Wraparound Program Aims To Care For Mentally Ill Children At Home

HEALTH 

By Rob Manning

Portland, OR  February 28, 2008 4:02 p.m.

How the state of Oregon cares for mentally ill children is undergoing a revolutionary shift right now. Oregon is charting a course aimed at keeping kids out of institutions and instead caring for them at home.

There they will  be supported by a team of people in what’s being called the Wraparound approach.

In this installment of "On Our Minds," OPB's series on mental health care, Rob Manning reports on what Wraparound means for Oregon kids.

Ezra Farish is eleven years old. He’s a little fidgety, just like a lot of eleven year old boys. He’s got a couple hobbies -- like building with Legos. . .

Ezra Farish: “I also have a drum set, um, I play the drums. I’m working on guitar. I have an electric guitar, Fender. It’s a Stratocaster made by Fender.”

But Ezra Farish also suffers from mental illness. Ezra’s mom Jammie began seeking professional advice before he was three.

Jammie Farish: “He would head-butt himself, you know, take his head and bang on the walls. He would punch or kick a wall, put a hole through it. Even as a seasoned pre-school teacher, the developmentally appropriate practices that I knew, which were quite a few – they didn’t work on him.”

Ezra acknowledges he does some things that aren’t very nice.

Ezra Farish: “Some of the things I said to people, or sometimes I would make a threat, every little while. So....”

Jammie Farish: “There were some times at recess – remember Eliza’s sister. You picked her up and threw her down?”

Ezra Farish: “I did?”

Jammie Farish: “Because you were angry. Yeah, you did. I’m not sure he remembers."

Ezra was diagnosed at age five with Attention Deficit Hyperactivity Disorder and Bipolar Disorder. He was eventually moved from a regular classroom into one for special needs’ kids.

Ezra Farish: “I was so mad that they did that, I couldn’t believe that, that I had to do that now.”

But even worse than that was Ezra's experience in residential treatment at an institution. He recalls a fight he got into with another boy.

Ezra Farish: "And he decided he was going to chase after me, so I went in the opposite direction. He caught up with me and he actually grabbed onto me and tried to strangle me and kill me.”

Jammie Farish: “The police were called and reports were filed.”

Plenty of kids spend time in institutions and never have that kind of  experience. But there’s growing consensus that long-term residential care should be minimized. And that’s where the community-based Wraparound approach comes in.

Janet Walker is an expert on Wraparound at Portland State University.

Janet Walker: “This was something that came out of a totally grassroots, community-based movement that said ‘we want to know what we have to do to get these kids out and keep them in the community.’ And it turns out that it was a lot.”

Wraparound uses community-based teams of family members, therapists, and possibly teachers, to provide the support and services kids need to stay out of institutions.

Ezra and Jammie have a team of volunteers and professionals paid from their private health insurance.

Oregon Governor Ted Kulongoski recently heard a progress report on getting Wraparound services to mentally ill kids on Medicaid and in child welfare.

On Our Minds OPB's series on mental health care in Oregon The health system in Oregon, as in the rest of the United States is in crisis. Costs are skyrocketing, millions of children and adults remain uninsured and even working people are going without health care. Presidential candidates are promising plans that will come to the rescue. Here at OPB, we’re focusing on one aspect of the health care system in Oregon: mental health. Our new series, "On Our Minds," examines who's getting and giving mental health care.

Stacy Allen: “My name is Stacy Allen, I’m 19, I’m half-Hispanic and half-Native American. I’m a young adult who struggled with depression and bipolar tendencies throughout my teenage years.”

Allen also battled drug addiction and dropped out of high school. She says a Wraparound program in the Columbia Gorge saved her.

Stacy Allen: “Currently, I have applied for financial aid through my tribe to get my GED, and plan to go to college and study for drug and alcohol counseling, and graphic arts.”

Stories like Stacy Allen’s are some of the strongest arguments in favor of Wraparound.

Janet Walker, says the research support is “promising”, but not conclusive.

Janet Walker: “You don’t really know if people implemented the program that they said they were going to implement. And then you can’t compare programs across sites because you don’t know what they were doing.

You’ll find few critics of the Wraparound concept of moving kids out of institutions. But the first systemic step – the Children’s Change Initiative – has drawn criticism.

Teachers say they’re not prepared for the intense needs of the children who're showing up in their classrooms.
And institutions have felt the effects of the change as well.

Kim Scott is the executive director at Trillium Family Services, a major mental health provider in the state. He supports Wraparound, but says the Children’s Change Initiative shifted funding in a way that devistated his agency.

Kim Scott: “Last year, Trillium, we combined everything we do, we lost about two million dollars, and that’s with fundraising in. And we had to make the decision to close some of those programs that are the very programs that the state wants to invest in moving forward.”

Wraparound supporter, Janet Walker, calls Trillium’s cuts a “sad irony.” But Walker and Scott disagree over whether Wraparound saves money. Scott says the services are costly. But Walker says a program in Milwaukee, Wisconsin saved money by cutting back on residential care.

Back in the Farish living room, 11 year-old Ezra is digging through a paper bag full of ribbons. He won them competing in horse shows in Portland.

Ezra Farish: “Some of the ribbons, they were running out of ribbons, so they had to use donated ribbons. Like this one, is a third-place ribbon, it says ‘Southern Oregon Horse Activities’. Yeah, it was crazy.”

Jammie Farish: “If he’d won one ribbon ever, I’d have been thrilled, as a parent. But to be able to have an accomplishment, at something you’re good at, and to be rewarded for that, not all our kids get that opportunity.”

Riding horses is part of Ezra’s Wraparound plan. It helps him control his anger, and keep his spirits up. The trainers are informal team members.

But what works for an intact family, like Ezra’s, is harder to implement for other kids.

That’s perhaps the biggest concern of Kim Scott, at Trillium. His non-profit tracked how kids did in a similar program, over three years.

Kim Scott: “We would follow kids into homes, and schools, and communities. It was pretty clear – those services worked wonderfully for kids who had resources and intact families. Child welfare kids – they don’t have the resources, don’t have the intact family – the services just didn’t work.”

But supporters of Wraparound emphasize that the program has worked in foster systems – including kids in Multnomah County. But making it work across Oregon will depend on different state agencies collaborating. That means teachers, social workers, and therapists coordinating Wraparound plans.

Higher up the bureaucracy, complex policies may need amending. And leaders who compete for money, may have to learn to share.

It's early in the transition, but so far, Wraparound advocates have been impressed with the level of cooperation.

Kids like Jessica, who say  Wraparound helped stop a constant revolving door of placements. She gave her thanks to Governor Kulongoski's Wraparound committee by singing at their last meeting.

Jessica singing: “I once was lost, and now, I’m found....”

Online:

Wraparound Oregon  

Our series on the mental health system is produced with help from the people in our Public Insight Network . People in the Public Insight Network are helping us cover the news by sharing their knowledge and experience.   If you'd like to contribute your knowledge, go to our web site - opb.org/publicinsight .
 

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