Keeping families together using wraparound approach

Evidence in Action

What you need to know

Adolescents who are removed from their homes and communities often have poor psychological, physical, and educational outcomes. To counter the negative impacts of out of home placement, Oolagen, an accredited, not-for-profit children’s mental health agency and University of Toronto teaching facility, partners with other child and youth mental health centres and child welfare agencies to implement the Keeping Families Together program.

Introduced in 2006, Keeping Families Together aims to respond to growing concern about the high rates of youth admissions into institutional care and the recognition that problematic behaviours can signal the presence of unmet mental health needs.

The program uses Wraparound, an innovative process for working with youth and their families that coordinates and integrates services while focusing on the youth’s unique needs and strengths.

In our latest Evidence in Action, EENet’s Tatyana Krimus profiles Oolagen’s Keeping Families Together. Evidence in Action profiles knowledge generation, exchange, and implementation activities across Ontario.

Read this Evidence in Action below or access the PDF here.

About the program

Adolescents who are removed from their homes and communities often have poor psychological, physical, and educational outcomes. To counter the negative impacts of out of home placement, Oolagen partners with other child and youth mental health centres and child welfare agencies to implement the Keeping Families Together program. 

Introduced in 2006, Keeping Families Together aims to respond to growing concern about the high rates of youth admissions into institutional care and the recognition that problematic behaviours can signal the presence of unmet mental health needs. 

The program uses Wraparound, an innovative process for working with youth and their families that coordinates and integrates services while focusing on the youth’s unique needs and strengths. 

Wraparound involves an intense planning process led by a mental health professional, who is part of a multi-disciplinary team. This team is made up of both informal and formal members and works closely with the youth and their family to align services and supports. By placing the individual, rather than the service, at the centre of the care planning process, the Wraparound model tailors the services and supports to the needs of the youth and their family. 

The Research

To assess the overall impact of Keeping Families Together, front-line child and youth mental health (CYMH) workers tracked all joint cases managed from March 31, 2008, to April 1, 2009. The annual caseload was then forwarded to the relevant child welfare manager, located at a partner agency, who updated the records for the youth in the program. 
The review of the data found that Keeping Families Together was largely meeting program goals and achieving impressive results for program participants: 

  • 86% of youth were kept in family/community settings; 
  • Of those youth who were admitted into care, 64% were reunited with family; and
  • Youth continued to have positive outcomes three and six months after they transitioned into their homes and communities. 

Evaluators looked at whether the Wraparound process was able to:

  • Identify child welfare clients in need,
  • Offer a flexible, intensive, time-limited intervention based on outreach to families and adolescents,
  • Ensure coordinated access to CYMH services; and
  • Make crisis intervention available, where needed. 

Wraparound successfully met all the criteria above.

Evaluators recommended that CYMH agencies begin tracking and evaluating families that are not participating in the program, to better understand how the program might meet their needs. They also suggested that criteria be developed to identify youth and families that would be best served by Wraparound, and those that would be better served by a different approach. 

Perhaps most importantly, this review helped inform the ways in which CYMH agencies work together, including referral mechanisms, to improve outcomes for youth and families. 

The Application

The partnership between CYMH and child welfare agencies was strengthened as a consequence of the evaluation process as well as its results. The evaluation increased knowledge and engagement between the different agencies and helped streamline processes for referrals to children’s mental health agencies. 

While each agency continued to implement individual referral processes, partner agencies worked in a more coordinated way to reduce access barriers, such as waitlists, and identify urgent cases. To date, 1633 youth and families have participated in the Wraparound program over the course of seven years, and the number is steadily increasing every year. 

While the evaluation did not specifically collect demographic information, previous research showed that Wraparound works well with different ethnic and cultural groups. The program has now evolved to adapt services and materials for groups with varying linguistic and cultural perspectives. 

As part of the Wraparound intake process, youth and their families are now asked to identify their culture, values, principles, and preferences, as well as itemize personal and family strengths. 

Lessons learned

The biggest challenge for community mental health agencies implementing Keeping Families Together is to stay true to the core principles of Wraparound. One way to do this is to participate in training sessions offered by Wrap Canada – a national community of practice. 

Wrap Canada works in partnership with children’s mental health agencies to provide training, coaching, and program evaluation to Wraparound projects across Canada. 

Another implementation challenge tends to be the complexity of the needs of families and youth. Families that are referred to Keeping Families Together typically have had little success with traditional services, including group homes, counseling, and individual psychotherapy. 

Using Wraparound achieves better outcomes by helping to assess and identify various underlying needs or hidden barriers (for example, the lack of a family doctor), and addressing needs in a systematic, prioritized, and targeted fashion. In this way, it allows agencies to see the “big picture,” enabling the appropriate matching of youth and their families with services that meet their needs while acknowledging and building on their strengths. 

Cathy Blocki-Radeke, Wraparound Manager, OolagenFor more information, contact Cathy Blocki-Radeke (pictured right), Wraparound Manager, Oolagen, cathyblocki-radeke [at] oolagen [dot] org.

Useful links:
Oolagen oolagen.org
Wrap Canada  www.wrapcanada.org
Children’s Mental Health Ontario www.cmho.org
Parents for Children’s Mental Health www.pcmh.ca
Hospital for Sick Children www.sickkids.ca
Catholic Children’s Aid Society www.ccastoronto.on.ca
Children’s Aid Society of Toronto www.torontocas.ca
Jewish Family and Child Services www.jfandcs.com
Native Child and Family Services www.nativechild.org

Author: Tatyana Krimus
Posted date: November 19, 2014

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