Wraparound Milwaukee

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Wraparound Milwaukee

• Exemplary Program Under Goal 2 Mental Health
  
• Care is Consumer Family Driven
• Every adult with a serious mental illness and
  child with a serious emotional disturbance should
  have an individual Plan of Care

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Wraparound Milwaukee Values

• The absolute necessity of building each plan on
  the strengths of the child and family
• A belief that as the needs of an individual or
  family become more complex, the interventions,
  services and supports they receive should become
  more individualized
• A continuing effort to develop system responses
  that have the best possible fit with the culture,
  values, preferences and life-situations of the
  consumer

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Wraparound Milwaukee Values . . . . . . .
.continued

• An unconditional commitment to continually
  readjust service design and delivery to find what
  ever it is that will be needed to help this child
  and family have a better life
• A presumption that the most effective supports
  and services are those which are delivered in the
  community
• An understanding that comprehensive plans of care
  for children must be based in the context of
  their families
• An ongoing struggle to create and select service
  options and strategies that increase client
  choice and independence

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Feature of Wraparound Milwaukee that Support
Individualized Care

• Organizational Design
• Collaboration Integration of Child Serving
  Systems
• Pooled Funding and Ability to Shift Monies to
  Meet Changing Consumer Needs
• Creating an Array of Services both Formal
  Informal thru Building a Provider Network

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Wraparound Supported Individualized Care . . . .
continued

• Commitment to Coordinated Care Planning thru a
  Child and Family Team Process
• Building Philosophically and Organizationally the
  ability to Deal with Eventual Crisis
• Evaluating Program thru Creating and Measuring
  Consumer Outcomes

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What is a Public Care Management Organization?

• Administrative entity responsible for
  operationalizing the values of Wraparound and
  creating a structure to deliver services to
  children with serious emotional and mental health
  needs and their families
• Public versus Private Care Management
  Organization
• Control
• Accountability
• Closer to funding sources
• Trust
• Intangibles

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What Does the Care Management Organization Do?

• Human Resource Functions
• Fiscal Management
• Provides or Contracts for Care Coordination
• Information Technology
• Creates and Manages a Provider Network
• Quality Assurance
• Assessment
• Training
• Program Evaluation
• Clinical and Medical Supervision
• Public Relations

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Wraparound Milwaukee Organizational Chart
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Key Child Serving Agencies Contracting With
Wraparound Milwaukee

• Bureau of Milwaukee Child Welfare
• State Administered - Privately Operated
• Milwaukee County Childrens Court
• County Operated Probation Services
• Division of Health Care Financing
• State Agency Operating Medicaid
• Milwaukee County Mental Health Division

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Funding Wraparound
Milwaukee
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Target Population

• How Was the Target Population of Youth Chosen
  for Wraparound Milwaukee?
• Over Utilization of Residential Treatment
• Poor Outcomes
• High Cost Resulting in Expenditure of Tax Levy
  Monies

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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 and

BLOCK GRANT
Care for Chips Children)
Juvenile Corrections Placements

HMO COMMERCIAL INSUR
8.0 M
9.2 M
10.5 M
3.5 M
WRAPAROUND MILWAUKEE
MANAGEMENT SERVICE ORGANIZATION
(MSO)
31.2 M
CARE COORDINATION
PROVIDER NETWORK 240 Providers 85 Services
CHILD
AND FAMILY
TEAM
PLAN
OF
CARE
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Enrollment Costs Without Wraparound Milwaukee
Child Welfare/Juvenile Justice Expenditures for
RTC without Wraparound Milwaukee
Wraparound Milwaukee Enrollments
RTC Rate Increase of 5/year
Enrollment Increase of 5/year
38.9
35.6
32.3
29.2
26.6
24.1
22.0
19.9
18.4
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Impact of Wraparound Program On Utilization Cost
REDUCTION IN EXPENDITURE FOR RTC CARE AVE.
DAIILY CENSUS WITH INITIATION OF WRAPAROUND
MILWAUKEE
338
328
324
273
229
152
MILLIONS
135
105
75
67
JULY OF 1996 WRAPAROUND MILWAUKEE ASSUMES
RESPONSIBILITY FOR RTC POPULATION
AVERAGE DAILY CENSUS IN RTC
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Care Coordination Services

• Meet the Child and Family
• Strength Based Inventory
• Convene Child and Family Team to Develop the
  Wraparound Plan
• Establish Goals
• Identify and Prioritize Needs
• Formal Services From a Provider Network
• Informal Services Within Familys Support System
• Obtain Commitments to Implement Plan
• Evaluate and Modify Plan as Needed

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What is a Child Family Team

• The team of individuals identified by the family
  who will work with them to address their needs.
• The team should be composed of informal and
  formal members who will continue to support the
  family after system involvement.
• The Team should be 50 formal/professionals, 50
  informal/natural supports and meet as frequently
  as needed.

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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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List of Available Servicesin Social / Mental
Health Plan

• Daily Living Skills - Individual
• Daily Living Skills - Group
• Parent Aide
• Child Care
• Housekeeping
• Mentoring
• Tutor
• Life Coach
• Recreation
• After School Programming
• Specialized Camps
• Discretionary Funds
• Supported Work Environment

• Case Management
• Referral Assessment
• Medication Management
• Outpatient
• Individual/Family
• Outpatient - Group
• Outpatient - AODA
• Psychiatric Assessment
• Psychological Evaluation
• Mental Health
• Assessment/Evaluation
• Inpatient Psychiatric
• Nursing Assessment/Management
• Consultation with Other Professionals

• Group Home Care
• Respite
• Respite - Foster Care
• Respite - Residential
• Crisis Bed - RTC
• Crisis Home
• Foster Care
• Treatment Foster Care
• In-Home Treatment (Case Aide)
• Day Treatment
• Residential Treatment
• Transportation

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Mobile Crisis Team

• Available 9 am - 10 pm M-F / 130 - 10 pm Sat
  Sun
• Psychiatric Crisis Line Handles Calls After 10 pm
• Crisis is Defined as a Situation in Which a
  Childs Behaviors Threaten Removal from School,
  Home, etc.
• M.U.T.T. Assesses Situation, Identifies
  Alternative to Hospitalization Makes Referrals
  as Needed
• SERVICES Crisis Intervention Short Term Case
  Management Intensive Case Management - 30
  Days Family Pres. Services - 60 Days Crisis
  Group Home

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Family Advocacy Component Families United of
Milwaukee

• Advocacy
• Support Groups Activities
• Family System Education
• Satisfaction Surveys
• Serve on Committees, Boards, etc.
• Train Care Coordinators
• Crisis Intervention
• Resource Development
• Develop Newsletter, Brochures, Other Info.

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Program Outcomes
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Outcomes - Program

• Average daily Residential Treatment population
  reduced from 375 placements to 55 placements
  (FOCUS Project 10)
• Psychiatric Inpatient Utilization reduced from
  5000 days per year to under 200 days (ave. LOS of
  2.1 days)
• Reduction in Juvenile Correctional Commitments
  from 385 per year to 285

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Outcomes - Financial

• Wraparound Milwaukee average monthly costs is
  4200 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 Active In
2003
Child Behavior Checklist (CBCL), n136 Youth
Self-Report (YSR), N109 Child Adolescent
Functional Assessment Scale (CAFAS), N210.
Reductions are significant at the plt.001 level of
significance using a repeated measures analysis
of variance.
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Increase In School Attendance For Clients Active
In 2003
N 142
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Legal Offense Referrals Adjudications One Year
Prior to Enrollment, During Enrollment, One
Year Following Disenrollment
n 802 Data through 1/31/04
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Specific Offense Types Three Years Prior To
Enrollment Three Years Following Disenrollment
In Wraparound Milwaukee
Other Offenses consist primarily of disorderly
conduct and/or resisting arrest/obstruction of
justice charges
n 490
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