Human service agencies have historically struggled with providing effective supports and services for students with emotional and behavioral challenges and their families. The concept of a System of Care (Stroul & Freidman, 1986) is driving change in service systems for children and youth with emotional and behavioral needs and their families. Interagency partners, together with families, are forging alliances to overcome the history of poor outcomes, fragmented service delivery, and blaming across disciplines. The idea that no one system can succeed in their mission of improving outcomes unless they collaborate with other service providers has been established. As a result, policy and funding mechanisms are beginning to address the need to build capacity for effective interagency partnerships around these children and youth and their families. (Yoe, Santarcangelo, Atkins, & Burchard, 1996; Osher, Quinn, Hanley, 2002)

The word “wraparound” is prevalent in the system of care discussions. Often initiated by mental health or child welfare, this value-based process for creating unique and flexible service networks has spread across the US during the 1980’s and 90’s as a viable alternative to residential and other restrictive placement options for children. Improvements in youth/family functioning and satisfaction have been reported. The use of wraparound directly in schools has also increased as educators experience success with students as they integrate the philosophy and planning process into existing school-based programs and services. In 1998, it was estimated that over 200,000 youth and their families were engaged in wraparound across the U.S. (Faw, 1999)

Understanding Wraparound

Wraparound is a family-centered, strength-based philosophy of care used to guide service planning for students with or at-risk of Emotional and Behavioral Disabilities (EBD) and their families. As a philosophy of care with a defined planning process, wraparound results in a uniquely designed individual plan for a child and family to achieve a set of outcomes that reflect family/youth voice and choice. Although primarily initiated through mental health or child welfare systems, the application of this process directly in schools has led to improved outcomes for students with EBD in a variety of educational settings, including general education classrooms (Eber, 1996; Eber & Nelson, 1997).

Wraparound is not a service or a set of services as each youth/family designs their own team that plans and implements supports and interventions individually designed for their unique strengths and needs. Labeling some services “wraparound services” can actually impede the development of the flexible systems needed for effective service delivery if services are merely selected off a predetermined list without careful linkages to a agreed upon strengths and unique needs. The youth, family and their team of natural support and professional providers define the needs and collectively shape and create the supports, services, and interventions connected to agreed upon outcomes. Ownership of the plan by the youth and family and those who spend the most time with and have the most responsibility for the youth (i.e. teachers, other caregivers) are hallmark traits of the process which these stakeholders have frequently reported as critical to successful outcomes.

Sharing a value-base with person-centered planning and positive behavior supports (Carr, et al, 2002) the wraparound process is a tool for building constructive relationships and support networks around youth with or at-risk of emotional/behavioral challenges, their families, teachers, and other caregivers. A key element in this process is families (including the student) and professionals reaching consensus on outcomes they want to achieve. Identifying and arranging the supports the adults (i.e. teachers, families) need to effectively implement interventions for the youth is an important component as well. Taking steps to ensure that the values and skills of those implementing the interventions are compatible with the plan designed is important.

The wraparound process can increase the likelihood that appropriate supports and interventions, including research-based behavioral and instructional interventions are effectively implemented. For example, having natural support persons as part of the team (i.e. extended family members, friends) can increase the likelihood that the student and/or parents follow through with interventions and activities developed through the team process.

Adapted from:
Eber and Keenan (in press) "Collaboration with Other Agencies: Wrap Around and Systems of Care for Children and Youth with EBD". In R.B. Rutherford, M.M. Quinn, S. R. Mathur (Eds), Handbook of Research in Behavioral Disorders. Guilford Press.

A History of Fragmentation

Special Education, mental health, primary health, child welfare, and juvenile justice are the primary systems that attempt to support students with serious mental health needs and their families. Unfortunately, these separate systems have very different structures, tools and even philosophies and, historically, they have not connected very well on behalf of children and families. Differences in eligibility criteria, definitions, policies and intervention approaches often create dissonance and confusion for children, families, teachers and other service providers. Passing from one system to the other while symptoms worsen and problems escalate is unfortunately a common experience for many youth and families. The fragmentation among systems has even resulted in families being forced to relinquish custody to the child welfare system as a last resort to allow their child to access treatment (Freisen, et al, 2003). The juvenile justice system has, also by default, responsibility for three to five times more youth (30-40% of the general population) with EBD than public schools (Leone & Miesel, 1997). Each year, there are over 150 million visits to a primary care pediatrician. They presecibe the majority of psychotropic drugs, and often counsel families about emotional and behavioral problems. Most children with mental health needs see their primary care providers rather than a mental health specialist. This may be the only contact with a “system” for many preschool children (Kelleher, 2000).

Overall, these individual systems working in isolation of each other have repeatedly failed to address the complex needs presented by youth with emotional/behavioral challenges and their families. In fact, many children/youth with serious emotional/behavioral problems are not receiving any specialized services from schools or mental health systems (Freidman, Katz-Levy, & Sondheimer 1996, Hoagwood & Erwin, 1997; Knitzer, Steiberg & Flesch, 1990; Leaf et al, 1996). And those that do receive services, have experienced dismal outcomes including lowest academic achievement, highest dropout rates, worst post-school adjustment, and highest use of restrictive placements and incarcerations (Blackorby and Wagner,1995; Carson, Sitlington et al, 1995; Koyangi & Gaines, 1993; Wagner, 1995; U.S. Department of Education, 1998).

Although the 1969 Joint Commission on Mental Health identified the need to address children’s mental health, not much actually happened in the ensuing years. In 1974, every federally funded Community Mental Health Center was required to provide children’s services but funding was insufficient. Additional unfunded mandates that were never implemented included the 1978 President’s Commission on Mental Health and the Mental Health System Act of 1980. The Education for All Handicapped Children Act (P.L. 94-142) in 1975, intended to ensure appropriate services for all students with disabilities, may have inadvertently slowed down progress for this population as state mental health agencies actually decreased their focus on children, assuming special education would be the children’s mental health service system (Duchnowski , Kutash & Friedman,2002). Over time, the education sector has been observed to be a primary player in providing what little mental health services youth with EBD receive (Burns et al, 1997; Farmer et al, 1999; Leaf, et al, 1996). Unfortunately, as previously stated, the outcomes have not been good. Over 25 years later, students with EBD continue to be the most under-identified and inadequately served of all disability groups (Forness, 2000)

Seeds of Change: The System of Care Concept

Jane Knitzer’s seminal document “Unclaimed Children” (1982) first exposed the woeful inadequacies of children’s mental health, child welfare, and juvenile justice. She proposed that a seamless “system of care” was needed and is credited with having “set in motion the idea that children and adolescents with SED should have access to community-based services and supports” (Herandez and Hodges, 2003, p.21). In 1983, The National Institute of Mental Health responded by funding the Child and Adolescent Service System program (CASSP), an initiative that provided funds and technical assistance to all fifty states, several territories, and some local jurisdictions to plan and begin to develop systems of care for children with SED. Recognizing the multiple system involvement of these children, a core factor of CASSP was interagency collaboration. (National Institute of Mental Health, 1983).

In 1986, Stroul and Freidman wrote their landmark monograph A System of Care for Children and Youth with Serious Emotional Disturbance (1986) that further described Knitzer’s concept of a full continuum of care. They outlined a set of values and principals that emphasized access to a full continuum of culturally relevant services in community settings (See Table 1). The emphasis of the system of care rhetoric was on a community-based service delivery process and an underlying philosophical base of flexibility to meet family/child needs rather than agency needs (Hernandez & Hodges, 2003).

The system of care concept created a vision of a comprehensive service system for youth and families. The charge was to increase collaboration and ensure access to a full array of community-based culturally relevant services rather than limiting treatment options to residential or other restricted settings. Active coordination and collaboration across all child-serving agencies was the primary goal. Mental health, child welfare, education, special education, juvenile justice, health and vocational rehabilitation would be organized into a coordinated network. This included more accessible, family-friendly options, and suggested integrated policies and funding structures that still remain elusive in many communities and states today (Hernandez & Hodges, 2003).

Communities and states initially responded with what Lourie (1994) described as “incremental optimism”, developing whatever services consistent with system of care principles and values they could get resources to support. Services such as case management, respite, day treatment, and in-home supports became available. Sometimes these new services were offered through interagency networks but in some states and communities new services were offered through single agencies and not necessarily with a coordinated approach. From 1989-1993, the Robert Wood Johnson Foundation’s Mental Health Services Program for Youth (MHSPY) funded 27 state and local initiatives which introduced managed care technologies to the development of systems of care. In 1992, the Comprehensive Community Mental Health Services for Children and Their Families Program was created through legislation. Since then, this program has funded 85 state and local communities, including tribal sites and territories, to build systems of care. The core of this program is the development of a comprehensive array of community based services and supports. Increasing access and satisfaction while decreasing use of restrictive and costly placements were system outcomes reported for these system of care initiatives (Hoagwood, et al 2001). This was a major shift in thinking and focus for the field of children’s services.

System of Care and Schools

Although schools were not a major player in the early system of care innovations, education for students with disabilities was being redefined with the previously mentioned passage of P.L. 94-142 in 1975. Students could not be excluded from school because of a disability and all students, including those identified as seriously emotionally disturbed (SED) were now ensured access to appropriate services to ensure educational success, including related services such as counseling and classroom modifications. Consistent with the community-based philosophy of system of care, the least restrictive environment (LRE) assurances directed schools to develop the services needed for students with disabilities, including those with SED, to be educated with their non-disabled peers.

Similar to mental health’s experiences with system of care, the concept of LRE has proven challenging for educators, especially with regards to students with identified EBD (Forness, 2000). At The Schoolhouse Door (Knitzer, Steinberg, & Fleisch, 1990) documented how special education programs for these identified children (a small segment of those who actually should qualify for special services) also were far from effective and perhaps even exacerbating problems for children with an overemphasis on behavior control at the expense of instruction. At the Schoolhouse Door made it clear that, due to the complex needs of these children, coordinated supports and services across home, school, and community are necessary. Providing special school programs without integrating treatment for their emotional/behavioral challenges and supports for families and without careful transitions across settings is not enough. Knitzer was reiterating that no system alone can begin to address the challenges presented by this population and a collaborative system of care must be the priority for education as well as mental health and the other systems involved with these children and their families.

In 1994, the U.S. Department of Education proposed a National Agenda for Achieving Better Results for Children and Youth with Serious Emotional Disturbance (U.S. Department of Education, 1994) that coincided with the system of care initiatives coming from the mental health field. The need for collaborative and comprehensive systems that partnered with families in organizing relevant and effective services was recognized in this agenda introduced from the field of education (Smith and Coutinho, 1997). Concurrently with the development of the National Agenda, The Office of Special Education Programs (OSEP) of the U.S. Department of Education funded a series of school-initiated demonstration projects based on the community-based system of care principles (Kallas,1992). Developing the skills and capacities of schools and communities to effectively respond to and prevent SED so that these students could succeed academically and socially was recognized. Collaboration across service sectors and with families was the crosscutting theme.

Within the reauthorization of the Individuals with Disabilities Education Act (IDEA) in 1997, there are provisions, which support the development of community based collaboration and systems of care. Regulations under Section 300.244, Coordinated Services System, allows a school system to use federal funds to develop and implement a coordinated services system designed to improve results for children and families. This includes interagency agreements. Section 300.235, Permissive Use of Funds, allows nondisabled children to benefit and have access to services or programs in which school districts use special education personnel in class wide or schoolwide behavioral and emotional support programs. Section 300.306, Nonacademic Services, requires the provision of nonacademic and extracurricular services such as counseling services, health services, and referrals to agencies. Section 300.142, Methods of Ensuring Services, requires each state to establish responsibility for services and other mechanisms for interagency coordination, which helps to define the financial responsibility of each agency for providing services. It clearly states that the financial responsibility of each noneducational public agency, including the state Medicaid agency and other public insurers of children with disabilities, must precede the financial responsibility of the local education agency. This provision has allowed some states to develop a wide array of services that are Medicaid eligible and complement the school based services. (Pumariega, 2003)

New provisions under the federal No Child Left Behind Act of 2002, Subpart 14, Section 5541 allow funds to be used to enhance or develop collaborative efforts between school-based service systems and mental health service systems, prevention, diagnosis, referral and treatment of services to students, the availability of crisis intervention services. This federal education law also allows funds to be used for training for the school personnel and mental health professionals as well as technical assistance and consultation to school systems and mental health agencies and families (U.S. Department of Education, 2002).

All of these provisions can help facilitate interagency collaboration, shared or blended funding and better outcomes for students. However few communities have taken advantage of these opportunities. This is most likely due to a lack of state funding to support planning, collaboration and the development of services.

Wraparound: A System of Care Tool

Neither the system of care principles nor the National Agenda for SED described or prescribed the actual changes in practices needed to improve child/youth functioning. What do practitioners need to do to ensure that community-based services are based on the strengths, needs and preferences of the children and families, many of whom had experienced multiple failed attempts of various agencies to provide effective interventions? What should practitioners do differently so that children with very intensive and comprehensive emotional and behavioral needs could be successful in their homes, schools and communities? What does it look like when the services offered, the agencies participating, and the programs generated are responsive to the cultural context and characteristics of the individual children and their families? During the 1980’s and 1990’s, the wraparound approach emerged as a grassroots response to the shift in thinking and practice that was needed to implement system of care values and principles.

Burchard and his colleagues (2002) explain how wraparound did not develop from a formal change theory but evolved as practitioners sought alternatives to more medically oriented models which “failed to recognize the importance of context and normative roles on behavioral adjustment and development” (Burchard, Bruns, and Burchard, 2003 p.70). They refer to the “wraparound theory of change” that has emerged as consistent with existing psychosocial child development theories such as Bronfenbrenner’s (1979) social-ecological theory, Bandura’s (1977) social learning theory and Munger’s (1998) systems change theory. Burchard et al (2002) describe the wraparound theory of change as follows: “…children with severe emotional and behavioral problems will develop a more normal lifestyle if their services and supports are family centered and child focused, strength-based, individualized, community based, interagency coordinated and culturally competent.” (p. 70).

In 1998, it was estimated that over 200,00 youth and their families were engaged in the wraparound process in 88% of U.S. territories and states (Faw, 1998). Consensus about definition of wraparound, programmatic values, elements and practices were documented by the Center for Mental Health Services (CMHS) as part of a series of monographs documenting promising practices in children’s mental health (Burns & Goldman,1998). Following a 2-day focus group with experienced wraparound implementers and evaluator, Burns and Goldman documented the group’s consensus that wraparound is a philosophy and approach with a defined planning process that is family-centered, strength-based, flexible and collaborative. Through the wraparound process, a uniquely designed child/family team that includes natural support persons as key players is developed with the family. The team designs a unique and culturally relevant set of individualized community services and natural supports so that a specific child and family can achieve a unique set of outcomes. (Burns and Goldman, 1998. p.13). Table 3 provides the core elements of wraparound.

Consistent with system of care philosophy, wraparound plans are uniquely designed to fit individual needs as opposed to attempting to make a youth and family fit into a prescribed program (Eber, Nelson, & Miles, 1997). Ownership of the plan by the youth and family and those who spend the most time with and have the most responsibility for the youth (i.e. teachers, other caregivers) are hallmark traits of the process which these stakeholders have frequently reported as critical to successful outcomes (Eber, 2003). Stepping outside of the box of the usual categorical service options, teams create or reorganize services based on unique needs and circumstances of students with complex needs. Services are created on a "one student at a time" basis to support normalized and inclusive options. Natural supports (i.e. childcare, transportation, mentors, parent-to-parent support) are combined with traditional interventions (i.e. positive behavior interventions, teaching social skills, reading instruction, medication, therapy). Examples of supports and services in wraparound plans include respite, mentors, peer supports, parent partners, and assistance for families in need of basic supports such as housing, transportation, job assistance, childcare, and health and safety supports. School components of wraparound plans include strength-based academic, behavioral, and social skills instructional strategies and reinforcement as well as consultation and supports for teachers (Eber, 2003; Eber, 1996).

As a broadly used tool for implementing a system of care (Burns & Goldman, 1999), the wraparound process has resulted in new ways to organize supports and interventions for youth with emotional/behavioral challenges, their families, teachers, and other providers and caregivers. Often reaching beyond the bounds of traditional, categorical program structures, wraparound plans alter ecological variables across settings, create consensus on needs and behaviors targeted for change, thereby creating a context where effective interventions are more likely to be applied and evaluated. An important by-product of wraparound, and a critical aspect of effective interventions for these young people, is alignment of families with teachers and other service providers in productive and proactive partnerships (Eber, Sugai, Smith and Scott, 2002).

Wraparound and Special Education

From a special education perspective, the wraparound process allows schools to more readily do what federal law proposed over 30 years ago: to develop effective individualized plans for children in collaboration with families and other service providers. In fact, use of this process has helped teams move from placement-driven discussions, often filled with conflict and blame among schools, agencies, and families, to productive planning and problem-solving sessions where families, teachers, and students are heard and supported. School-based wraparound planning guides the implementation of interventions that develop and support academic and behavioral skills needed for students to succeed at school, home, and in the community.

Wraparound plans should be uniquely designed to fit individual student’s needs as opposed to attempting to make a student fit into a prescribed program (Eber, Nelson, Miles, 1997). This involves identifying, accessing and/or creating resources and strategies to enhance the school’s capacity to effectively educate the student. The comprehensive plan my need to include effective instructional and behavioral interventions, as well as comprehensive supports for students, families and teachers. Building collaborative teams around students with a clear focus on strengths, needs, and outcomes allows for more successful application of behavior interventions that have been well-researched but, historically, not applied in schools.

The wraparound plan addresses all life domains that affect the quality of life of the student and family at home, school, and in the community. Not all supports and services included in a wraparound plan must be included in the IEP. Services for other family members (parents, siblings) or basic living assistance for families are often important components of a youth’s wrap plan but are not necessarily part of the IEP.

Wraparound plans often involve more frequent team meetings than typically associated with the IEP process as interventions are monitored closely and new domains are addressed after high priority needs are met. The cohesive and dynamic team approach ensures that the team meetings themselves are viewed as supportive and helpful to the youth, family and teacher and that problem-solving occurs as needed to ensure optimum success. The team does not try to take on every area of need at one meeting but reaches agreement about which needs require immediate team attention and which the team will go back to after main concerns are addressed. For example, active parent involvement in problem-solving homework completion, a priority for the teacher, is more likely to occur after the family’s living environment is stabilized. The wraparound process thus becomes more proactive than reactive and can result in increasing the skills and capacity of the youth, family, and teacher so they can move beyond safety and crisis management to activities that connect the youth to typical school and family functioning.

The Art and Science of Wraparound

Wraparound is grounded in a set of values that include family voice and choice; unconditional commitment; a focus on strengths; cultural competence and safety, among others (Burns & Goldman, 1999; VanDenBerg & Grealish, 1996). Arising from this value base is the “art” of wraparound that happens when perspectives are heard and blended so that practitioners and families develop new partnerships. Listening to the stories of youth and families, ensuring they are able to guide their own destiny with dignity and choice in spite of the challenges they struggle with can only result from a truly artful dialogue. Adherence to the value-base requires team members to think and function differently as they come to consensus about what the youth/family need to improve the quality of their lives.

The science of wraparound involves the design, implementation, and evaluation of interventions likely to produce positive change in the quality and life experiences of individual youths and their families. Ensuring that educators and families are equipped with the knowledge about what interventions are likely to result in positive outcomes is critical. Understanding how wraparound is a component of school-wide systems of positive behavior support offers great promise in this direction. Carr and his colleagues (1994) introduced the concept that intervention involves changing the social systems, not the individual. Therefore, a key component of positive behavioral supports is recognizing that the goal is not to change the individual, but to alter the environment around them so that positive behaviors are more likely to occur. This knowledge can become a powerful tool for teams committed to unconditional support for youth.

The process of creating a team that will go beyond traditional agency boundaries to support families so they can address the real needs of their children reflects the art of thinking differently. Hearing the family’s (including the student’s) story is a critical part of the process. Blending their voice with the perspectives of teachers, agency representatives and other team members requires skillful facilitation and consensus-building expertise. A cohesive, family-centered team provides the environment for planning and implementing effective strength-based interventions that are likely to result in improved outcomes for the student. Examples of critical shifts in thinking and practice needed to implement wraparound are included in the example box on the left.

There is another aspect to the emerging science of wraparound. Although research-based studies that test and confirm hypotheses about wraparound are needed, program evaluations at national, state, and local levels are suggesting guidelines for effective implementation, training, and evaluation (Burns & Goldman, 1999). Decreasing out-of-home placements and use of restrictive school settings while improving behavioral, academic, social, and post-school adjustment indicators for students with EBD have been reported (Eber, Rolf & Schrieber, 1996; Eber & Nelson, 1997, Malloy, et al, 1998). These developments can allow us to move closer to the development of the wraparound process as a scientific rule-governed approach to solving problems as discussed by Kaufman (1999) in his dialogue about the role of science in the education of students with emotional and behavioral disorders.

The need to define the science of wraparound as a rule-governed process that can be consistently applied in education and human services is emerging as implementation expands across the United States. This includes the development of standards and criteria to guide training, supervision, and evaluation of wraparound implementation. For example, some states have developed interagency training curriculum including procedures for training trainers. Counties in the state of Washington have established procedures for certifying wraparound facilitators. The importance of integrating research-based instructional and behavioral interventions into individualized plans that utilize community and family resources to provide supports such as mentoring, friendship building, social activities, health/medical needs, etc. is recognized.