More communities are moving toward a wraparound model of care for youths, with a growing recognition of the need to redesign how services are provided to multi-stressed children and families. Adoles-cent substance abuse treatment programs need to be aware of this trend to maximize opportunities to integrate with a wraparound model.
Margie Taber, CASAC
Wraparound began in the late 1960s and early 1970s with John Brown and his colleagues at the Brownsdale programs in Canada. Karl Dennis at the Kaleidoscope program in Chicago and others have since followed in implementing wraparound programs. The approach generally involves establishing a team that develops a strategic, individualized plan for meeting child and family needs through a variety of resources. A critical goal of wraparound is to allow the child to remain living safely within the community.
Wraparound is a process, not a service. It is a collaborative strategic planning process driven by identified needs voiced by the family. The individualized plans are strengths-based and needs-driven. The family selects Child and Family Team (CFT) members from a variety of sources, both formal (teacher, therapist, psychiatrist, probation officer, child welfare worker, school paraprofessional, etc.) and informal (neighbor, family member, friend, church member, coach, etc.). CFT members can be permanent or short-term team members, depending on need. The team adheres to a value of unconditional care, meaning that everyone involved in the process must embrace a “never give up” attitude.
In wraparound work, it is believed that the youth's problematic behaviors communicate an unmet need. It is the CFT's responsibility to identify the youth's and family's unmet needs and to assist in brainstorming options that may help address them. CFT members must think outside the box when identifying ideas to help meet these needs—not just identify programs or services that already exist within the community. It is important to remember in this process that underlying needs generally are not identified instantly or easily.
Shedding service-driven approach
Substance abuse treatment professionals must adopt a new way of thinking in order to work successfully in a wraparound model. Wraparound is not a service-driven model, so collaboration and flexibility among service providers are needed for this process to work effectively.
Oftentimes, a youth arrives at an agency for an evaluation and if he/she meets criteria for a substance use diagnosis, a referral to an existing program occurs. Many agencies have outlined in advance how frequently sessions occur for their program (individual or group) and what the expectations are for the program to be completed. An established service might not take into account the underlying needs of the youth or his/her family. Treatment providers do strive to provide individualized care; however, limitations from insurance, the agency, or other considerations often erect barriers to individualized planning.
In wraparound, the CFT identifies the strengths, cultural values, and vision of the family. The team also identifies the unmet needs that support moving toward the vision. In prioritizing the most significant need and brainstorming options to meet this need, team members must expand their thinking from “service” to any potential resource when brainstorming options. The CFT plan is individualized based on the specific identified need of the family. If an option doesn't work, the CFT meets again to identify other options—a “try, try again” approach that supports unconditional care.
Treatment programs must support collaboration in a wraparound model in order for the outcome to be effective. This includes: (1) allotting time for the clinician to participate in CFT meetings; (2) individualizing the clinical treatment plan in a way that supports the needs the CFT identifies; and (3) maintaining a belief that if drug-using behaviors do not cease through an identified substance abuse treatment program, this does not mean that the alternative is a more restrictive treatment program.
The wraparound approach works best with families that are multi-stressed and/or involved in multiple systems (i.e., substance abuse treatment, rehabilitation services, prevention programs, mental health treatment, juvenile justice, child welfare, etc.). The wraparound model offers a needs-driven process that better supports the family's vision than a service-driven program does. Needs-based planning is a proactive approach that supports lasting change.
Margie Taber, CASAC, is a member of the leadership group of the Adolescent Specialty Committee at NAADAC, The Association for Addiction Professionals. She currently is employed as a care coordinator with the Monroe County, New York, Youth and Family Partnership program, a collaboration among the county's Department of Human Services, Office of Probation-Community Corrections, and Office of Mental Health that facilitated a wraparound model for youth and families in Monroe County. Taber wrote on moving to a strengths-based approach in adolescent treatment in the September 2005 issue.