Last week we updated you on some proposed policies about Mississippi Youth Programs Around the Clock (MYPAC). There have been several changes made to MYPAC over the past few months. The issue that originally led to these changes was the need to separate wraparound, the care coordination process that is used by MYPAC, from the MYPAC services that children and families receive.
This separation was done by the Mississippi Division of Medicaid in June 2021 in order to comply with federal rules about conflict-free case management. Conflict-free case management means that care coordination is separated from services, often with care coordination delivered by an organization that is not a service provider. This separation allows case managers/care coordinators to focus just on helping families obtain the services and supports that they want for their children, evaluating how well these services work, and changing them if they don’t work well or are no longer needed.
In looking at MYPAC, if wraparound facilitators who provide care coordination work for the same agencies that offer MYPAC services, they may feel obligated to offer services to families just from their own agencies. They could also be hesitant to help a family complain about a service from their own agency or to support a family in ending or changing a service from their agency. These situations could mean that care coordinators have a conflict. If so, it would not be conflict-free case management.
These types of situations could also limit family voice and choice, one of the ten key principles of wraparound, and that would go against the idea that youth and families drive the process. Families should be told about all of the services available for their children from any agency and also be given the opportunity to describe the formal and informal supports that they want their children to have.
We know that all these acronyms and changes can get confusing, so we thought that it would be helpful to explain what the wraparound process is and how it works so that families can have a better understanding of it and be able to make informed choices for their families’ and their children’s care. Much of this information is taken from two excellent resources on our website: The Wraparound Process User’s Guide: A Handbook for Families from the National Wraparound Initiative and The Wraparound Family Flyer from the Mississippi Wraparound Institute.
So what is Wraparound? Wraparound is a care coordination process, a team-based activity that youth and families are part of, that brings together groups of people involved in a family’s life to work together with them toward a common goal. The wraparound process is organized and managed by someone who is trained to coordinate the wraparound team (the care coordinator who is usually referred to as the wraparound facilitator) and to facilitate the creation of a plan that helps “children/youth and their families…experience success in their communities, homes and schools”.
It should be noted that wraparound is intended for children who would otherwise need the level of care of a psychiatric residential treatment facility. Typically this means that the child has a significant mental health challenge and is involved with at least two child-serving systems – for example, mental health and education or mental health and juvenile justice. It is also important to understand that Mississippi chose wraparound as its approach to care coordination for this population of children and their families and that this is in state law (lines 69 and 70). This means that wraparound should be available as a support to children and families regardless of what services they are receiving or in which system their children’s problems emerge. For instance, if a child from this population first comes to the attention of the juvenile justice or child welfare system, there should be a pathway for that child and their family to be provided wraparound and for the relevant state agency to be supported in accessing that option.
The wraparound process is implemented in 4 phases: 1) Engagement and team preparation, 2) Initial plan development, 3) Plan implementation, and 4) Transition. In the engagement and team preparation phase, the care coordinator meets with the family to discuss the wraparound process and to hear the family’s story. Together the family and care coordinator discuss the concerns, hopes, and dreams of the family, and also the family’s strengths, and the family identifies the people that they want on the team. In the initial plan development phase, the family has its first team meeting and, facilitated by the care coordinator, focuses on the initial plan development with those who are providing services to the family as well as the people that the family selected to be a part of the team. The team uses this first meeting to write a mission statement for the team, look at the family’s needs and decide on a few different ways to meet those needs that are aligned with their strengths, and figure out which team members will take on different tasks. Together with the team, including the family, has created a plan of care (also called the Wraparound plan).
In the plan implementation phase, the plan of care is implemented, and the team meets regularly (usually monthly) to discuss how things are going. At every meeting, the team reviews the accomplishments (what’s been done and what’s been going well), assesses whether the plan is working to achieve the goals, adjusts things that aren’t working, and assigns new tasks to team members. Finally, in the last or transition phase, the family and the team will decide at some point that it is longer necessary to meet regularly with the team, and the family will begin the transition out of the wraparound process. A record of what worked during the wraparound process will be provided, and before the transition begins the team will make a plan for the future, and who the family should reach out to if they need help.
These are some concerns that families sometimes express related to wraparound and some ideas on ways to address them:
- Wraparound feels too involved and intense for my child and family – It could be that your child doesn’t need the level of care of a psychiatric treatment facility so wraparound is too intense of a service for their current needs. You know your child better than anyone. Feel free to share your perspective on this with the people working with your child and family and ask about less intensive services. Also, ask if any objective tool was or can be used to assess you child’s current level of need. Many mental health providers use the Child and Adolescent Functional Assessment Scale. You can ask about this scale or any other one that might be used and what the score indicates.
- Wraparound sounds good, but I don’t want people coming to my house all of the time – This likely has to do with wraparound getting confused with the services of MYPAC, which typically provides three in-home visits per week. This confusion is understandable because the primary use of wraparound in Mississippi up until now has been it being done with MYPAC. But MYPAC services and wraparound facilitation are two separate things. If your child is in the population that wraparound is intended to support, you should be able to receive wraparound facilitation whether or not your child is in MYPAC and it would not involve multiple in-home visits each week unless you wanted that service. As a state, we need to figure out better ways to make wraparound more widely available. The Interagency Coordinating Council for Children and Youth (ICCCY) is designated in state law to oversee Mississippi’s system of care for children’s mental health and will be discussing this issue at its November 16 meeting. This meeting is open to the public and includes time for public comments.
- My family’s wraparound meetings don’t sound like what you described in this blog – It could be that your family’s wraparound facilitator or their agency needs more support in understanding wraparound and how to partner with you to implement it. The Mississippi Wraparound Institute (MWI) provides support and coaching to wraparound facilitators and their agencies. You can contact the MWI if you have questions about your family’s experience with wraparound and how to make it better. Email MWI at wrap@usm.edu or call 601-266-6112. MWI also gathers data on how Wraparound is being implemented in Mississippi. We encourage the ICCCY to use this data to determine how agencies and providers can be supported as a whole to implement high fidelity wraparound in Mississippi.
If you have additional questions or feedback about wraparound, please feel free to contact us at 601-355-0915 or info@faams.org. This is a chance for all of us to work together to make things better for our children.
