Kids with a psychiatric or mental health diagnosis or any social or emotional challenges are at an increased risk for an out-of-home placement, something that decades of data indicates is not in the best interest of the child or the state, according to Lisa Brockman with the Division of Healthcare Financing of the Wyoming Department of Health.
The Department of Health is working to help kids with complex behavioral health challenges find local care, allowing them to remain in their homes and communities, rather than being placed in residential psychiatric treatment.
The High Fidelity Wraparound program is a family-focused planning process that brings people together from different areas of a family’s life to form a support team to help kids stay in their homes, schools and communities, according to Brockman.
A key component of the High Fidelity Wraparound program is the “family voice and choice,” according to Kim Pope, Compass for Families’ High Fidelity Wraparound coordinator.
“The family gets to choose who they want on that team, who they feel will be a good support system for them.” Pope said. “We really focus on what the family is needing.”
Beginning in 2015, the state has contracted with Magellan Health to coordinate care and support families through the High Fidelity Wraparound model to allow children to receive mental and physical healthcare along with other interventions in their own communities while remaining safely at home, in school and out of trouble.
Since February of 2015, 943 kids have been served by the program, according to a Wyoming Department of Health press release.
But wraparound programs have been used elsewhere in the nation for three decades. Dr. Lenore Behar of North Carolina coined the term “wraparound” in the early 1980s to describe the application of an array of comprehensive community-based services to individual families, and programs were in wide use by the ’90s according to “The History of the Wraparound Process.”
Team members include anyone who has an impact in the life of the child or the supporting family members, which could include extended family or even friends, Pope said. The focus of the team is to provide support for both the family and the child. That focus could mean educating families on the child’s specific mental or emotional disability.
“We’re working with a family in which the parents are in a specialized parenting class, learning how to deal with the child’s diagnoses,” Pope said. “But we’re also working with the child to make sure they are with the right counselor, that they are getting the support at school, that peer interactions are going well. And the older the child is, the more they get to pick their team.”
Children and families that stay with the program begin to show improvement in mental and emotional health around the six-month mark, according to Brockman.
“We can’t keep everybody engaged that long,” Brockman said. “But we hope to keep folks engaged until they meet their goals.”
The average family uses the program for 12 to 18 months, according to Brockman.
“This is not fast work,” she said. “But around that six-month mark, we start to see changes.”
To ensure that the Wraparound program is achieving the goals of helping children and their families, Brockman and her team conduct assessments and compile numbers to ensure that the treatment program is appropriate and meeting the child’s needs.
“We just got some great news back,” Brockman said. “One of the assessments, the Child – Adolescent Needs and Strengths, showed that families and kids are improving.”
Each plan for care with a family and child is reviewed every 90 days, Brockman said. Magellan coordinates the reviews. With each assessment and report of success, the program proves itself to Medicaid.
“They allow us to color outside the usual Medicaid lines to provide some home- and community-based services to children and young adults that would normally be served by psychiatric residential treatment facilities or in some of the other systems that kids get caught up in, where their needs are not getting met or the family’s needs are not getting met, like the juvenile justice system,” Brockman said.
Once the information is gathered, a national team reviews the findings to ensure that the best care and support is made available.
“All of that data is collected and submitted to a national group called the National Wraparound Initiative,” Brockman said. “They measure our performance based on those surveys, and they assign a percentage. Wyoming just got their report back for the last year, and we are 3% above the national average (of survey results). We have a good program.”
The program keeps children at home with their families. This has proven to be better for the mental health of the child and family, as well as more cost effective for the taxpayer.
According to Brockman, the cost to Medicaid for children in psychiatric residential treatment facilities in 2018 was approximately $58,000 per youth. The cost to Medicaid per youth involved in the Wraparound project was approximately $15,000, a difference of about $43,000 per youth every year, while keeping the youth in the home and in the community, which is the goal of the program, according to Pope.
“This program is for the family and the child,” Pope said. “The focus is really on both.”
Parents who feel they or their children could benefit from the High Fidelity Wraparound program can find a local provider online at www.magellanofwyoming.com or make an appointment with Kim Pope at Compass for Families in Buffalo by calling 684-2446.