“Wraparound” is a word which has been used a good bit during the last two years as Louisiana prepares to unfold a Coordinated System of Care for children in out of home placements or at risk of being placed out of their homes for behavioral health care. While “wraparound” is new to Louisiana, the concept of wraparound is not new.
One of the exemplary, comprehensive wraparound efforts, Wraparound Milwaukee, began in 1995. The National Wraparound Initiative began in 2004 when a group of families, youth, providers, researchers, trainers, administrators and others came together to better define the wraparound practice model, compile specific strategies and tools, and share information about how to implement wraparound to achieve positive outcomes for youth and families.
Louisiana’s Coordinated System of Care will create regional wraparound agencies which will provide care planning and case management for families. Wraparound services are the primary component of a “coordinated, community-based, family-driven, and youth-guided system of care” designed to provide prevention and early intervention in family crises.
Wraparound is NOT residential care. In fact, a primary goal of wraparound is to surround a family with the support and resources they need to remain intact. Wraparound is about providing services to children and families in their own homes to keep them home.
For children who will require out of home care, Louisiana United Methodist Children and Family Services will continue providing intensive residential treatment at Louisiana Methodist Children’s Home in Ruston, at Methodist Children’s Home of Southwest Louisiana in Sulphur, and at Methodist Home for Children of Greater New Orleans in Mandeville. Geographically, these three residential treatment centers are located in the key “corners” of Louisiana’s boot shape. Our facility in Ruston is in north central Louisiana. Our location Sulphur is in the southwest region of Louisiana. Our site in Mandeville provides intensive residential care of the southeast region of Louisiana. But again, residential care is not wraparound.
Wraparound “wraps” home and community-based services around families needing care. Home and community-based services include all the services a family might need to prevent the removal of a child from the family or to support a family experiencing a crisis that might lead to separation. Examples of home and community-based services which we currently provide include our Multisystemic Therapy programs in Shreveport and Monroe and our Family Plus programs in communities across Louisiana.
The Rural Challenge
Louisiana, like many states, does not have all the community-based resources required to provide care for families. Much of Louisiana is rural – approximately 80% of the state qualifies as rural. Unlike Wraparound Milwaukee with about a million people within 20 minutes of each other, Louisiana’s Coordinated System of Care faces what I’ll call the “Rural Challenge”. Milwaukee County has 3,926 people per square mile. Louisiana, which is creating a statewide system of care has 4.5 million people – only 105 people per square mile. If Jefferson Parish and East Baton Rouge Parish are removed from the calculations, Louisiana’s population density is 87 people per square mile. Louisiana’s rural areas have about 2% of the people per square mile that Milwaukee County contains. (The population data was provided by http://quickfacts.census.gov).
The Physics of Time
The “Rural Challenge” is about the distance between providers and the families who need services. If you remember high school physics, you’ll recall a formula related to distance, time and speed: Time = Distance/Velocity.
Here’s why the Rural Challenge is related to physics. While there are unique variables specific to each location, on average a therapist in rural Louisiana will travel 45 times farther than a therapist in a densely populated area like Milwaukee County. Travel time is time away from families. An MST therapist in Milwaukee may easily visit six different families in a day who live within 20 minutes of each other. In rural Louisiana, because of distances traveled, an therapist may be fortunate to visit two families in a day who are separated by entire parishes.
This simple example shows why an early focus of CSoC must be on expanding the availability of home and community-based services across rural Louisiana. The need is obvious and great. Fortunately, some of the changes already made by the Department of Health and Hospitals will ease this expansion. However, it will take time to build the capacity needed by Louisiana’s children and families.