Wraparound mental health services: questions and answers.
WHAT ARE WRAPAROUND SERVICES?
The term wraparound is used to designate several mental health (MH) services provided to children in their homes, school, or in the community. In essence, these services "wrap around" a child and help to avoid unnecessary out-of-home placements or hospitalization. Wraparound services have been available in Pennsylvania for some time, yet many parents have never heard of them and have no idea how to obtain them for their child.
WHAT SPECIFIC MENTAL HEALTH SERVICES ARE AVAILABLE THROUGH WRAPAROUND?
The wraparound mental health services used most frequently include therapeutic staff support (TSS), mobile therapy (MT) and behavioral specialist consultation (BSC).
Therapeutic staff support is one-on-one intervention by a trained person with a specific student in order to modify symptomatic behaviors. It might include crisis intervention, immediate behavioral reinforcement, re-direction, role-playing and consequence strategies. The purpose of TSS is to increase the sense of responsibility and age-appropriate behaviors of the student and to promote the student's problem-solving and self-sufficiency skills.
Mobile therapy is individual and family psychotherapy. However, the format for delivery of this service varies according to the individual needs of the student. Critical elements of mobile therapy include active listening, treatment planning and exchanging information with the student and family.
Behavioral specialist consultation involves assessment, program design and student monitoring, rather than direct therapy. A behavioral specialist designs a behavioral plan that incorporates non-aversive methods and can be implemented on-site by a TSS person.
WHAT ARE THE QUALIFICATIONS OF THE INDIVIDUALS WHO PROVIDE WRAPAROUND?
TSS people are required to have a bachelor's degree in a human-services field and training in crisis intervention. Other levels of education can be accepted contingent upon experience. Mobile therapists are licensed mental-health professionals or individuals with graduate degrees in mental health who have experience in implementing MH services. Behavioral specialists are often licensed doctoral-level psychologists or graduate-level clinicians skilled in behavior modification.
I LIVE IN RURAL PENNSYLVANIA. ARE THE SAME SERVICES AVAILABLE TO MY CHILD THAT MIGHT BE AVAILABLE ELSEWHERE?
Not necessarily. Wraparound is largely dependent on the number of local service providers and trained individuals available to provide the services. Consequently, rural areas may not have the same availability of wraparound as larger communities.
WHERE CAN THESE SERVICES BE PROVIDED? FOR EXAMPLE, WHAT IF MY CHILD NEEDS THEM WHILE HE IS IN SCHOOL?
Wraparound services can be provided in almost any setting where the child's behaviors are preventing normal functioning. In the public schools, TSS, MT and BSC are readily available. TSS may even be available on the school bus, should the student require it.
MUST I PAY FOR ANY OF THESE SERVICES?
No. Wraparound in Pennsylvania is covered by Medical Assistance (MA). As each child must have a mental health diagnosis to receive these services, s/he is eligible to receive an individual MA card regardless of parental income. The use of the MA card will not affect any insurance coverage that parents may have.
IS IT TRUE THAT WRAPAROUND SERVICES ARE BEING CUT AND PARENTAL INCOME IS GOING TO BE CONSIDERED BEFORE AUTHORIZING THEM?
No. While the Department of Public Welfare in Pennsylvania recently drafted a document suggesting these very changes, the Pennsylvania State Legislature passed a budget on June 2, 2002 that appears to have denied this income cap.
MUST MY CHILD HAVE AN IEP IN ORDER TO GET WRAPAROUND?
No. Wraparound services are available to more students than just those served by the special education system. While students identified as seriously emotionally disturbed under IDEA are eligible to receive wraparound, so, too, are students who are at risk of developing emotional problems.
MUST MY CHILD BE LABELED IN ORDER TO GET THESE SERVICES?
No. The evaluation process and the criteria required for eligibility are less formalized with wraparound. A psycho-educational evaluation of the student is not required; rather, a psychiatrist or licensed psychologist must recommend that the services are medically necessary for the student, and the Child and Adolescent Service System Program (CASSP) team must determine that the services are required.
EXACTLY HOW DO I GO ABOUT GETTING WRAPAROUND FOR MY CHILD? IS THERE MUCH RED TAPE INVOLVED?
All requests for wraparound services must go through the CASSP team. Under the direction of a CASSP coordinator, an interagency team of parents, community agencies, local service providers and school personnel develops an individual treatment plan that authorizes MH services for a designated period of time for a specific child.
Do I HAVE ANY SAY IN DETERMINING THE SELECTION OF SERVICES FOR MY CHILD?
Absolutely. Parents are full participants in the CASSP process. In fact, the CASSP team may not even proceed unless the parent attends the meeting. Parents also have the final choice of local service provider should several be available. On the negative side, students who are 14 years of age and older may legitimately refuse to take part in these services regardless of the recommendations of the CASSP team or the wishes of the parent.
WHAT IF MY CHILD NEEDS MORE THAN ONE WRAPAROUND SERVICE?
Depending on the needs of the child, several wraparound services might be implemented. For example, it is common for a student to receive TSS at school and MT at home.
How SOON AFTER THE CASSP MEETING CAN I EXPECT THESE SERVICES TO BEGIN?
It depends. As noted above, the availability of wraparound is often contingent upon having trained individuals to provide the service. Consequently, there may be delays of several weeks or longer between the CASSP Team meeting and the actual delivery of the service. Typically, TSS takes the longest time because the state must review each case and authorize services prior to their provision. If staff is available, TSS should be provided within 60 days from the date of the request.
WHAT IF THERE ARE DELAYS IN GETTING THESE SERVICES STARTED?
In areas served by more than one service provider, delays in beginning wraparound may be addressed by selecting the provider who has trained staff available. Should delays occur in delivering TSS in the school, the CASSP Team may consider asking the school district to assign a teacher aide to the child on a temporary basis and only until wraparound begins. Such a consideration must be done with full cooperation of the local school district.
As MT and BSC do not require prior authorization from the state, these services can begin almost immediately. Should delays be encountered in implementing TSS, MTs and/or BSs can assist the teacher aide in providing interventions until a regular TSS is assigned.
How LONG MAY MY CHILD RECEIVE THESE SERVICES?
One of the main components of wraparound is to transfer these skills to parents, teachers and other caregivers so that children can be maintained in their natural settings without the presence of wraparound staff. So, unlike special education and related services made available under IDEA, wraparound is designed to be of short duration and may only be available for an abbreviated period of time.
WHAT HAPPENS IF MY CHILD STILL NEEDS THESE SERVICES AND THEY ARE NO LONGER AVAILABLE? OR WHAT IF THE CASSP TEAM DETERMINES MY CHILD IS NO LONGER CONSIDERED ELIGIBLE FOR WRAPAROUND?
Routinely, the child is re-evaluated every four months to determine if wraparound is still appropriate. Before the termination of any wraparound service, the service provider should reduce the frequency and length of sessions over a period of time to allow for behavioral improvements to occur in more normalized situations. In situations where long-term assistance is required in the school and is not authorized by the service provider, the school district may again need to consider assigning a teacher aide or paraprofessional to the student. Before this occurs, it is important that the service provider and district ensure that the aide is properly trained to deliver the same type of MH services as was done previously by the TSS.
WHAT HAPPENS IF THESE SERVICES DON'T WORK? WHAT ELSE CAN BE DONE?
The CASSP Team should reconvene and address the child's needs. The current level of service might need to be increased, or additional wraparound services may be required.
WHAT IF I AM UNHAPPY WITH THESE SERVICES? WHAT ARE MY RIGHTS?
Medical Assistance suggests that parents share such concerns with the agency providing the service first. Should this step prove to be insufficient, parents should contact the county Mental Health Administrator. A phone number should be included as part of the paperwork related to the student's situation.
WHAT HELP MIGHT THERE BE SO THAT I CAN UNDERSTAND THE SYSTEM AND ACCESS WRAPAROUND FOR MY CHILD?
The local county Mental Health Office can provide parents with more information on wraparound and the CASSP Team process. Additional assistance may be obtained through intensive case management (ICM), which helps parents acquire needed medical, social and educational services for their children. ICM coordinates the delivery of these services for the family once they are obtained, and helps families access seven day/24 hour assistance in crisis situations. Ask the local Mental Health Office if ICM is available in the area.
Two articles that might provide additional information are: Suggestions for Improving the Delivery of Therapeutic Staff Support in the Public Schools (Bugaj & Manning), Journal of Mental Health Counseling, January, 2002; and Linking Schools with Youth and Family Centers (Bush & Wilson), Educational Leadership, 1997.
Stephen J. Bugaj, D. Ed. Superintendent Cameron County School District email@example.com
Randall L. ManningExecutive Director Northwestern Human Services Canal Ways Center 1301 Allegheny St, Ste 119 Hollidaysburg, PA 16648
Renee Brunner BHRS Director Northwestern Human Services