WRAPAROUND MILWAUKEE

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WRAPAROUND MILWAUKEE

• Never doubt that a small group of committed
  citizens can change the world indeed, its the
  only thing that ever does.
• Margaret Mead

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Presented by

• Bruce Kamradt
• Project Director

WRAPAROUND MILWAUKEE
Operated by Milwaukee County Mental Health
Division Child Adolescent Services Branch
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What Has Been Achieved In Wraparound Milwaukee
forChildren with Severe Emotional Needs

• Better Clinical Outcomes
• Children Families Function Better
• Reduced Recidivism of Delinquent Youth Served
• Improved School Attendance
• Reduction in the Use of Residential Treatment
• Psychiatric Hospitalization
• Reduction in Cost of Care

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Wraparound Approach for Children with Serious
Complex Mental Health Needs

• Focus on Family and Childrens Strengths
• One Family - One Plan Across Systems
• Community-Based Care and Treatment
• Needs Driven vs Categorical Services
• Care for Children in Context of Families
• Parent Choice in Provision of Services
• Focus on Refinancing Strategies
• Unconditional Care

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What is Wraparound Milwaukee

• Public Care Management Organization
• Governance with Milwaukee County Behavioral
  Health Division
• Manages the Care of Children with Serious
  Emotional Mental Health Needs at Immediate Risk
  of Residential Treatment, Correctional Placement
  or Psychiatric Hospitalization
• All referrals come through the Child Welfare or
  Juvenile Justice System
• Pools 30 Million in Funds from
• Child Welfare ? Medicaid
• Mental Health ? Juvenile Justice

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Key Components of Program

• Fiscal Operational Management
• 24 Hour Mobile Crisis Team
• Care Coordination
• Provider Network
• 80 Services
• 230 Agency and Individual Providers
• Family Advocacy / Support Organization
• Quality assurance / Program Evaluation
• Clinical Support and Resource Teams
• Extensive Use of Informal Supports ie. Boys
  Girls Clubs, Churches, Civic Organizations, etc.

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Demographics of Children Families We Serve

• 70 Male ? 30 Female
• Average Ave - 13.5 years
• Ethnicity
• 64 African American
• 27 Caucasian
• 7 Hispanic
• 2 Other
• 52 Delinquent - 48 Child Welfare
• 50 with Annual Family Income Under 15,000
• 40 Regular Education - No IEP
• Continued

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Demographics of Children Families We Serve

• Diagnosis
• 65 Conduct Disorder
• 50 Depression / Oppositional Defiant
• 46 Attention Deficit
• 25 Substance Abuse
• 15 Adjustment Disorders
• 12 Cognitive / Developmental Disorders

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What are Pooled Funds?
CHILD WELFARE
JUVENILE JUSTICE
MEDICAID CAPITATION
MENTAL HEALTH
Funds thru Case Rate
(Funds Budgeted for
(1557 per Month per Enrollee)
CRISIS BILLING
(Budget for Institutional
Residential Treatment

BLOCK GRANT
Care for Chips Children)
for Delinquent Youth)

HMO COMMERCIAL INSUR
9.5 M
8.5 M
10 M
2.0 M
WRAPAROUND MILWAUKEE
MANAGEMENT SERVICE ORGANIZATION
(MSO)
30 M
CARE COORDINATION
PROVIDER NETWORK 240 Providers 85 Services
CHILD
AND FAMILY
TEAM
PLAN
OF
CARE
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Provider Network

• 80 Services
• No Formal Contracting -- services purchased on a
  fee-for-service basis -- rates established by
  Wraparound Milwaukee
• Extensive Quality Assurance/Quality Monitoring
• Residential Treatment Vendors were asked to
  re-engineer institutional services to
  community-based services
• Consumer Choice of Providers
• All Providers Care Managers linked through
  internet-based IT system for authorizations, plan
  submission, invoicing, etc.

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Outcomes - Program

• Average daily Residential Treatment population
  reduced from 375 placements to 60 placements
• Psychiatric Inpatient Utilization reduced from
  5000 days per year to under 200 days (ave. LOS of
  2.8 days)
• Reduction in Juvenile Correctional Commitments
  from 385 per year to 285

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Outcomes - Financial

• Wraparound Milwaukee average monthly costs is
  4350 per child per month versus 7200 for
  residential treatment, 6000 monthly for a
  correctional placement or 600 per day for
  psychiatric inpatient care

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CAREGIVER, CARE COORDINATOR, YOUTH REPORTED
IMPROVEMENT IN FUNCTIONING FOR CLIENTS
Child Behavior Checklist (CBCL), N219 Youth
Self-Report (YSR), N155 Child Adolescent
Functional Assessment Scale (CAFAS), N374.
Reductions are significant at the plt.001 level of
significance using a repeated measures analysis
of variance.
Year 2001
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REDUCTION IN PERCENTAGE OF CLIENTS REFERRED FOR
FELONIES MISDEMEANORS WHILE ENROLLED
FOLLOWING DISCHARGE
N 490 Year 2001
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REDUCTION IN SPECIFIC OFFENSE TYPES PRIOR TO
ENROLLMENT, DURING ENROLLMENT, AND AFTER
DISENROLLMENT
N 492 OTHER OFFENSES CONSIST PRIMARILY OF
DISORDERLY CONDUCT Year 2001
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• Serving Children and Families with Complex Needs

Operated by Milwaukee County Behavioral Health
Division Child Adolescent Services Branch
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Operated by Milwaukee County Behavioral Health
Division Child Adolescent Services Branch