Tuesday, May 12, 2009

Is half a "Wrap" better than none?

We will be chatting with Jack Simon tomorrow about the Rosie D. implementation, and I am certain that many issues will be raised.  One, however, was raised today in an e-mail, and I wanted to reflect on it a bit.  One of our colleagues, who cannot be at tomorrow's meeting, wrote:

As usual, I can’t attend – I’ll be at [away]...  but I want to make a couple of comments, just in case you might find them useful. ... I’ve been going to a lot of meetings about the CBHI.  In that process I’ve learned there really won’t be true wraparound services – not a full wrap program.  And as of a couple of weeks ago, the state still hadn’t completed negotiations with the feds about what services will be supported by Medicaid.  I believe that’s still up in the air.  The CBHI folks I’ve met with are optimistic, but it’s not a done deal.  As I understand it, the agreement with the plaintiffs is that the state won’t have to provide any service that isn’t covered by Medicaid.

My instant reply was "Isn't half a wrap better than none?"  (I considered "A half-wrap in hand is worth two in the bush", but it didn't flow).  Our colleague is correct:  what we have been authorized to do so far is to provide Intensive Care Coordination.   Family Partners and Mobile Crisis Services,  Behavior Management and Therapeutic Mentoring; In-Home Therapy; and Crisis Stabilization have not yet been approved as services by CMS, and can't really start until they have been.  So, how does an agency plan to implement these services without that approval?  And what does that do to the effectiveness of the wraparound model of care?

I think that the short answer is "We don't know".  The effectiveness of the model is not well established despite it's popularity.  In a recent article in the Journal of Behavioral Health Services and Research, Bruns, Sutor and Leverantz-Brady wrote:

"The wraparound research base is still “on the weak side” with respect to utilization of rigorous designs. Nonetheless, results of evaluation studies, success stories from individual communities, and clear popularity with communities and families have led to wraparound’s inclusion in two Surgeon General’s reports, and the discussion in the research literature of its integration with evidence-based practices."

Popularity with families and communities is the key to the political success of this program and the key to that success is the relationships built between the treatment team and the family.  So, as long as the program has the ICC situated to build those relationships, than I really do believe that half a wrap is better than none.  Way better.

FEEDJIT Live Traffic Map