Psychiatry Online published an article on the success of Wraparound programs in helping troubled youth. They offer an interesting perspective on the role of a Psychiatrist collaborating with the wraparound team. The article also highlights an opportunity for the Psychiatrist to work more closely with the wraparound team for better outcomes.
For anyone unfamiliar with the term, “Wraparound” has been described as a philosophy, an approach, and a service. In recent years, Wraparound has been most commonly conceived of as an intensive, individualized care planning and management process. Our Wraparound plans are more holistic than traditional care plans in that they are designed to meet the identified needs of caregivers and siblings and to address a range of life areas. Wraparound has the advantage of keeping the youth in their home and community as much as possible to reinforce their existing support structure.
Below are some selected highlights from the article.
Posted by: Psychiatry Online
Wraparound Programs Succeed in Helping Troubled Youth
“Visiting a child's school can be especially helpful,” Bow said, as many of the parents she deals with seldom visit the school or get feedback from teachers on their child's behavior.
She believes it is important to give parents choices about their child's treatment, a key part of the Wraparound philosophy. For example, if they want their child to get off medication, she may tell them to go ahead and contact her in a week to let her know how the child is doing. Then she follows up with the teacher to see if the child is acting up or has skipped school.
Bow will not start a child on medication without a report from the school, which she feels is critical. Her staff has a detailed protocol describing when medication is needed or should be discontinued.
She believes the key to a successful Wraparound program is to have everyone involved with it talk about each case and coordinate their efforts.“ That has worked out really well,” she said.
Jeanette Scheid M.D., Ph.D., an assistant professor of psychiatry at Michigan State University, agrees. She has been a contractual psychiatric consultant for several Wraparound programs in Michigan.
“When Wraparound is done with fidelity to the model, it is a really good way to approach working with kids and families,” she told Psychiatric News.
She maintained that the best work gets done when each member takes responsibility for what he or she is supposed to do, and group members hold themselves accountable for the results. When team members are not in sync in terms of seeing to the needs and strengths of the child and family, then the process doesn't work optimally.
She noted that one problem that may hinder this teamwork goal is the way in which some team members may view the psychiatrist involved. “I do think that there is a general bent within the world of nonpsychiatrist mental health providers to view what the doc does as medical and therefore separate from any of the work that they are doing together with the kid, family, and team,” she said. Many people feel that psychiatrists are only interested in seeing the case from a narrow viewpoint, that is, focusing on psychiatric symptoms and medication management, and are not interested in working with the team and seeing the child and family from a more inclusive point of view.
Unfortunately, this view of psychiatrists, along with some of the difficulties of providing mental health care in the 21st century, “can get in the way of collaborative care,” she said.
No two families are alike, and Victor believes in tailoring services to meet each family's individual and unique needs. We encourage collaboration and teamwork in everything that we do. The more that therapists, clinicians, teachers and medical professionals work together on cases, the better the outcomes will be.
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