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 Original article: 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.