Nearly 1,000 youth and emerging adults with severe emotional disturbance (SED) annually receive care coordination, education, and skill-building services in their communities through High Fidelity Wraparound programs in Georgia. An evaluation of the program’s operations in 2014 conducted by the Georgia Health Policy Center’s Center of Excellence for Children’s Behavioral Health found that wraparound supports improvements in youth functioning.
The wraparound program, funded by Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD), Medicaid, and federal grants, helps youth, who are either in or at high risk for institutional care, and their families access needed services in their communities in the hopes of improving youth functioning and avoiding out-of-home placements. The Center of Excellence produced the Evaluation of Georgia Care Management Entities Using High Fidelity Wraparound Annual Report on behalf of DBHDD. The evaluation focused on the care management entities’ (CMEs) fidelity to the wraparound model and the program’s effect on children’s stability, educational success, and family empowerment.
“Although many programs within children’s behavioral health have noble intentions, it’s those programs with research-based outcomes that warrant continued support,” says Matt Yancey, director of DBHDD’s Office of Children, Young Adults, and Families. “The Department of Behavioral Health and Development Disabilities is fortunate to partner with the Center of Excellence for Children’s Behavioral Health to ensure that services provided in Georgia are evidence-driven, implemented with fidelity, and result in positive, tangible impact.”
High fidelity wraparound addresses the complex emotional needs of clients through integrated, individualized plans developed and facilitated by CME team members, in coordination with youth, families, community supports, and other child serving agencies. To qualify for wraparound services, youth and emerging adults (aged six to 21 years) with a primary mental health diagnosis must be at imminent risk of out-of-home placement.
In state fiscal year (SFY) 2014, CMEs served 980 youth in the wraparound program. The vast majority of youth served (83 percent of CME enrollees) were at-risk for admission to a psychiatric residential treatment facility (PRTF), meaning the youth were involved with mental health providers or multiple child serving agencies at the time of enrollment.
Out-of-Home Placements
One of wraparound’s strategic goals is to limit the time spent in out-of-community settings.
- During FY 2014, among the 683 youth that were discharged from the two CMEs, more than half of the at-risk youth (55 percent) successfully transitioned to the community.
- Yet, of the remaining discharged youth, 20 percent of the at-risk and almost 36 percent of those qualifying for PRTF level of care experienced an out-of-community discharge to either a behavioral health care facility or placement in the custody of the Department of Juvenile Justice (DJJ) or Division of Child and Family Services (DFCS).
Findings from the study are consistent with previous research that shows, compared to the general youth population, those with emotional disturbances are significantly more likely to be arrested while still in school, with up to 20 percent of youth with emotional and behavioral disorders arrested while in secondary school.
- Forty-one percent of youth who were ultimately discharged experienced an out-of-home placement during wraparound enrollment. The majority of out-of-home placements occurred to crisis stabilization (32 percent), DFCS (24 percent), or DJJ (21 percent).
Center of Excellence evaluators note that the child welfare and juvenile justice placements during enrollment could be a result of either pending actions prior to CME enrollment or the result of youth or court actions while enrolled in wraparound services.
School Performance
The wraparound team also develops strategies to strengthen attendance and performance in school.
- More than 70 percent of youth had no unexcused absences while in wraparound care.
- Few youth discharged from wraparound during FY 2014 experienced school expulsions (2 percent) and less than one-fifth were suspended from school while receiving services from a CME.
This compares to previous research that shows the majority of youth with emotional disturbance will be suspended or expelled during their school career.
Caregiver Impact
Caregivers are given an opportunity to assess the impact of wraparound services on family empowerment and to rate their satisfaction with services received. The vast majority of caregivers reported positive responses (90 percent or more) for the program’s cultural sensitivity, access to care services, services received by youth, participation in treatment, and social connectedness.
“Because preventing out-of-home placements is one of wraparound’s primary goals, determining the profile of youth who continue to experience out-of-home placements while enrolled in wraparound is important,” notes the Center for Excellence’s wraparound evaluation team. “By determining this profile of youth, one may distinguish the population of youth for whom wraparound is more successful in minimizing out-of-home placements. This could promote targeted implementation of wraparound towards youth with higher likelihoods of success and/or an increase in service intensity towards youth who are more at-risk for experiencing out-of-home placements.”