Psychiatr News February 1, 2008
Volume 43, Number 3, page 12
© 2008 American Psychiatric Association
Wraparound Programs Arose as Institutional Alternative
The seeds for Wraparound programs were planted in the 1960s and 1970s when
children with emotional and behavioral problems were receiving increasingly
costly but unsatisfactory care in residential treatment programs. Many
families complained that removing children from their homes traumatized them
and denied parents a role in the treatment process. In response to the outcry
that children were "falling through the cracks," in 1984 the
National Institute of Mental Health launched the Children and Adolescent
Service System Program to incorporate mental health, education, welfare, and
other social services into a coordinated system that would meet the individual
needs of emotionally disturbed children in their communities. An outgrowth of
this movement is the holistic treatment program referred to as Wraparound,
which is based on using the least-restrictive treatment regimens. Its main
features are patient-empowered, strengths-based treatment with families
heavily engaged in the process and viewed as partners.
The Wraparound process is now integrated into programs in schools and in
mental health, child welfare, juvenile justice, and other human service
agencies nationwide. A 1999 estimate put the number of children receiving
Wraparound services at 200,000, and 46 states were using the approach. A
majority of Systems of Care sites funded by the federal Center for Mental
Health Services use the Wraparound process.
While few outcome studies have been done on Wraparound, a special issue on
Wraparound services in the Journal of Child and Family Studies in
1997 indicated that under the program clients are more likely to be in
less-restrictive and more-stable living arrangements. In addition, improvement
has been shown in behavioral, academic, social, and adjustment aspects of
these young people's lives (see Wraparound Programs Succeed in Helping
Troubled Youth).
Psychiatrist Jan Bow, M.D., who is involved in Southwest Detroit's
Wraparound program, said that it is difficult to evaluate these programs
because children who saw a psychiatrist cannot be compared with those who
didn't, because a psychiatrist usually sees only the youngsters who are the
most seriously troubled.
Clear advantages of Wraparound are that it involves community-based
services and is a cost-effective alternative to institutional care. Assessing
evidence of the effectiveness of Wraparound has been hampered by the lack of
generally agreed upon guidelines for such programs.
Related Article:
-
Wraparound Programs Succeed in Helping Troubled Youth
- David Milne
Psychiatr News 2008 43: 12.
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