[SAMHSA - Substance Abuse and Mental Health Services Administration TA Monthly Minute: Bite-sized knowledge from the TA Network] [Title Card: Wraparound] [Narrator] Wrap-around, before it was even called wraparound, got started several decades ago as a response to what was obviously not working well for children and youth with serious mental health or behavioral challenges and their families. In places where systems of care are not developed, the kinds of intensive and helpful services and supports that children and families need are often simply not available in their communities. [Animation of a family sitting at the dinner table while it rains outside. They look sad or defensive, with their arms crossed and downturned expressions. The mother talks at the daughter, who stands and walks away. The parents slump at the table, discouraged. We see the mother and father on the couch, alternately working on a laptop or tablet, talking on the phone, and searching for help together.] [Narrator] And as for the services that are available, they are often focused on what the systems or providers want families and children to do and not focused on what children and families need in order to thrive. This means that children and families are often involved with multiple systems and providers, with each one developing a separate plan telling the child and family what they needed. [The family walks into an office and shakes hands with the worker at the desk. They sit down and talk together. This image fades into a screen split into four sections, with each one showing the same family talking with a different provider, looking frustrated. This fades into a screen with nine sections, all of the family, looking even more frustrated, talking with still more different providers, which fades into yet another screen, this one with 36 sections all depicting the same thing.] [Narrator] Not surprisingly, outcomes from this situation were not good. Families and children felt overwhelmed, frustrated and even angry with the experiences of too many services and too little actual help. Many children ended up placed in residential treatment far away from their families and communities, often for very long periods of time. After being out of home it was hard for children to come back and do well in their home communities and schools. [The family stands in the center of the screen. The original provider who met with the family stands at the left side of the screen. Between the provider and family is an arrow pointing up that says, "Increase in children placed out of home." Other providers appear around the family, all talking at the same time. An arrow pointing downward appears, reading, "Decrease in school attendance." The background changes to a dark spiral, and we zoom in on the family. Cut to the family gathered in their living room, looking exhausted and overwhelmed. In the next scene, the father comforts the mother in the front yard while a social worker walks away with the daughter. The social worker takes the daughter to a large facility. Several calendars cover the screen, and the girl returns home, looking detached, even as her parents welcome her back. She turns away from them, and the mother cries.] [Narrator] Wraparound is a completely different way of organizing help when children or youth experience serious mental health or behavioral challenges. In wraparound, the families' ideas and perspectives about what they need and what will be helpful drive the work. The young person and their family members work with a wraparound care coordinator to bring together people and providers who support them. With the help of the team the family and young person take the lead in developing creative and individualized services and supports that will help them achieve their own vision for their family. Team members work together to put the plan into action monitor how well it's working and change it as needed. [A hand waves over the front yard scene and places a new provider in the yard with the family. The provider says, "Hello! Tell me about your family." They all walk into the home together. In the living room, the family watches, smiling, as the new woman presents with a whiteboard that says, "Family Vision." The hand waves again, and we see a conference room full of the team of providers. The wraparound worker walks in with the family and stands between them and the rest of the team, bridging the gap between them. Two team members present at the whiteboard with the word, "Vision" on it as the family and rest of the team watch and nod. Over various meetings, we see different combinations of team members presenting with words on the board like, "Plan" and "Monitor." ] [Narrator] There is now strong evidence that when wraparound is done well -- we call this "done with fidelity" --young people are more often able to stay in their home communities or be in out-of-home placements only for short periods of time. [In the conference room, the team and family are gathered around the whiteboard, which reads, "Fidelity." Zoom in on the whiteboard which now has a chart that shows "Average Effects Sizes for Common Wraparound Outcomes. In the "Functioning" column, there is one star labeled 0.28. The "Juvenile Justice" column has one and a half stars and is labeled 0.29. The "School" column has two stars labeled 0.31. and the "Living Environment" column has three stars and is labeled 0.44.] [Narrator] Young people in wraparound tend to have better outcomes than similar young people who don't receive wraparound, but the catch here is doing wraparound well. When wraparound is done well it is a true partnership between young people, their families, the care coordinator, and the rest of the team together, they ensure that all of the team's work is grounded in the ideas and preferences of the young person and family and informed by the knowledge and expertise of all its members. Team members work together to come up with strategies to address the challenges that are most important to the family and to make sure that the services or supports provided are tailored or individualized to reflect what the family and youth think will be most helpful. [The family, happy now, rides bikes together through the park. We see them gathered in the conference room with the various members of their team, taking turns talking, presenting, drawing on the whiteboard.] [Narrator] The resulting plan guides the work of all the team members. The care coordinator oversees implementation of the team plan and works to ensure everyone is successful and completes the task they have agreed to take on. [The Care Coordinator writes, "Meeting @ 6pm next week" on the whiteboard and waves at everybody as the leave. We see various team and family members talking, working on projects, talking on the phone, and completing tasks together.] [Narrator] The National Wraparound Initiative and the National Wraparound Implementation Center have gathered many resources and tools to support this work and ensure that wraparound is done well. These materials range from very basic descriptions to highly technical materials and resources focused on very specific topics. We encourage you to visit our websites to learn more. [Care Coordinator standing at the whiteboard with the logos for the National Wraparound Institute and National Wraparound Implementation Center, then a sample webpage showing Featured Publications and Products About Wraparound. Zoom in to see examples of the various documents that are available with information about wraparound from these organizations. Web addresses: https://nwi.pdx.edu/ and https://www.nwic.org/. Zoom out to see all the family and team members smiling together in the conference room.]