fidelity levels over time. They would have big push, everybody would up their efforts and scores, and six months later they were back where they started. We came in to help them figure out the problem. There were a few things happening, but by far and away the biggest change we helped them makes was to align their paperwork with the process. They have maintained a higher level of fidelity ever since.
The truth is that people do what they have to do. When they are busy, up against a deadline, being evaluated, or struggling with a difficult family, they will hunker down and do what they are actively required to do to make it through. If your paperwork checks things like form completion, services offered, or physical people present – but doesn’t reflect the process – then guess what most people will do, and what they will let slid.
Similarly, if someone can bill for family treatment meetings, but not less formal work, then guess what they will end up doing. The problem is that wraparound depends on this less formal work with the family and team. Wraparound depends on the process.
Wraparound is not services as usual. If we want it to work, we have to restructure to allow it to work.