The landscape of child mental health services is diverse, with various approaches designed to meet the unique needs of young individuals and their families. Two terms frequently encountered are “wraparound programs” and “person-centered care.” While related and often used in conjunction, understanding their nuances is crucial for families seeking the best support for their children. This article clarifies how wraparound programs, such as the Child Mental Health Wraparound (CMHW) offered through Indiana Medicaid, embody and expand upon the principles of person-centered care.
Person-Centered Care: Focusing on the Individual
Person-centered care is a philosophy of healthcare that prioritizes the individual’s unique needs, preferences, and values. It moves away from a standardized, one-size-fits-all approach and instead places the person at the heart of the care planning process. Key elements of person-centered care include:
- Respect for Autonomy: Recognizing the individual’s right to make choices and participate actively in decisions about their care.
- Strengths-Based Approach: Focusing on the individual’s strengths and resources rather than solely on their deficits or problems.
- Holistic Perspective: Considering all aspects of a person’s life – physical, emotional, social, and cultural – when developing a care plan.
- Collaborative Partnership: Fostering a partnership between the individual, their family (when appropriate), and healthcare providers.
- Individualized Care Planning: Developing a treatment plan that is tailored to the specific needs and goals of the individual.
Wraparound Programs: Implementing Person-Centered Care in a System of Support
Wraparound programs, like the Indiana Medicaid CMHW, are not a separate entity from person-centered care but rather a structured and intensive way to deliver it, particularly for children and youth with complex needs. Wraparound is a team-based, collaborative process designed to create a comprehensive, individualized plan of care. It “wraps around” the child and family with a network of support, drawing upon various services and resources to meet their needs in a holistic and coordinated manner.
Here’s how wraparound programs build upon person-centered care:
- Intensified Person-Centered Approach: Wraparound takes person-centered care principles and intensifies them through a structured team approach. The CMHW program, for example, explicitly states that “a person-centered treatment plan is built upon the member and family’s strengths.”
- Formalized Collaboration: Wraparound formalizes the collaborative partnership by creating a team that typically includes the child, family members, care coordinators, therapists, school personnel, and other relevant individuals. This team works together to develop, implement, and monitor the plan.
- Comprehensive Needs Assessment: Wraparound programs conduct thorough assessments that go beyond just the child’s mental health diagnosis. They examine the family’s strengths and needs, community resources, and any other factors impacting the child’s well-being. The CMHW program highlights identifying “the unique needs of the CMHW member” and “services and strategies that assist the member and family.”
- Community-Based Services: Wraparound emphasizes providing services in the least restrictive setting possible, typically within the child’s home and community. This aligns with person-centered care’s focus on the individual’s natural environment and support systems. CMHW is specifically defined as “home and community-based services (HCBS).”
- Flexible and Adaptive Planning: Wraparound plans are not static; they are regularly reviewed and adjusted based on the child and family’s changing needs and progress. This dynamic approach ensures the care remains person-centered over time.
Eligibility for Child Mental Health Wraparound (CMHW) in Indiana
To access CMHW services through Indiana Medicaid, youth between the ages of 6 and 17 must meet specific eligibility criteria, reflecting the program’s focus on serving those with significant needs. These requirements include:
- Age and Medicaid Eligibility: Be between 6 and 17 years old and eligible for Indiana Medicaid.
- Mental Health Diagnosis: Have at least two diagnoses from the Diagnostic and Statistical Manual of Mental Disorders (DSM), excluding certain primary diagnoses like substance use disorder, pervasive developmental disorder, ADHD, or intellectual disability.
- Demonstrated Need: Score a 4 or higher on a DMHA-approved assessment tool and exhibit behavioral or emotional needs such as trauma adjustment, psychosis, debilitating anxiety, conduct problems, sexual aggression, or fire-setting.
- Family/Caregiver Need: Demonstrate significant need in at least one family or caregiver area (mental health, supervision, stress, substance abuse) that negatively impacts the child’s mental health.
It’s important to note that CMHW is not suitable for youth who pose an imminent risk of harm to themselves or others or those requiring institutional care.
Conclusion: Wraparound as Person-Centered Care in Action
In conclusion, wraparound programs are not distinct from person-centered care but are a robust and structured application of its principles, particularly beneficial for children and youth with complex mental health needs. Programs like Indiana Medicaid’s CMHW demonstrate how wraparound provides an intensified, formalized, and community-based approach to person-centered care, ensuring that services are tailored to the unique strengths and needs of each child and family. Understanding this relationship is essential for families navigating the mental health system and seeking effective, individualized support for their children.
