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An Introduction to WraparoundAn Introduction to Wraparound
J. Watson, PhD, MSW, MBAJ. Watson, PhD, MSW, MBA
L. Griffin-Davis, BSW StudentL. Griffin-Davis, BSW Student
A. L. Hines, BSW StudentA. L. Hines, BSW Student
Oct. 25, 2011Oct. 25, 2011
“A person working
alone has all
the power of
social dust.”
Saul Alinsky, Community Activist
(1909 - 1972)
How it all began…
Wraparound or WarparoundWraparound or Warparound
Karl Dennis & VanDenBergKarl Dennis & VanDenBerg
““Social Work terms…”Social Work terms…”
Systems & Ecological PerspectiveSystems & Ecological Perspective
A Strengths-Based ApproachA Strengths-Based Approach
Similarities of the
Generalist Intervention Model
(GIM)
&
Phases and Activities of the
Wraparound Process
Similarities of Generalist Intervention Model & Phases & Activities of theSimilarities of Generalist Intervention Model & Phases & Activities of the
Wraparound ProcessWraparound Process
The Generalist Intervention ModelThe Generalist Intervention Model
WRAPAROUNDWRAPAROUND
Engagement and Team Preparation
Orient the family to Wraparound
Stabilize crises
Facilitate conversations about strengths
needs, culture, and vision of the family
Engage other potential team members
Make needed meeting arrangements
Initial Plan Development
Develop a plan of care
Develop a detailed crisis/safety plan
Implementation
Implement the plan
Revisit and update the plan
Maintain team cohesiveness and trust
Complete documentation and handle
logistics
Transition
Plan for cessation of wrap
Conduct commencement ceremonies
Follow-up with the family after graduation
Elements of Wraparound
 Inter-Agency
Collaboration & IntegrationCollaboration & Integration
 State
 Community
 Child & Family Teams
 Family Focused
 Unconditional Care
 Community - Based
 Strength - Based
 Individualized Services
 Culturally Competent
 Cost Effective
 Meets Needs of Family
 Outcome Driven
The Wraparound Approach
 Wraparound is a facilitated team based practice
model designed to integrate natural and professional
supports, with the family in the driver’s seat
 A wraparound team is formed to help define and
refine family strengths, culture, vision and needs;
prioritize needs and create the plan; and then carry
out the plan one prioritized need at a time until the
formal team is no longer needed because the vision of
the family has been achieved.
Do’s and Don'ts for
Working with Families
 Don’t form opinions
about a family
 Be direct
 Trust family’s instincts
 Speak language that
families understand
 View families as a
whole, not as a case
 Assist families with life
plans; not treatment
plans
 Don’t be just a voice
on the phone
 Don’t be
condescending
 Involve families in
every level of planning
Do’s and Don'ts for working
with Families (Cont.)
 Keep families informed
 Accept lifestyles and
cultural differences
 Help to preserve
privacy
 Follow house rules
 Respect family’s
schedules
 Be patient
 Be accessible
 Follow through
 Don’t become another
layer of bureaucracy
 Be a partner
 Look at services that
families need, not
whether they are
billable
What Makes It Work
Access
 Parent/Child has valid
option at inclusion in
decision making process
Ownership
 Parent/Child agree with
and are committed to any
plan concerning them
Voice
 Parent/Child were heard,
listened to at all junctures
of planning
Consistency
 Parent/Child were served
by a consistent team of
workers for services and
crisis
““Voice and Choice”Voice and Choice”
 In Wraparound, families and youth have a clear say inIn Wraparound, families and youth have a clear say in
what plans look like, how they are designed, how they arewhat plans look like, how they are designed, how they are
implemented, and how they are evaluated. The familiesimplemented, and how they are evaluated. The families
and youth drive the process.and youth drive the process.
 If safety is an issue, and the state is involved, voice andIf safety is an issue, and the state is involved, voice and
choice is shared between the state and the family, withchoice is shared between the state and the family, with
safety as the most important issue.safety as the most important issue.
 Gaining and exercising voice and choice is a process.Gaining and exercising voice and choice is a process.
Child & Family Team
Who’s On It
 Parents & Children
 Four to eight people
who best know the
strengths and needs of
the family
 Chosen by the family
and lead agency
 All members must
agree to actively
participate
 Some possibilities:
 Teacher - Counselor
 Social Worker
 Service Coordinator
 Therapist
 Clergy
 Friend - Neighbor
 Big Brother/Big Sister
 Grandparents -
Relatives
Child & Family Team
Meetings
 Time
 Set times so all can
participate
 May involve evenings
or weekends
 Place
 Where the family is
comfortable
 Frequency
 Weekly for four weeks
 Monthly for next
several months
 Quarterly thereafter
 Change frequency to
meet family and/or
crisis needs
Child & Family Teams
Tasks
 Assess family strengths
 Develop Plan
 Plan for Crisis
 Develop community
support network for
plan implementation
 Advocate for the
family
 Monitor services and
plan
 Evaluate plan’s
effectiveness
 Redo plan as needed
 Be creative
entrepreneurs
 Never Ever Give Up!
Effective Crisis Planning
 Plans anticipate crisis based on past
knowledge.
 Assume the “worst case” scenario
 Research past crisis for cause, best
interventions and consequent behaviors.
 Clearly defined plans help teams function in
difficult times
Crisis Planning
 See crisis as a process with a beginning, middle, and
end.
 Change plan based on “what works”
 Build plans that “triage” for differing levels of
intensity and severity of crisis.
 Build plans early with child & family team
 Begin by asking family “what can go wrong with plan”
as a first step.
Crisis Planning
 Always build in 24 hour response.
 Clearly define roles for team members including
family and natural support people.
 Create time for team to assess management of crisis
within two weeks of event.
 Decide that no major decisions will be made until at
least 72 hours after the crisis event.
(Grealish & Vandenberg)
 Cultural competence is an understanding of the shared values,
traditions, norms, customs, art, history, folklore and institutions
of a group of people.
 Cultural competence is knowledge that helps us understand
how people interpret and function in their environment.
 Cultural competence is acceptance of the diversity of people as
to: (1) personal and group values and attitudes (2) what works
and doesn’t work for them and their families, (3) what is helpful
and not helpful in resolving their problems, and (4) what makes
sense to them and what does not.
 Cultural competence is an understanding of the shared values,
traditions, norms, customs, art, history, folklore and institutions
of a group of people.
 Cultural competence is knowledge that helps us understand
how people interpret and function in their environment.
 Cultural competence is acceptance of the diversity of people as
to: (1) personal and group values and attitudes (2) what works
and doesn’t work for them and their families, (3) what is helpful
and not helpful in resolving their problems, and (4) what makes
sense to them and what does not.
2020
Culture should be regarded as the set of
distinctive spiritual, material, intellectual and
emotional features of society or a social
group, and that it encompasses, in addition to
art and literature, lifestyles, ways of living
together, value systems, traditions and beliefs.
United Nations Educational, Scientific, and Cultural Organization (UNESCO)
Culture should be regarded as the set of
distinctive spiritual, material, intellectual and
emotional features of society or a social
group, and that it encompasses, in addition to
art and literature, lifestyles, ways of living
together, value systems, traditions and beliefs.
United Nations Educational, Scientific, and Cultural Organization (UNESCO)
21
22
Characteristics of Culture
Defining What Is Undesirable and Desirable In a Society
22
 Culture defines every individual; it influences who we are.
 Everyone has culture; it influences how we view others.
 Organizations have distinct cultures developed by their
mission and goals.
 Communities have diverse cultures influenced by their
members, the environment, and socioeconomic conditions.
 Behavior of any individual or family is affected by economic,
class, religious, geographic, age, and acculturation factors.
(Mather et al., 2007)
 Culture defines every individual; it influences who we are.
 Everyone has culture; it influences how we view others.
 Organizations have distinct cultures developed by their
mission and goals.
 Communities have diverse cultures influenced by their
members, the environment, and socioeconomic conditions.
 Behavior of any individual or family is affected by economic,
class, religious, geographic, age, and acculturation factors.
(Mather et al., 2007)
23
24
25
Culture is important!
The potential influences that define one’s culture
 Group – who the family is identified with (race, ethnicity,
religious, activity)
 History – for the group, family and/or individual
 Beliefs – that define what is important to the family and
individual
 Traditions – practices that are valued and handed down or
developed new by the family
 Preferences – are what motivate us to act (futures, activities,
values)
Community Culture
 Every community has their own unique
culture
 Who are the enforcers of community culture
in your part of the county?
 We link the strengths and culture of the
community to the needs of families and create
the Village…
First Me!First Me!
 Self-Assessment Exercise
Prejudice
Ethnocentrism
Stereotype
Sexism
Multiculturalism
Cultural Sensitivity
Ethnicity
Racism
Race
Internalized Oppression
Discrimination
Heterosexism
Culture
The ability to be
open to learning
about and
accepting of
different cultural
groups.
Cultural Sensitivity
Prejudice
Ethnocentrism
Stereotype
Sexism
Multiculturalism
Cultural Sensitivity
Ethnicity
Racism
Race
Internalized Oppression
Discrimination
Heterosexism
Culture
A belief that racial
differences produce
and inherent
superiority of a
particular race.
Racism
Prejudice
Ethnocentrism
Stereotype
Sexism
Multiculturalism
Cultural Sensitivity
Ethnicity
Racism
Race
Internalized Oppression
Discrimination
Heterosexism
Culture
A generalization
of characteristics
that is applied to
all members of a
cultural group.
Stereotype
Prejudice
Ethnocentrism
Stereotype
Sexism
Multiculturalism
Cultural Sensitivity
Ethnicity
Racism
Race
Internalized Oppression
Discrimination
Heterosexism
Culture
A subconscious belief in
negative stereotypes
about one’s group that
results in an attempt to
fulfill those stereotypes
and a projection of those
stereotypes onto other
members of that group.
Internalized
oppression
Prejudice
Ethnocentrism
Stereotype
Sexism
Multiculturalism
Cultural Sensitivity
Ethnicity
Racism
Race
Internalized Oppression
Discrimination
Heterosexism
Culture
To make a
difference in
treatment on a
basis other than
individual
character.
Discrimination
Prejudice
Ethnocentrism
Stereotype
Sexism
Multiculturalism
Cultural Sensitivity
Ethnicity
Racism
Race
Internalized Oppression
Discrimination
Heterosexism
Culture
The recognition and
acknowledgement that
society is pluralistic. In
addition to the dominant
cultural, there exists many
other cultures based around
ethnicity, sexual orientation,
geography, religion, gender,
and class.
Multiculturalism
Prejudice
Ethnocentrism
Stereotype
Sexism
Multiculturalism
Cultural Sensitivity
Ethnicity
Racism
Race
Internalized Oppression
Discrimination
Heterosexism
Culture
An attitude, opinion, or
feeling formed without
adequate prior
knowledge, thought,
or reason.
Prejudice
Prejudice
Ethnocentrism
Stereotype
Sexism
Multiculturalism
Cultural Sensitivity
Ethnicity
Racism
Race
Internalized Oppression
Discrimination
Heterosexism
Culture
The belief in the
inherent superiority
of one sex (gender)
over the other and
thereby the right to
dominance.
Sexism
Prejudice
Ethnocentrism
Stereotype
Sexism
Multiculturalism
Cultural Sensitivity
Ethnicity
Racism
Race
Internalized Oppression
Discrimination
Heterosexism
Culture
A body of learned
beliefs, traditions,
principles, and guides
for behavior that are
shared among
members of a
particular group.
Culture
Prejudice
Ethnocentrism
Stereotype
Sexism
Multiculturalism
Cultural Sensitivity
Ethnicity
Racism
Race
Internalized Oppression
Discrimination
Heterosexism
Culture
To judge other cultures by
the standards of one’s own,
and beyond that, to see
one’s own standards as the
true universal and the other
culture in a negative way.
Ethnocentrism
Prejudice
Ethnocentrism
Stereotype
Sexism
Multiculturalism
Cultural Sensitivity
Ethnicity
Racism
Race
Internalized Oppression
Discrimination
Heterosexism
Culture
As a biological concept, it
defines groups of people
based on a set of
genetically transmitted
characteristics.
race
Prejudice
Ethnocentrism
Stereotype
Sexism
Multiculturalism
Cultural Sensitivity
Ethnicity
Racism
Race
Internalized Oppression
Discrimination
Heterosexism
Culture
Sharing a strong
sense of identity
with a particular
religious, racial, or
national group.
Ethnicity
Understanding Diversity
 G.R.A.C.E.S.
Wraparound is both EBP and PBE
 Most states now accept WrapAround as an
accepted EBP. There are more children,
youth, and families in WrapAround than all
other EBP combined (Suter, 2007).
 WrapAround is unique in that it comes from
both a research and a community culture
competent perspective.
Positive Outcomes are Not Guaranteed!
Studies indicate that WrapAround teams often fail to:
 Incorporate full complement of key individuals on the
Wraparound team;
 Engage youth in community activities, things they do well,
or activities to help develop friendships;
 Use family/community strengths to plan/implement services;
 Engage natural supports, such as extended family members
and community members;
 Use flexible funds to help implement strategies
 Consistently assess outcomes and satisfaction.
Core Lessons…
 The more complex the needs of the family/youth, the
more individualized the plan must be. The opposite is
standard practice in most systems
 Out of home placement can be reduced by up to 90% with
the right flexibility to the staff and families, and use of the
process
 The more complex the needs of the family/youth, the
more integrated the plan must be to ensure positive
outcomes. In fact, current practice reveals lower
integration with high complexity families.
 WrapAround must address more than just the youth, and
often must look at three generations of needs.
Benefits to
Systems & Agencies
 Fosters Interagency Collaboration
 Decision making given to family and direct
care givers
 Promotes “top down” and “bottom up”
change
 Increases community responsibility
 Creates flexible funds
 Services monitored by multiagencies
Discussion & Conclusion

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Introduction to Wraparound Presentation 2011

  • 1. An Introduction to WraparoundAn Introduction to Wraparound J. Watson, PhD, MSW, MBAJ. Watson, PhD, MSW, MBA L. Griffin-Davis, BSW StudentL. Griffin-Davis, BSW Student A. L. Hines, BSW StudentA. L. Hines, BSW Student Oct. 25, 2011Oct. 25, 2011
  • 2. “A person working alone has all the power of social dust.” Saul Alinsky, Community Activist (1909 - 1972)
  • 3. How it all began… Wraparound or WarparoundWraparound or Warparound Karl Dennis & VanDenBergKarl Dennis & VanDenBerg
  • 4. ““Social Work terms…”Social Work terms…” Systems & Ecological PerspectiveSystems & Ecological Perspective A Strengths-Based ApproachA Strengths-Based Approach
  • 5. Similarities of the Generalist Intervention Model (GIM) & Phases and Activities of the Wraparound Process
  • 6. Similarities of Generalist Intervention Model & Phases & Activities of theSimilarities of Generalist Intervention Model & Phases & Activities of the Wraparound ProcessWraparound Process The Generalist Intervention ModelThe Generalist Intervention Model WRAPAROUNDWRAPAROUND Engagement and Team Preparation Orient the family to Wraparound Stabilize crises Facilitate conversations about strengths needs, culture, and vision of the family Engage other potential team members Make needed meeting arrangements Initial Plan Development Develop a plan of care Develop a detailed crisis/safety plan Implementation Implement the plan Revisit and update the plan Maintain team cohesiveness and trust Complete documentation and handle logistics Transition Plan for cessation of wrap Conduct commencement ceremonies Follow-up with the family after graduation
  • 7. Elements of Wraparound  Inter-Agency Collaboration & IntegrationCollaboration & Integration  State  Community  Child & Family Teams  Family Focused  Unconditional Care  Community - Based  Strength - Based  Individualized Services  Culturally Competent  Cost Effective  Meets Needs of Family  Outcome Driven
  • 8. The Wraparound Approach  Wraparound is a facilitated team based practice model designed to integrate natural and professional supports, with the family in the driver’s seat  A wraparound team is formed to help define and refine family strengths, culture, vision and needs; prioritize needs and create the plan; and then carry out the plan one prioritized need at a time until the formal team is no longer needed because the vision of the family has been achieved.
  • 9. Do’s and Don'ts for Working with Families  Don’t form opinions about a family  Be direct  Trust family’s instincts  Speak language that families understand  View families as a whole, not as a case  Assist families with life plans; not treatment plans  Don’t be just a voice on the phone  Don’t be condescending  Involve families in every level of planning
  • 10. Do’s and Don'ts for working with Families (Cont.)  Keep families informed  Accept lifestyles and cultural differences  Help to preserve privacy  Follow house rules  Respect family’s schedules  Be patient  Be accessible  Follow through  Don’t become another layer of bureaucracy  Be a partner  Look at services that families need, not whether they are billable
  • 11. What Makes It Work Access  Parent/Child has valid option at inclusion in decision making process Ownership  Parent/Child agree with and are committed to any plan concerning them Voice  Parent/Child were heard, listened to at all junctures of planning Consistency  Parent/Child were served by a consistent team of workers for services and crisis
  • 12. ““Voice and Choice”Voice and Choice”  In Wraparound, families and youth have a clear say inIn Wraparound, families and youth have a clear say in what plans look like, how they are designed, how they arewhat plans look like, how they are designed, how they are implemented, and how they are evaluated. The familiesimplemented, and how they are evaluated. The families and youth drive the process.and youth drive the process.  If safety is an issue, and the state is involved, voice andIf safety is an issue, and the state is involved, voice and choice is shared between the state and the family, withchoice is shared between the state and the family, with safety as the most important issue.safety as the most important issue.  Gaining and exercising voice and choice is a process.Gaining and exercising voice and choice is a process.
  • 13. Child & Family Team Who’s On It  Parents & Children  Four to eight people who best know the strengths and needs of the family  Chosen by the family and lead agency  All members must agree to actively participate  Some possibilities:  Teacher - Counselor  Social Worker  Service Coordinator  Therapist  Clergy  Friend - Neighbor  Big Brother/Big Sister  Grandparents - Relatives
  • 14. Child & Family Team Meetings  Time  Set times so all can participate  May involve evenings or weekends  Place  Where the family is comfortable  Frequency  Weekly for four weeks  Monthly for next several months  Quarterly thereafter  Change frequency to meet family and/or crisis needs
  • 15. Child & Family Teams Tasks  Assess family strengths  Develop Plan  Plan for Crisis  Develop community support network for plan implementation  Advocate for the family  Monitor services and plan  Evaluate plan’s effectiveness  Redo plan as needed  Be creative entrepreneurs  Never Ever Give Up!
  • 16. Effective Crisis Planning  Plans anticipate crisis based on past knowledge.  Assume the “worst case” scenario  Research past crisis for cause, best interventions and consequent behaviors.  Clearly defined plans help teams function in difficult times
  • 17. Crisis Planning  See crisis as a process with a beginning, middle, and end.  Change plan based on “what works”  Build plans that “triage” for differing levels of intensity and severity of crisis.  Build plans early with child & family team  Begin by asking family “what can go wrong with plan” as a first step.
  • 18. Crisis Planning  Always build in 24 hour response.  Clearly define roles for team members including family and natural support people.  Create time for team to assess management of crisis within two weeks of event.  Decide that no major decisions will be made until at least 72 hours after the crisis event. (Grealish & Vandenberg)
  • 19.  Cultural competence is an understanding of the shared values, traditions, norms, customs, art, history, folklore and institutions of a group of people.  Cultural competence is knowledge that helps us understand how people interpret and function in their environment.  Cultural competence is acceptance of the diversity of people as to: (1) personal and group values and attitudes (2) what works and doesn’t work for them and their families, (3) what is helpful and not helpful in resolving their problems, and (4) what makes sense to them and what does not.  Cultural competence is an understanding of the shared values, traditions, norms, customs, art, history, folklore and institutions of a group of people.  Cultural competence is knowledge that helps us understand how people interpret and function in their environment.  Cultural competence is acceptance of the diversity of people as to: (1) personal and group values and attitudes (2) what works and doesn’t work for them and their families, (3) what is helpful and not helpful in resolving their problems, and (4) what makes sense to them and what does not. 2020
  • 20. Culture should be regarded as the set of distinctive spiritual, material, intellectual and emotional features of society or a social group, and that it encompasses, in addition to art and literature, lifestyles, ways of living together, value systems, traditions and beliefs. United Nations Educational, Scientific, and Cultural Organization (UNESCO) Culture should be regarded as the set of distinctive spiritual, material, intellectual and emotional features of society or a social group, and that it encompasses, in addition to art and literature, lifestyles, ways of living together, value systems, traditions and beliefs. United Nations Educational, Scientific, and Cultural Organization (UNESCO) 21
  • 21. 22 Characteristics of Culture Defining What Is Undesirable and Desirable In a Society 22
  • 22.  Culture defines every individual; it influences who we are.  Everyone has culture; it influences how we view others.  Organizations have distinct cultures developed by their mission and goals.  Communities have diverse cultures influenced by their members, the environment, and socioeconomic conditions.  Behavior of any individual or family is affected by economic, class, religious, geographic, age, and acculturation factors. (Mather et al., 2007)  Culture defines every individual; it influences who we are.  Everyone has culture; it influences how we view others.  Organizations have distinct cultures developed by their mission and goals.  Communities have diverse cultures influenced by their members, the environment, and socioeconomic conditions.  Behavior of any individual or family is affected by economic, class, religious, geographic, age, and acculturation factors. (Mather et al., 2007) 23
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  • 25. Culture is important! The potential influences that define one’s culture  Group – who the family is identified with (race, ethnicity, religious, activity)  History – for the group, family and/or individual  Beliefs – that define what is important to the family and individual  Traditions – practices that are valued and handed down or developed new by the family  Preferences – are what motivate us to act (futures, activities, values)
  • 26. Community Culture  Every community has their own unique culture  Who are the enforcers of community culture in your part of the county?  We link the strengths and culture of the community to the needs of families and create the Village…
  • 27. First Me!First Me!  Self-Assessment Exercise
  • 31. Prejudice Ethnocentrism Stereotype Sexism Multiculturalism Cultural Sensitivity Ethnicity Racism Race Internalized Oppression Discrimination Heterosexism Culture A subconscious belief in negative stereotypes about one’s group that results in an attempt to fulfill those stereotypes and a projection of those stereotypes onto other members of that group. Internalized oppression
  • 33. Prejudice Ethnocentrism Stereotype Sexism Multiculturalism Cultural Sensitivity Ethnicity Racism Race Internalized Oppression Discrimination Heterosexism Culture The recognition and acknowledgement that society is pluralistic. In addition to the dominant cultural, there exists many other cultures based around ethnicity, sexual orientation, geography, religion, gender, and class. Multiculturalism
  • 35. Prejudice Ethnocentrism Stereotype Sexism Multiculturalism Cultural Sensitivity Ethnicity Racism Race Internalized Oppression Discrimination Heterosexism Culture The belief in the inherent superiority of one sex (gender) over the other and thereby the right to dominance. Sexism
  • 36. Prejudice Ethnocentrism Stereotype Sexism Multiculturalism Cultural Sensitivity Ethnicity Racism Race Internalized Oppression Discrimination Heterosexism Culture A body of learned beliefs, traditions, principles, and guides for behavior that are shared among members of a particular group. Culture
  • 37. Prejudice Ethnocentrism Stereotype Sexism Multiculturalism Cultural Sensitivity Ethnicity Racism Race Internalized Oppression Discrimination Heterosexism Culture To judge other cultures by the standards of one’s own, and beyond that, to see one’s own standards as the true universal and the other culture in a negative way. Ethnocentrism
  • 38. Prejudice Ethnocentrism Stereotype Sexism Multiculturalism Cultural Sensitivity Ethnicity Racism Race Internalized Oppression Discrimination Heterosexism Culture As a biological concept, it defines groups of people based on a set of genetically transmitted characteristics. race
  • 41. Wraparound is both EBP and PBE  Most states now accept WrapAround as an accepted EBP. There are more children, youth, and families in WrapAround than all other EBP combined (Suter, 2007).  WrapAround is unique in that it comes from both a research and a community culture competent perspective.
  • 42. Positive Outcomes are Not Guaranteed! Studies indicate that WrapAround teams often fail to:  Incorporate full complement of key individuals on the Wraparound team;  Engage youth in community activities, things they do well, or activities to help develop friendships;  Use family/community strengths to plan/implement services;  Engage natural supports, such as extended family members and community members;  Use flexible funds to help implement strategies  Consistently assess outcomes and satisfaction.
  • 43. Core Lessons…  The more complex the needs of the family/youth, the more individualized the plan must be. The opposite is standard practice in most systems  Out of home placement can be reduced by up to 90% with the right flexibility to the staff and families, and use of the process  The more complex the needs of the family/youth, the more integrated the plan must be to ensure positive outcomes. In fact, current practice reveals lower integration with high complexity families.  WrapAround must address more than just the youth, and often must look at three generations of needs.
  • 44. Benefits to Systems & Agencies  Fosters Interagency Collaboration  Decision making given to family and direct care givers  Promotes “top down” and “bottom up” change  Increases community responsibility  Creates flexible funds  Services monitored by multiagencies