The 2002 Achievement Award Winners
The American Psychiatric Association will honor five outstanding mental health programs in an awards presentation on October 9 at the opening session of the Institute on Psychiatric Services in Chicago. The Wraparound Process of the Oaklawn Psychiatric Center in Elkhart, Indiana, an effort that involves the entire community in a commitment to supporting and empowering families who have children with severe functional impairments, won the Gold Achievement Award in the category of small community-based programs. In the category of large academically or institutionally sponsored programs, the Arkansas Center for Addictions Research, Education, and Services (Arkansas CARES) won the Gold Achievement Award for its long-term residential treatment program for low income women with dual diagnoses and their children. Each of the programs will receive a $10,000 prize made possible by a grant from Pfizer, Inc., U.S. Pharmaceuticals.
Certificates of significant achievement were awarded to the Nathaniel Project in New York City, to the Theiss Child Development Center in Pittsburgh, and to the Western Psychiatric Institute and Clinic Homeless Continuum in Pittsburgh.
The winning programs were selected from among 62 applicants by the 2002 Achievement Awards board, chaired by Dale P. Svendsen, M.D., of Columbus, Ohio. The awards have been presented annually since 1949.
The Elkhart County Community Wraparound Process empowers families and children by building on their strengths and developing an individualized network of support to help each family meet its goals in the home, school, and the community. The Process is built on two foundations: the belief that children and families have the potential, the ability, and the desire for positive change and the community's commitment to supporting that change. The goal is to create a lasting circle of caring people around the family and the child.
The Wraparound Process, which was launched in 1997, serves residents of Elkhart County, Indiana, and is based in the Oaklawn Psychiatric Center, Inc., a 40-year-old, private, not-for-profit community mental health and substance abuse treatment facility. The Wraparound Process is part of Oaklawn's effort to forge a continuum of care to treat and support entire families. The Process serves children with severe functional impairments who are at risk of out-of-home placement or who have already been removed from their home. The families it serves are at risk of dissolving because of physical or mental illness, homelessness, substance abuse, divorce, or other factors.
The philosophical base of the Wraparound Process is an unconditional commitment to creating services "one child at a time." It is called a process rather than a program because its developers and staff have understood from the outset that its success depends on "community ownership." Wraparound requires a creative combination of all types of services, resources, and formal and informal supports. Because planning and coordinating the services and supports to "wrap around" each child and family cut across traditional agency and funding boundaries, the Wraparound Process involves the commitment of the entire community. When the Process began in 1997, community leaders from service agencies, schools, city and county governments, churches, businesses, police and the juvenile court, hospitals, and advocacy groups pledged their continued support of the Wraparound Process by signing a resolution at a press conference to be a part of the Process and to educate those serving under and beside them daily.
Involvement in the Wraparound Process also involves a high level of commitment on the part of families. Because all referrals must be voluntary, the Process is not driven by court orders, nor do providers tell families what they should do to meet their goals. Instead, the Wraparound Process is driven by the family. The Process takes place where it is most convenient and comfortable for the family, most often in a home or church. Eligibility is not income based, and any family that is in need of support may apply. Also, in an effort not to cause additional stress to a family, the service is free.
In initial meetings the family and child engage with a staff facilitator in a "discovery process" to identify the family's strengths—the aspects of family life that are working—along with its needs and preferences. The Wraparound Process addresses not only emotional and behavioral issues but all aspects of the family's life, including but not limited to spiritual, cultural, housing, financial, and medical issues. Many families have not been full participants in the community: their circumstances, educational level, or mental illness may have limited their access to community resources. Therefore, one important role of the facilitator is to educate families about its resources.
The family and child then create an invitation list with the names of specific people whom they wish to join their child and family team. There is no limit to the number of people invited. The list includes professionals, such as a school social worker, a teacher, and a probation officer, as well as nonprofessional "informal" supports. Informal supports include members of the extended family, friends, church volunteers, and people from the neighborhood. Informal support building is a critical aspect of providing lasting effective services. The ultimate goal of the Process is to empower families and then to gradually separate from them when they are surrounded by informal supports and educated about resources in the community.
The Wraparound Process of the Oaklawn Psychiatric Center was selected as the winner of the 2002 Gold Award in the category of small community-based programs. The winner for large academically or institutionally sponsored programs is described in a separate article on page 1311. Each winning program will receive a plaque and a $10,000 prize made possible by a grant from Pfizer, Inc., U.S. Pharmaceuticals. The awards will be presented on October 9 during the opening session of the Institute on Psychiatric Services in Chicago.
The Wraparound Process was launched in August 1997 with nine families and 12 children. It began as an intervention process that dealt solely with children involved with the legal system. In the current fiscal year the Process served 171 families and 353 children. One marker of the success of the Process is that more than 80 percent of the youths it currently serves are involved in prevention programs, whose goal is to keep the children out of the legal or child welfare systems. Community awareness of the presence of the Wraparound Process and its success has grown, and now providers, clergy, teachers, and parents seek help at an earlier stage, before the child or family require crisis interventions.
The Elkhart County Wraparound Process is not the only one of its kind. It uses the model developed by John VanDenBerg, Ph.D., a child psychologist and pioneer in developing and improving such cross-agency programs. When the Wraparound Process was introduced to Elkhart County, more than 170 people attended five days of intensive training with Dr. VanDenBerg. The training, which was offered to all community members who were committed to using a wraparound approach, focused on teaching Elkhart County service providers to use this strengths-based service model.
The Wraparound Process includes 16 paid staff and more than 100 volunteer community leaders and family members. The multidisciplinary staff have a broad range of experience. Extensive efforts are made to recruit staff members who are able to make families feel comfortable sharing their life circumstances during the Process and who can help them identify their needs and establish their goals.
Community service coordinator and team leader. The Process is led by a community service coordinator who develops and implements policies and procedures, prioritizes families to be served, defines outcome goals and evaluation criteria, provides training and supervision for team facilitators, and identifies and reduces barriers to service delivery. The coordinator also provides consultation to county agencies about the Process and promotes public awareness and community partnerships.
Community resource developer. Another key staff member is the community resource developer, who focuses on creating the all-important informal supports. The resource developer recruits and trains people in the community to serve as the informal team members and trains volunteers in the Wraparound Process. The community resource developer also supports parents and graduates of the Process to become its advocates and helps parents develop support groups. Other efforts focus on facilitating the collaboration of schools, churches, and families to work on common neighborhood goals.
Lead parent. Another paid staff position is the lead parent, a graduate of the Wraparound Process who organizes groups for parents and other caregivers and sets agenda items suggested by parents and responses to quality improvement surveys.
Wraparound facilitators. Each family who enters the Process is assigned a facilitator who helps the family identify it strengths, prioritize its most important needs and goals, and create a plan that incorporates a child and family team composed of formal and informal caregivers. The Process currently has 11 facilitators who each work with ten to 13 families at a time.
With the facilitator's help, family members look at past behaviors that did not work and identify fears about the future. The family develops preventive and reactive plans for each of the feared scenarios. The average family participates in the Wraparound Process for about seven months, and the facilitator keeps the Process focused on strengths, helping the family recognize its changing needs and set new goals. The facilitator strives to gradually replace the professional formal supports on each family's team with informal community supports.
Psychiatrist. A full-time psychiatrist is on the staff and meets weekly with the Wraparound Process team to provide consultation in challenging situations and to address medication issues. The psychiatrist also makes home visits with the facilitators.
Parent support group facilitators. Parent groups are an important aspect of informal support networks. The team has from two to four stipend positions for parents, either graduates of the Process or users of community services, to help develop support groups to address a variety of issues.
Community team. Fifty volunteers form the community team, which is made up of community leaders and parents who care about children and families and wish to make a difference in their lives. Members are representatives from both formal and informal sectors of the community. The team, which has no set meeting schedule but which convenes as needs are identified, works to eliminate barriers to and gaps in services and to address current priorities.
Operations committee. Thirty-one volunteers form the operations committee, which consists of frontline supervisors, parents, and directors of social service agencies, many of whom provide innovative services for children. The committee meets as needs arise in such areas as policies and procedures, gaps in services, and conference planning.
Plan review panel. Seven volunteer members of the community meet monthly to review each Wraparound plan to ensure that it is moral and safe.
Informal subcommittee. Twenty volunteers meet periodically to brainstorm about ways to make the Wraparound Process better through more informal activities and options for families.
The Wraparound Process has overcome several barriers and faces continuing challenges. According to staff members, one of the most critical barriers has been providers' ideas of the "perfect family." Staff help providers reframe their views so that they can work toward the goals set by the family, even if they do not agree with them or have higher expectations. Another continuing challenge is to encourage both formal and informal support persons to focus on the strengths of a family rather than on its past weaknesses. Persuading families to believe that the Process works and that it will focus on their strengths is another challenge. Staff have learned that "verbalizing the positives" and helping families put the needed supports in place over time keeps them in the Process.
In the beginning some agencies were reluctant to work together, and some program requirements created barriers to access. Also, some schools and churches resisted interacting, because many people did not want to "mix church and state." Many such barriers were overcome by asking that all participants in the Process focus on the family as the top priority. The community continues to grow in this area.
Other barriers that the staff encountered involve the geographic isolation of some families and their lack of transportation, multigenerational substance abuse and dependence, and fathers who are present in the home but who are ineffective parents. Several changes were made to the Wraparound Process to address these issues. In-home therapy and assessments are now provided for isolated families. A mentoring component was added for families who want support for the children but do not want to be a part of the formal Process. A community psychiatrist with subspecialties in addictions and family systems was added to the team to provide more comprehensive assessments and to guide addiction treatment. Funds are being sought for a DADs program (Dads Aiding Dads)—a support group to help male caregivers play an active role in children's lives.
An obstacle that staff have recently encountered is locating funds to provide respite care for families with children who have serious emotional disturbances. When team members were asked how they would spend the $10,000 Gold Award prize, they replied that they would expand respite through training and licensing respite families.
The Wraparound community team and the operations committee set goals and continually monitor outcomes. Outcomes from July 2000 to June 2001 were measured for 231 clients from 97 families. The number of out-of-home placement days for this group decreased by 67 percent, and the number of days children lived with their family increased by 47 percent. The number of foster care placement days fell by 62 percent. Overall placement costs decreased by 72 percent, and the average annual cost per child decreased from $9,276 a year to $2,567. The number of days spent in juvenile detention increased by 27 percent because of efforts to keep children out of the Department of Corrections. Over the same period the number of Department of Corrections placement days fell by 75 percent.
An important and continuing goal is to increase the number of informal support persons on or available for the child and family teams, and during this period the number of informal supports—pastors, former teachers, church members, and friends—increased by 27 percent.
The current annual budget of the Wraparound Process is $1.1 million. Staff positions are funded through the Medicaid Rehab Option (55 percent) and Elkhart County (45 percent).
The Flex Fund is an important part of the Wraparound Process. Money in the fund comes from United Way, grants, private donations, and donations from community churches and other agencies. The 50 members of the community team help maintain the fund and encourage contributions. Each child and family team has access to the fund, which allows the team to implement parts of the Wraparound plan that may not be possible to realize in any other way. There are no mandates for how Flex Fund dollars can be used. In 2001 contributions totaled nearly $25,000.
The energy and commitment of the Elkhart County community and the staff of the Wraparound Process have made a critical difference in the lives of the community's most vulnerable families and children. Together they have created an outstanding model of community change for others to follow.
For more information, contact Sharese Swafford, M.A., L.M.H.C., L.P.C., Community Service Coordinator, Oaklawn Psychiatric Center, 2600 Oakland Avenue, Elkhart, Indiana 46517; phone, 574-533-1234; fax, 574-537-2638; e-mail, firstname.lastname@example.org.