[ Main Page of Report | Contents of Report ]
In recent years, California has reinvigorated its efforts to preserve and reunify families coming to the attention of its child welfare system through legislative initiatives that enable counties to implement a continuum of services and undertake a number of innovative programs. One of these innovative programs is the use of wraparound services to remove severely emotionally disturbed children from residential placements and reunify them with their families. These cases represent some of the most difficult ones to serve and reunify in the child welfare system, where parents' problems with parenting are exacerbated by children's serious mental health needs. Wraparound services refers to an approach whereby an extensive array of services are individualized and "wrapped around" the family unit to support their strengths and meet all their needs with respect to personal and community safety, education, emotional and physical health, family life, recreation and legal issues. As Santa Clara County was the first county in California to pilot wraparound services for severely disturbed children and has the most established program, it was selected for a visit to examine the program in more detail. This site visit report first gives an overview of California's child welfare system and its efforts to reduce the number of children in foster care, and then highlights Santa Clara County's wraparound program. (1)
California's child welfare system is state supervised and county administered. Counties organize and deliver services, and the state monitors counties' compliance with federal and state legislation and regulations. The state also channels federal and state funding to counties. A county's funding allocation is based on it's caseload size. Funding is capped by the state, and counties must rely on their own revenue once state funding is exhausted. Counties are required to match state dollars to receive their full state allotment Some counties consistently under-match and do not receive their full allotments. Other counties, including Santa Clara, over-match their state allotment.
Over the last decade, like many other states, California experienced an enormous growth in its foster care population. The number of children in foster care doubled over a 10- to 12-year period. At that time, the state was hamstrung in its efforts to stem the flow of children into foster care because no resources were available for in-home services to prevent placement or reunify families. Since that time, California's child welfare system has recommitted itself to ensuring that children remain with their families whenever possible. The state's recommitment to maintaining families has materialized in recent policy changes.
The overall thrust of current child welfare policy in California is to encourage counties to provide strength-based, family-centered, and community-oriented services. Placement prevention is the primary focus, but whenever placement is unavoidable, state statutes require that children be placed in close proximity to their families' homes and within their local school districts. These policies are intended to facilitate family preservation and reunification. At the same time, child safety and permanency considerations continue to substantially influence placement decisions. In practice, the everyday philosophy is to seek the most permanent placement with preference given to relatives if, for safety reasons, the child must be removed from the home.
In order to implement state policies that emphasize prevention and reunification, California has adopted a continuum of care that encompasses four service categories -- Emergency Response, Family Maintenance, Family Reunification, and Permanent Placement. Most county child welfare agencies are organized around these four service categories, and every child in their care falls into one of them. In addition to offering a continuum of care, the state encourages county child welfare agencies to use family conferencing, family group decision-making, and concurrent planning to assist workers in assessing whether reunification is likely and making alternative permanency plans.
In addition to implementing the continuum of care described above, the state has adopted several pieces of legislation that affect specific groups of children in its foster care population. KinGap addresses the 56,000 children in California foster care who are placed with relatives. The purpose of KinGap is to formalize the permanency of those placements by encouraging relative guardianship or adoption. Under KinGap, when relatives assume guardianship, the family exits the child welfare system, and social work visits and court supervision end. However, the family continues to receive a modest subsidized guardianship payment.
In January 1998, California Senate Bill 163 (1997) initiated a 5-year wraparound services pilot that targets youth who are residing, or at risk of being placed, in residential facilities licensed at a Rate Classification Level (RCL) of 12 to 14 -- California's highest level and most expensive out-of-home care. Senate Bill 163 allows counties to use state foster care dollars and Adoption Assistance Program funds to provide the individualized, intensive in-home services that are necessary to keep children in or return them to family settings. Counties may provide wraparound services only after they have met state training and technical assistance requirements. Five counties -- Los Angeles, Sacramento, Humboldt, Alameda, and Santa Clara -- are currently participating in this state program, and another 24 are receiving the required technical assistance and training. In addition to S.B. 163, some counties have implemented wraparound services under California's Title IV-E Child Welfare Waiver Demonstration Project. As required by the Waiver, those counties' wraparound programs are being evaluated by the Child Welfare Research Center, University of California-Berkeley. The Santa Clara County program that is highlighted in this report operates under S.B. 163 only, not Title IV-E, and is therefore not participating in the evaluation.
In order to successfully move children from residential to family care, S.B. 163 made two important changes to service funding. Prior to this legislation, service funding was discontinued after children were reunified with their families. Families faced enormous challenges trying to maintain these children in their homes, given the severity of their mental health needs. S.B. 163 allows service funding to continue after children return home. Furthermore, S.B. 163 provides for the flexible, rather than categorical, use of wraparound funds. This flexibility in the use of funds enables providers to develop and implement wraparound services that meet each individual family's unique needs.
Santa Clara County has adopted the state's continuum of care model and offers emergency response, family maintenance, family reunification, and permanent placement services. Child abuse and neglect reports are initially screened and referred to emergency response. Workers in the emergency response unit are to investigate all referred cases within 3 to 10 days and within 3 hours if the case is critical. A majority of referred families never officially enter the system, and many others receive voluntary services from Family Maintenance. (2)
Most children who are taken into custody enter the system through the county children's shelter. The early intervention unit at the shelter contacts the family and makes an assessment of whether the child can go immediately to the parents' or a relative's home. Children who are not released to a parent or other relative are referred for intake. Dependent intake makes a decision within 48 hours as to whether the child should return home. In about half of the cases, the decision is to return the child to the family. A dependency petition is filed for children who remain in the shelter beyond 48 hours. Many of these children are soon returned home with informal supervision or other voluntary services. Voluntary Family Maintenance workers usually visit these children and families in their homes once a month and refer parents to parenting classes.
Reunification workers are assigned to children who are placed in foster care. They are mandated to visit the child and family once a month and refer parents to services such as drug testing and treatment, counseling, and parenting classes. In addition, case aides may visit the parents' home every 2 weeks and provide a minimal level of service such as transportation. Typically, concurrent planning is used from the beginning of reunification cases. For every case, two plans are developed -- reunification and an alternative permanency plan. Adoption workers may be assigned to these cases if there is no other placement alternative, such as guardianship with a relative.
[Go To Contents]
In accordance with S.B. 163, Santa Clara County's wraparound program is offered exclusively to children who are residing or at risk of being placed in level 12 to 14 residential facilities. Level 12 to 14 residential facilities serve children with severe mental health and behavior disorders. Wraparound is an alternative to residential placement whereby a wide array of services are provided to children and their caretakers in less restrictive community settings -- parents' homes, foster homes, and group homes. Wraparound is a family-centered, strengths-based approach to developing an individualized service plan that allows a child to live in a normalized setting outside of residential care. Ideally this setting is with parents, but if return home is not possible, wraparound may allow a child to function effectively in a foster home or group home. Although wraparound staff initially provide many services themselves, the program's ultimate goal is to build a system of community supports upon which children and their caretakers can rely for the long term.
Currently, the county contracts with two private agencies to deliver wraparound services. A brief history and description of the program model follows.
Santa Clara County was the first and is now the largest provider of wraparound services in the state. In early 1994, prior to the state enabling legislation, Santa Clara County's Social Services Agency, Department of Family and Children's Services (DFCS), and Mental Health Department, Family and Children's Services Division contracted with a private, nonprofit, community agency, Eastfield Ming Quong (EMQ), to provide wraparound services. EMQ's program, UPLIFT (Uniting Partners to Link and Invest in Families of Today), began as a pilot and has since become a permanent service within the local system of care.
Prior to UPLIFT, EMQ was the largest high-level residential treatment center in the county. EMQ became interested in residential treatment alternatives in response to parents' dissatisfaction with the system of care for severely emotionally disturbed children. To address parents' concerns, the agency initiated a nationwide search for promising alternative treatment programs. As a result of its search, EMQ decided to implement a wraparound program based on a model used in the Kaleidoscope (Chicago, Illinois) and Alaska Youth Initiative programs. These two programs had demonstrated success in treating emotionally disturbed children in their homes by providing creative, comprehensive, eclectic, interdisciplinary services that kept children out-of-community treatment facilities.
Lacking funding from the state, the county agreed to finance the project by reallocating county funding from 88 of EMQ's 125 residential slots to wraparound slots. Concomitantly, the private and county agency coalition lobbied the state legislature and administration to enact legislation to shift state foster care dollars to wraparound services.
After EMQ implemented its wraparound program, a residential treatment facility in southern Santa Clara County, Rebekah Children's Services, also sought county funding to provide wraparound services. The county initially funded Rebekah's Compadres program to serve children in foster homes because EMQ was already serving children with biological families. Implementing the program, however, was problematic. Efforts to recruit existing foster families into the Compadres program were largely unsuccessful, primarily because of the level of care that children needed. In addition, many of the children in residential treatment had biological families; hence foster placement was inappropriate for them. Following the enactment of S.B.163, the county expanded Compadres' contract to include the provision of wraparound services to children in their biological parents' homes.
Santa Clara County reimburses wraparound providers at the rate of $5,700 per month for each month that a child receives wraparound services with no limit on the number of months that services may be provided. For children placed out-of-home, the cost of foster or group home care is deducted from the provider's reimbursement. In addition to the monthly reimbursement rate, children receiving wraparound services in their parents' homes remain eligible for MediCal insurance for their medical and dental care. MediCal-eligible children may also receive county-funded mental health services. If other services are needed to maintain a child in a lower level of care, including parents' homes, DFCS and the Mental Health Department will supplement the wraparound reimbursement.
Case managers from the Departments of Family and Children's Services, (DFCS), Mental Health, and Juvenile Probation make referrals for wraparound services. About 50 percent of referrals are from DFCS, 45 percent are from Mental Health, and 5 percent are from Juvenile Probation. The flow of referrals from these departments into wraparound programs is diagrammed in Figure 1.
Wraparound Services Referral Flow
Referrals are submitted by case managers in these three departments to the Resource and Intensive Service Committee (RISC) for review. The team consists of representatives from Juvenile Probation, Mental Health, and DFCS, the four local residential treatment facilities -- including EMQ and Rebekah (the two wraparound program), the regional center for developmentally delayed children, and the child psychiatric hospital. DFCS referrals are primarily made for children who are currently residing in level 12 - 14 group homes but who case managers believe could function effectively in a less restrictive environment with appropriate support services. The team reviews all referrals at a weekly meeting and decides whether the children should be assigned to the wraparound programs or admitted or maintained in a residential facility. In making their decision, team members consider whether there is a parent, foster, or group home available and the child's symptoms and intensity of need. Parents with serious substance abuse problems, families who have adequate support from family and friends, and children who pose a risk to the community are not assigned to wraparound programs. In addition, wraparound providers may refuse a referral if they can't provide the services necessary to help a particular family, such as specialized treatment for sexual perpetrators or children who set fires.
Assignment to one of the two wraparound programs may depend on available slots. Each program has a limited number of slots designated for Juvenile Probation, Mental Health, and DFCS. A DFCS referral is assigned to the program with an open DFCS slot. Although both programs serve all of Santa Clara County, whenever all other considerations are equal, assignment to a program may be determined by geographical factors. For instance, if the referred child's family resides in southern Santa Clara County, they are referred to Compadres because of its proximity.
UPLIFT and Compadres have implemented essentially the same program model and staff structure. Program staff are organized into service units composed of clinical program managers, team facilitators, family specialists, and parent partners. Remarkably, in both programs, the family to staff ratio is approximately 1.3 to 1. UPLIFT serves 149 families with a staff of 115 and Compadres has a staff of 46 and can serve up to 46 families. The unique role of each staff position is as follows:
UPLIFT, the larger of the two programs, has six service units. Each unit consists of 4 facilitators, 12 family specialists, and one parent partner. Service units can serve up to 32 families -- 6 to 8 families per facilitator. In addition to the service teams, UPLIFT employs a staff psychiatrist, a parent partner coordinator, and a community development specialist.
Compadres has two service units. Each unit consists of a clinical program manager, 4 facilitators, and 16 family specialists. Each unit can serve up to 32 children -- 6 to 8 families per facilitator. In addition to the service units, the program also has two parent partners, a substance abuse coordinator, and a behavioral services manager. The behavioral services manager provides staff consultations and implements an occasional behavioral intervention with some children.
Ultimately, the program goal is to enable parents to care for their children without the assistance of wraparound services. Hence, both providers rely first on community resources rather than directly providing or purchasing services. Reliance on community resources requires that program staff develop a thorough knowledge of available resources throughout the county. Compadres builds this knowledge by assigning staff to specific service areas such as education and parks and recreation. UPLIFT's community development specialist compiles information about community resources and disseminates it to the service units.
Family Team. Once a family has been assigned to a service unit, the facilitator organizes a family team. The family team is responsible for planning services and making decisions. Parents are considered the most important members of the team and are the primary decision-makers with regard to developing the service plan -- identifying what their needs are and how they will be addressed. The wraparound philosophy emphasizes a strength-based approach that builds upon families' existing strengths and assets and works to implement the family's vision of a normalized life outside residential care. Professional members of the family team include the facilitator and representatives from each of the agencies working on the case (i.e., DFCS, Mental Health, and Juvenile Probation). Recruitment of "natural supports" to the family team is particularly important because the program expects the family to eventually shift its reliance from program staff to these informal supports. Facilitators consult with the family to develop a list of potential family team members and will approach candidates and ask for their participation. Non-professional team members may include teachers, coaches, pastors, neighbors, friends, former foster parents, and extended family. Because of the demands on the family of caring for an emotionally disturbed child, many parents have severed their social ties with extended family and friends. In these cases, family specialists and parent partners work to reestablish these relationships.
The first family team meeting is held within 30 days of referral. Initially, the team typically meets about once or twice a week. As the case progresses, the team meets less frequently, about twice a month, but may continue to meet more often at the family's request. After developing the initial service plan, the purposes of meetings are to assess progress toward implementing the plan, address issues that have emerged, and revise the plan accordingly.
In addition to the service plan, the family team develops a safety plan for coping with every conceivable crisis -- psychological, educational, and medical -- that may occur in the home, at school, or in the community. If the child's safety is compromised, the DFCS worker, or other professional on the team, may unilaterally decide to remove the child from the home.
DFCS Monitoring. DFCS retains responsibility for the medical, educational, and emotional needs of children that they refer to wraparound programs and provides progress reports to the court. Hence, several mechanisms -- primarily the community and family teams - are in place to assist DFCS with monitoring the status of children in their care.
The wraparound community team is made up of representatives from DFCS, Mental Health, Juvenile Probation, the Office of Education, and the wraparound programs. This team has responsibility for oversight of the wraparound programs and monitoring the agencies' contractual obligations.
The team meets monthly to review progress reports provided by the wraparound facilitator. In addition to reviewing the service plan and family progress, the team approves a proposed itemized budget for services. An official guideline recommends the dollar amount that may be approved for a particular service. Thousands of dollars for services have been approved, but the monthly budget is usually around $500.
DFCS workers assigned to wraparound cases may regularly attend family team meetings. However, the frequency of team meeting attendance is left to individual worker discretion. Some workers meet with the team weekly, and others attend only if there is a crisis. Likewise, the role of the worker on the team also depends on the individual worker. Workers typically view themselves as either team supervisors or collaborators. Those with a supervisory style want to ensure that facilitators are providing the services necessary for the family to succeed and take a more directive approach toward the team. Collaborators also are concerned with adequate service provision but rely more on team deliberation to achieve this goal.
Because each family, and hence their service plan, is unique, providers organize a wide array of services to meet families' needs. A majority of services are sought out in the family's community. In fact, identifying and accessing community services for families is a major function of family specialists. The program prefers relying on community resources rather than directly providing or purchasing services to better ensure that these services will remain in place after wraparound services end. However, services are provided directly by program staff until alternative community resources are in place or the family is functioning without assistance. A brief description of the most commonly provided services follows.
In addition to those already mentioned, Compadres has organized several other supportive services for parents. A parent support group meets monthly to provide a place where parents can share their stories, frustrations, and successes, and link up with other parents. For families who can't attend these evening support group meetings, the parent partners sponsor roaming coffees. The coffees are held at libraries around the county at various times of the week and on Saturday morning. The program has also established a resource center that provides parents with information and access to the Internet.
In keeping with the program's individualized and flexible service model, the length of time services are provided varies depending on the family's needs. The providers consider flexible service timeframes to be crucial to the success of the program. Families in the Compadres' program typically receive services for at least 9 months, but service may continue for several years. On average, families remain in the program for about a year. Families in UPLIFT generally remain in the program for 6 months after the child is returned home and the family is stable, and the average length of service is 16 months.
In consultation with the clinical manager, the family team makes the decision to end wraparound services. Their decision is based on a review of the initial service plan and ongoing progress reports and an assessment of the family supports that are in place in the community and how well that system is working. To denote the end of wraparound services, providers have an informal graduation ceremony to recognize the family's accomplishments and staff contributions to their success.
Aftercare. From the time that services begin, providers inform families that wraparound services are temporary and will be withdrawn gradually. After services are terminated, the program provides minimal support to the family. Facilitators remain available for telephone consultations with families; parent partners continue to provide some support to parents, and the DFCS case typically remains open for another 6 months. Non-professional family team members, however, are encouraged to continue their level of support to the family after wraparound services have ended.
Success rate. Providers estimate that, overall, 80 percent of the children who have received wraparound services from their programs have been successfully returned to a family setting. Of the 274 children discharged from the UPLIFT program between December 1996 and December 1999, 82 percent were living with their parents or other relatives, 2 percent resided with foster parents, and 16 percent were placed in group homes. In contrast, for the period of 1998-1999, only 48 percent of other children discharged from level 12-14 group homes were successfully maintained in their families and communities.
Challenges. Despite their overall success with returning children in high-level residential treatment centers to family care, providers identified several areas that continue to challenge the program. Recruiting, training, and retaining staff is a common problem shared by DFCS and wraparound providers. Staff shortages are the result of the high cost of living in the Silicon Valley region and the inability of the social service sector to offer competitive wages to skilled social workers. Providers report that their front-line workers' pay is comparable to that offered in the fast food industry. Although staff attrition is prevalent in many child welfare agencies, problems generally associated with staff turnover are exacerbated in wraparound programs because the paradigm shift from traditional services requires intensive and ongoing training. Moreover, as a result of staff shortages, the program has been unable to operate at full capacity. The total capacity for both providers is 195 children, but only 170 are currently served.
Wraparound programs rely heavily on community resources to meet families' needs, yet providers reported that the availability of affordable housing, respite care, and foster homes in Santa Clara County is quite limited. Affordable housing is so scarce that one program director, out of exasperation, has suggested that families who need housing be transferred to programs in other counties. Indeed, some families already move out of the agencies' service area to more affordable communities before completing the program. The high cost of housing in the county may also contribute to the shortage of foster homes. Foster homes are generally in short supply.
Ideally, providers would include respite care in every family's service plan because most parents identify it as a primary need. But respite care for birth and foster parents is also very limited. For respite care, Compadres relies on the one residential bed that Rebekah Children's Services provides and to a greater extent on the agency's foster families. When these resources are exhausted, they rely on other agencies that provide emergency and 30-day placements. Occasionally, Compadres' parents volunteer to provide respite for other families.
Given the apparent success of the initial pilot, S.B. 163 was recently amended to broaden the program to include children in group homes. Both Compadres and UPLIFT are planning to expand their programs to accommodate the amendment. At the same time that these programs are expanding, the legislature is considering reauthorization of S.B. 163 in 2003. Although S.B. 163 pilot programs do not have an experimental evaluation component, evaluation of wraparound programs operating under California's IV-E Waiver is underway. It would be desirable for policy decisions regarding wraparound services to be informed by the solid evidence that can be gained through rigorous evaluation.
[Go To Contents]
Public and private agency administrators attribute the success of Santa Clara County's wraparound services in returning children to community settings to five critical elements -- multi-agency collaboration, state enabling legislation, program staff, family-centered decision making, and community-based services.
Early collaboration among the multiple public and private agencies adopting the wraparound model ensured a unified effort and a strong commitment to the program. Once established, the multi-agency coalition was instrumental in both implementing the County's pilot program and initiating the state legislation that provides its funding and extends wraparound services to other counties across the state. Furthermore, through each agency's active participation on the RISC, this multi-agency collaborative decision-making process remains central to the administration of the program.
Several aspects of California's wraparound legislation, S.B. 163, and recent changes in its Medicaid policy have been particularly critical to the program's success. Because S.B. 163 does not specify timeframes within which services must be delivered, intensive in-home services may be provided for as long as necessary to stabilize a family after reunification. In addition to flexible timeframes, the legislation also provides for the flexible use of wraparound funds. That is, rather than funding specific services, the legislation allows programs to use wraparound dollars for whatever services are necessary to meet families' individual needs. The program also benefits from the extension of California's Medicaid program to children receiving wraparound services. The MediCal extension ensures that children who are returned to their parents' homes continue to have access to basic medical and dental services.
Perhaps one of the most important aspects of the County's wraparound program is its 1.3 to 1 family-to-staff ratio that adequate funding has made possible. This low family-to-staff ratio helps to ensure that families receive ample supportive services without overburdening program staff. In addition, having a larger staff allows the program to employ workers with a range of skills that can be deployed according to the family's needs. An adequate number of staff also enables front-line workers to keep flexible schedules so that they can be available at the times that families most need their assistance, including nights and weekends.
According to administrators, another indispensable feature is the program's use of experienced parent partners to provide support services to incoming parents. Because they share similar life experiences, these paraprofessionals are uniquely equipped to engage parents in the wraparound effort and provide professional staff with greater insight into parents' perspectives.
Program administrators repeatedly identified family-centered decision-making and community-based services as critical factors in successfully returning children to family settings. Family-centered decision-making requires professionals to not only take the family's perspectives into consideration but to actually let the family identify problems and propose remedies for themselves. Although family-centered decision-making is central to wraparound philosophy, in practice, it may be one of the most difficult aspects of the program to implement. This difficulty arises partly because the philosophy is a departure from traditional decision-making processes that rely almost exclusively on professionals. The family-centered approach to problem solving necessitates that professionals accept a certain degree of risk in relinquishing complete control over the decision-making process. To some extent, professionals have had trouble accepting the idea that, in terms of the families' needs, expertise resides with the family. For many, especially more seasoned professionals, this practice reorientation has required extensive and ongoing training.
A major advantage of flexible service timeframes is that it allows family functioning to guide decisions regarding the duration of services. But despite flexible timeframes, wraparound services do eventually end. To maintain ongoing supportive services for the family, it is essential that the program rely on community-based services and informal supports (e.g., extended family, friends, neighbors, community recreation centers). Reliance on community resources, however, requires a substantial commitment of staff time to building their knowledge of resources, developing relationships with community service providers, and actively linking families to community agencies. Furthermore, staff must develop skills to effectively interact with members of the family's informal and formal support systems and devote time to engaging these people in providing support to the family.
Furthermore, the program's reliance on community resources may make its success partially dependent on whether a range of services actually exists in the community. In Santa Clara County, primary wraparound services -- in-home family support, 24-hour access to wraparound staff, and limited financial assistance -- are provided directly by the program. A second tier of supportive services -- parent support groups and youth mentoring -- is offered by paraprofessionals. The most commonly used community resources include mental health agencies, community schools, and youth centers. Provision of this mix of services has assisted many children to reunify with their biological families or live with a foster family. Statistics provided by the DCFS indicate that of the 268 children served by wraparound services between January 1994 and January 2000, 84 percent (225) were maintained successfully within their families and communities. Wraparound services allow children who would otherwise stay in residential care until they age out of the child welfare system to return to their homes and communities and re-establish a more normal life outside of an institutional setting.
1. The program was visited in October 2000.
2. In October 2000, there were 4,398 dependent children in Santa Clara County's Department of Family and Children's Services care. The racial makeup of this population of children was 50% Hispanic, 27% white, non-Hispanic, 12% Black, and 11% other. One hundred seven of these children were in RCL 12-14 group homes.
Top of Page | Contents
Main Page of Report | Contents of Report
Human Services Policy (HSP)
Assistant Secretary for Planning and Evaluation (ASPE)
U.S. Department of Health and Human Services (HHS)