The value base also deviates from more traditional approaches by emphasizing an ecological model, including consideration of the multiple systems in which the youth and family are involved, and the multiple community and informal supports that might be mobilized to successfully support the youth and family in their community and home. This value base explicitly dissents from more traditional service delivery conceptualizations, in which a professional, viewed as the source of primary expertise, singlehandedly creates a treatment plan based on a diagnosis and/or enumeration of deficits. Wraparound represents a philosophy and value base which has been presented fairly consistently over the past 25 years and has recently been distilled into a set of ten principles ( Bruns et al. In the rest of this introductory section, we will summarize each of these components of the wraparound model in turn. When implemented in this context, wraparound can help overcome common barriers to accessing effective services and supports for youth with multiple needs and/or multiple agency involvement. These necessary system and programs conditions recognize that, though wraparound has historically been delivered on an individual basis, it is most likely to be faithfully implemented (and effective for youth and families) within a hospitable system that includes a care management model that can support the wraparound values and principles across all services delivered in the system. Wraparound can also be described with respect to the types of system and program conditions that are necessary to facilitate model adherent implementation. As it is currently conceived, wraparound is an individualized, family-driven and youth-guided team planning process that is underpinned by a strong value base that dictates the manner in which services for youth with complex needs should be delivered (similar to system of care values Stroul and Friedman 1994). Wraparound has been described variously as a philosophy, a process, an approach, and a service. We conclude with a discussion of the opportunities and challenges presented by the wraparound model, and recommendations for federal actions that have the potential to improve the likelihood of wraparound’s positive contribution to improving the well-being of youth with the most serious behavioral and emotional needs and their families. In the pages that follow, we will review the place of the wraparound process in behavioral health and discuss related systems changes that accompany successful wraparound implementation. In this paper, we take a fresh look at the wraparound philosophy and intervention model, to understand its role in children’s mental health systems. Recognizing the considerable work that has been done in children’s mental health over the past 25 years and with an eye toward the future, we present reason for optimism and a belief that research and practices exist that can inform new approaches and policies. While all of this may be true, we are poised at a moment in history in which health care reforms are being proposed, access to care is being emphasized, and coordination of care for specialty mental health populations has become a focal point for change efforts. And, for many youth, the result is all too often placement in restrictive out-of-community placements, use of which continues to increase nationally despite a lack of evidence for their long-term effectiveness ( Burns et al. Moreover, when a child’s needs are complex and overlapping, services are not likely to be coordinated across key providers and helpers and/or engaging of parents, teachers, family members, and the youth themselves ( McKay and Bannon 2004 New Freedom Commission 2003 Stroul and Friedman 1994). 2004 US Department of Health and Human Services 2005a), and that when it is provided, the services will be unlikely to be based on current evidence of what will be most effective ( Hoagwood et al. It is true that it has become standard operating procedure to preface articles on children’s mental health with a recitation of bad news- that the children’s mental health system is “in shambles” and getting worse ( Knitzer 1982 New Freedom Commission on Mental Health 2003 Tolan and Dodge 2005), that access to services for youth with mental health problems is limited ( Huang et al. With the recent change in presidential administrations and ongoing scrutiny of the nature of our nation’s health care system, it is incumbent upon those of us who work in the arena of children’s mental health to take stock of recent research and promising frameworks, in the name of improving our policies and practices.
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