High Fidelity Wraparound, Transitions and Family Engagement

I recently joined a group of professionals for the first half of the High Fidelity Wraparound (HFW) training in Richmond, VA. While “wraparound” care is something often referred to when arranging discharge planning for clients and families, HFW is a specific, evidenced-based process of facilitating intensive care coordination. I left this training with a new appreciation for the role of the family in determining their goals and making decisions in the High Fidelity Wraparound process. Wraparound is defined by the National Wraparound Initiative as “…an individualized, team-based service planning and care coordination process underpinned by a strong value base intended to improve outcomes for youth with complex behavioral health challenges and their families (Bruns, et al., 2010).” In her February 2012 report, “Statewide Implementation of Wraparound,” Barbara J. Bazron, Ph.D. states, “This intensive process has been used historically to integrate youth back into their families and communities from out-of-home placements; these include residential treatment centers, psychiatric hospitals, juvenile justice facilities, group homes, and foster care placements. The wraparound process is also used to keep youth at imminent risk of costly out of-home placement in their families, schools, and communities. The populations of focus include youth with complex behavioral health needs who are involved in one or more of the following systems: child welfare, juvenile justice, mental health, and/or special education.”

The High Fidelity Wraparound process focuses on the family’s vision for success. I found myself remembering the many times that families entering residential have described feeling overwhelmed but relieved that their child is safe for the time being. At different points in time, they discuss different experiences of being judged, being given too much advice and feeling that they had failed in meeting their child’s needs. When we are talking about high risk behaviors (drug use, running away, fighting, self injury or suicide attempts, and sexual behaviors), most families also have many systems and contacts to keep track of, each with their own combination of helping process, requirements, and meetings. The wraparound focus on helping the family choose and effectively communicate their needs to members of their team is straightforward and focuses on incremental steps towards meeting underlying needs that the family identifies.

As a social worker, the importance of strengths seems obvious. But High Fidelity Wraparound takes this even further, especially in comparison with the individual and medical models used in assessing and treatment planning in traditional treatment. It is easy to focus supports on the client in short-term stabilization but when these supports phase out, the family that has worked with wraparound care is able to recognize their strengths and natural supports in responding to challenges in the future. One of the challenges in many families I have worked with has been isolation, as over time their need for help may have overwhelmed others.
I was very impressed with the safety planning process within the HFW process. There is an emphasis on safety as defined by the family, with behavioral analysis of underlying needs and ways to meet these to prevent further cycles of crisis. High Fidelity Wraparound does not replace the services of individual and family therapy, but integrates these supports in helping the family. One of the primary mottos of the HFW process is Do for, Do with, Cheer on. Initially, this may mean a high level of coordination but there is an emphasis on celebrating family and youth strides in increasing independence as well as successes on their action steps.

The HFW process mobilizes resources and talents from a variety of sources resulting in the creation of an individualized plan of care that is the best fit between the child/family vision and story, family strengths, family needs, team mission and strategies. The services identified in HFW will provide the child and family the necessary supports to build resiliency and move towards recovery.
I see a clear role for Wraparound in both prevention of out-of-home placement and successful transition. Maybe I “drank the Kool-Aid”, but I am excited about High Fidelity Wraparound expanding to support families in Virginia.