Wraparound Milwaukee is a coordinated system of community-based care and resources for families of children with severe emotional, behavioral, and mental health problems, and is operated by the Children and Adolescent Services Branch of the Milwaukee County Mental Health Division. The features of this care management model are a provider network that furnishes an array of mental health and child welfare services; an individualized plan of care; a care coordinator management system to ensure that services are coordinated, monitored, and evaluated; a Mobile Urgent Treatment Team to provide crisis intervention services; a managed care approach including preauthorization of services and service monitoring; and, a reinvestment strategy in which dollars saved from decreased use of inpatient or residential care are invested in increased service capacity. Since its inception in 1994, one of the goals of the program has been to blend funding streams.

Excerpted from: Mental Health: A Report of the Surgeon General. (1999) Chapter Three - Children and Mental Health.

Outcomes for youth participating in Wraparound Milwaukee have been encouraging. The use of residential treatment has decreased 60 percent since Wraparound Milwaukee was initiated (from an average daily census of 364 youth in placement to fewer than 140 youth). Inpatient psychiatric hospitalization has dropped by 80 percent; in 1998, only 322 days of care were provided. As mentioned above, the average overall cost of care per child has dropped from more than $5,000 per month to less than $3,300 per month. Because the savings have been reinvested into serving more youth, the project now serves 650 youth with the same fixed child welfare/juvenile justice monies that previously served 360 youth placed in residential treatment centers.

Clinical outcomes, as measured by the Child and Adolescent Functional Assessment Scale (CAFAS) (Hodges, 1994), have improved significantly for delinquent youth. CAFAS is used in all Children's Mental Health Services programs to measure changes in the youth's functioning at home, at school, and in the community. With CAFAS, a lower score indicates the youth is functioning more adequately. For a group of 300 delinquent youth enrolled in Wraparound Milwaukee, the average score at the time of enrollment was 74, which is considered in the high range of impairment. By six months after enrollment, the average score decreased to 56, in the moderate range of impairment. One year after enrollment, the average score was 48, again a moderate level of impairment.

The reduction in recidivism rates for a variety of offenses for delinquent youth enrolled in Wraparound Milwaukee has been even more encouraging. The county's Child and Adolescent Treatment Center collected data for a period of one year prior to enrollment in the project and one1 year following enrollment. The center reviewed court records for 134 delinquent youth enrolled in Wraparound. The reduction in reoffense patterns is statistically significant.

Excerpted from: Wraparound Milwaukee: Aiding Youth with Mental Health Needs Office of Juvenile Justice and Delinquency Prevention, Volume VII, (1). April, 2000.

Promising Practices In Wraparound For Children with Serious Emotional Disturbance And Their Families; National Technical Assistance Center for Children’s Mental Health, Georgetown University

National Mental Health Association's Treatment Works For Youth In The Juvenile Justice System