Systems of Care / Wraparound Initiative
How Wraparound & Systems of Care Came to Be (Background)
House Bill 2144 passed the 2009 Legislative Session providing statutory direction for the Statewide Systems of Care and Wraparound Initiative. The legislation called for an advisory committee and a biennial report to the legislature on progress and cost of full implementation. Mental Health was named the lead administrative agency amongst Child Welfare, Juvenile Justice and Education. 2010-2013 three mental health organizations and eight counties were awarded to be part of the demonstration sites for the pilot project. Due to providing better health outcomes, better care at lower costs, in 2014 the SOCWI grant was awarded to 13 CCOs across 30 Counties. As of January 2017, 15 out of 15 CCOs will be implementing the System of Care Wraparound Initiative.
**For additional historical background please visit the Oregon Health Authority SOCWI page.
**For more info on CCOs please visit the OHA CCO page
What is Wraparound?
Wraparound is an intensive team based planning process that follows a series of steps to help children, young adults, and their families accomplish their family vision. This individualized care planning process is a shared commitment amongst professionals, youth, families, and natural supports to the 10 principles of Wraparound to drive the process.
Download the Wraparound Best Practice Guidelines [PDF]
Download the Wraparound Process User’s Guide: A Handbook for families [PDF]
What is Systems of Care?
Systems of Care is a spectrum of effective services and supports for children, youth, and families with or at risk of health or other challenges and their families organized into a coordinated network that builds meaningful partnerships with youth and families and addresses their cultural and linguistic needs in order to help them to function better in all life domains. This is a necessary organizational infrastructure to collaboratively overcome cross-sector barriers in child serving systems which youth, families, and system providers are experiencing locally. Wraparound operationalizes Systems of Care at the practice level.
10 Principles of Wraparound
- Family Driven & Youth Guided
- Strengths Based
- Natural Supports
- Cultural and Linguistic Responsiveness
- Team Based
- Community Based
- Outcome Based
What youth and families can expect from the Wraparound Staff
- Coordination of all professional providers and natural supports in facilitating Child and Family Team (CFT) monthly meetings. The first CFT will take place within 30 days of enrollment.
- Community based Wraparound supports to maintain the youth in the community and/or the least restrictive environment possible.
- Assist you in effectively using and understanding community resources and legal expectations (if relevant) that effect the youth and your family.
- An individualized and single Plan of Care that identifies: Family Vision, Team Mission, Strengths, Needs, Strategies and Action Items to prioritized needs.
- Child and Adolescent Needs and Strengths (CANS) Assessment every 90 days to measure outcomes.
- Co-Authored team-based Safety/Crisis plan that address all necessary domains in one plan.
- Access to a Youth and Family Partner dependent upon CANS items.
- Wraparound staff are Mandatory Reporters in relations to abuse reporting laws.
- Centralize youth and family voice and choice.
- Youth and family are critical members of the team, CFT meetings will not be held without the family present.
What the Wraparound staff expects from youth and family
Participants understand that:
- Willingness to discuss the youth and family’s goals, strengths, needs, and concerns as well as identify potential Wraparound team members
- Active participation as a member of the Child and Family Team (Be present for all CFT, assist in the development of my family’s Wraparound Plan of Care, and follow through with assigned action items).
- Participating in Wraparound is voluntary to youth and their family.
Who is eligible for Wraparound?
- Medicaid Eligible
- Multi-system involved (Mental Health, Child Welfare, Juvenile Justice, Developmental Disabilities, Medical, Mental Health needs affecting academic, social and emotional developmental progress) (IEP/504)
- 0-17 years of age
- Identified family/guardian and youth are willing to engage in the Wraparound Process
- Wraparound is a voluntary process and not a mandatory service
- Care Coordination needs cannot be met by other system partners
Automatic Acceptance into Wraparound
Youth are automatically accepted into Wraparound when they are placed at the following levels of care until a Participation Agreement is signed not agreeing to the terms:
- Secure Adolescent Inpatient Program (SAIP),
- Secure Children’s Inpatient Program (SCIP),
- Psychiatric Residential Treatment Services (PRTS), or
- Commercially Sexually Exploited Children’s (CSEC) residential program.
How do I get accepted into Wraparound?
Each county has their own referral packet but any youth, family, provider, or community member can fill out a referral packet. (Please click on your county’s link below for a referral packet). Once the packet is complete and submitted to the county, the Program Manager or Lead Wraparound Care Coordinator will contact you to orient you to the Wraparound Review Committee. It is expected that the referent come present to the Wraparound Review Committee. All youth and families must consent to be discussed for eligibility at the Wraparound Review Committee. The Wraparound Review Committee takes place every month with a group of cross-sector supervisors of child serving systems and local youth and family representatives.
Utilizing System of Care Values and Wraparound Principles, the Wraparound Review Committee will collectively, as a cross system committee review submitted Wraparound referrals for eligibility determination. The referrals will be determined for eligibility based on the above mentioned criteria, program capacity (each Wraparound Care Coordinator not exceeding serving 15 youth and families), and admitted based on a consensus vote of committee members present. In addition, the committee will provide assistance with recommendations for those not accepted into Wraparound at that time, analyzing the types and mix of referrals received, will look for patterns and disparities, monitoring transitions out of the program and ensuring reasonable access. The Wraparound Review Committee will not be in a position of approving transitions but rather ensuring that as space becomes available new youth are screened and admitted so that we are utilizing all capacity.
Measuring Success in Child and Family Team Meetings with the WFI-EZ
The WFI-EZ (Wraparound Fidelity Index Version EZ) is a tool designed to assess the quality of individualized care planning and coordination for youth and families with complex needs, according to the model defined by the State of Oregon, Wraparound Best Practice Guidelines. The WFI-EZ is a 40 item interview organized by the four phases of the Wraparound Process with four items dedicated to each of the 10 Principles of Wraparound. In order to gain a complete picture of Wraparound implementation, four separate surveys are given to:
- Caregivers or Parents*
- Youth (11 years of age or older)*
- Wraparound Care Coordinators
- Team members
*Indicates WFI-EZ’s OHA will be collecting as an outcome measure. The goal is to obtain a response rate greater than 35%
The survey is separated into four sections: 1) Basic information 2) Your experience in Wraparound 3) Satisfaction 4) Outcomes. The WFI-EZ data will be used for quality assurance/ improvement, program evaluation and research purposes. As part of a plan to continually improve the practice of Wraparound and supports in our communities all Wraparound teams are asked to participate in a survey about the Wraparound process.
This survey collects information on your experiences in Wraparound. Your answers are confidential and not shared with anyone else on the team. Your answers to this survey are combined with others to create group data that is analyzed to measure our fidelity to the Wraparound Process and improve our delivery of the model. As you take the survey, please think only about this Wraparound team. Your responses to the survey will not affect the services that are received.
Remember that the purpose of this survey is to help us understand our strengths and needs and improve the Wraparound Process.
Dowload a WFI-EZ [PDF]:
How do I submit a Barrier?
Just like a Wraparound referral, anyone in the community can submit a barrier they are experiencing with youth that are 0-17, multisystem involved and enrolled in Medicaid to their counties local Practice Level Workgroup. The System of Care Site Lead of your county will follow up with you individually to determine if this is a pattern others are experiencing, if it involves multiple systems, and additional context to the barrier. The individual that submitted the barrier has the option to remain anonymous and also share the barrier to their Practice Level Workgroup.
Please see your county’s Practice Level Workgroup Barrier submission form and Charter for specific details.
Technical Assistance Partners
The National Wraparound Initiative:
Wallowa Wraparound Referral Packet