I have been working in a Wraparound program for nearly seven months. The program consists of a few different facets, several different powers that be and each case goes through a very intricate process reaching into every corner of each case, leaving no stone un-turned. Typically, a referral is received from the county Department of Mental Health, filtered down to them from the Department of Children and Family Services or the Probation Department for juveniles. Once a referral is received, it is assigned to a wrap team and a therapist. The wrap team usually consists of three individuals: a facilitator, a parent partner, and a child family specialist. The facilitator is the overall supervisor of the team and conducts weekly meetings with the family to address needs, improvements, and to monitor the overall progress of the case. The parent partner provides support to the parents of the client and coaches them through parenting skills, connects them to classes and resources, and assists them in dealing with their child. They also provide support in parental needs such as finding jobs, finding financial resources, and taking care of themselves medically and otherwise. The child family specialist acts a mentor to the client, engaging them in positive exchanges and provides support and guidance through every day trials and tribulations, as well as larger difficulties. The therapist, a separate entity from the team, collaborates with them as they provide specialized mental health services to the client. The therapist is also considered the SFPR, or the single fixed point of responsibility, managing the treatment approach of the client and the family. If necessary, following an assessment, a Therapeutic Behavior Specialist coach may come on to provide strictly behavioral therapy to address the client’s maladaptive behaviors.
Unlike most therapeutic services, the wrap team and the mental health team provide services within the community, either in the client’s home, in the school, or out and about in the neighborhoods. There is no laboratory, no sterile clinical office; free will is unbridled, and with the help of the therapist, the client must learn to operate in their natural environments. And, unique from the clinic approach of treatment, given that so many of their problems stem from that environment, the wrap team addresses root causes such as family dysfunction, negative influences in the community, and other environmental factors that may impede treatment. Drawing from Maslow’s Hierarchy of Needs, if the family is lower SES (all are in the service provider area we cover), and the family’s basic needs of food and shelter are not met, the team is able to request flex funds to cover necessary bills (electricity, water, food). Helping the family meet the basic needs will ultimately help the family ascend to the next block on the pyramid by reducing the strain on the family unit and allowing them to focus on treatment. We can also use funds to connect the kids to clubs or activities to keep them out of trouble, such as organized sports, classes, and social events. We’ve even sent families out to a nice dinner who couldn’t typically afford it so they might spend quality time together and foster stronger relational ties.
Given the pitfalls of group homes and treatment facilities I had addressed in my earlier blog, it would seem that this approach is damn near infallible, impenetrable, and practically perfect in every way (yes, if Miss Mary Poppins were an LMFT, this would be her approach). But alas, nothing is perfect, and multi-systemic therapy has it’s short-comings as well. First off, nearly all referrals given to the agency are court-ordered services, either by DCFS or Probation court. Unfortunately we are a voluntary service, which means we cannot force clients or their families to participate, and with most court-ordered clients, resistance is inevitable. Many times we track families like the English on a fox hunt, making several calls, surprise visits at the home, and mailing letters, to no avail. Our only defense is to inform the families that a report will be made to the social worker or the PO and we close out. Whatever comes later will come, but it no longer concerns us. Other times, we have the half-assed participants, people who agree to meet, but don’t necessary complete any interventions, follow up on any recommendations, or follow through with any expectations. Or, once in a great while, we have families who take advantage of every service offered in hopes of helping their child. And we get every type in between. Every case is unique in their circumstances.
As previously mentioned, all of our families are struggling financially, and we provide assistance to basic utilities and bills, as well as clothing and food for the client and their siblings, and word travels fast. Most families come to that question “what can you guys do about my bills?” or “what else can you help me with, like with money?” It’s quite easy to take advantage of this aspect of services and it’s a lifestyle most kids are adapting to in planning their futures, seeking out government assistance rather than pursing goals and ambitions.
Wraparound services are not for the meek or faint of heart. Children who generally qualify for wraparound are not simple cases of mild depression or disobedience. Most cases have heightened severity, some to a degree most clinicians will never be faced with in the length of their careers. Referrals and case histories are littered with tales of woe and horror above and beyond basic cases of neglect and abuse, sadness and despair. I have had to begin my own personal therapy to cope with the cases I take in, and it’s a wonder therapists can survive in such a field, let alone thrive. My future in this career is well armored with a harrowing experience in the trenches that has prepared me for any feat I will face in the years to come.
Another factor of wraparound is safety. Leaving the confines of a protected and public clinic, we clinicians venture out into the concrete jungles of projects, ghettos, and crime infested cities. It is not uncommon to see gang members patrolling their territory, crack heads pan-handling for their next hit, expansive homeless camps of tents, used rugs and curtains, towels and sleeping bags, and police. Violence is not in short supply in the hood. During one session where I was playing baseball with a client in the grass area of a project, I observed an individual across the street, stepping out of his apartment, stuffing two nickel plated 9 millimeter guns into the waistband of his boxers. I quickly decided it was time to go inside. We are constantly faced with balancing personal safety with obligation to our clients. Sometimes our obligations leave us no choice. Much to my clinical supervisor’s apprehension, I transported a client in my car who had a green light on him (meaning he was marked by a gang to be killed) because I couldn’t bear the guilt if something had happened to him walking home after I left him on a distant but safer street corner. Sometimes we go into the community because we know we need to. Other times we have had to suspend services because safety concerns prevented us from visiting that area or that family.
The most difficult aspect of wraparound is the intimacy of the service. In stark contrast to clinic-based services where you see a client (and maybe the parent, if it’s a child) for one hour a week on a couch, in wraparound you are immersed in the home and the lives of the client and their family. You go beyond the one dimension perspective you develop in the office and see their entire world and every thing it in. You can’t help but become attached to the family, and when they struggle, you struggle. When they hurt, you hurt. When they experience a loss, you lose. One family (not mine) lost their teenage son to gang violence. Though the son was just the sibling of a client and not receiving direct services, the loss was overwhelming for the treatment team on the case. One of my families was left battered by fate who dealt them one devastating blow after another, and the team felt every impact with them. You return home feeling worn and emotionally bruised.
So why when an approach seems so riddled with complications would one continue? Because even though we have some families resistant to services, we have others just begging for help and willing to do whatever it takes to help their children and rebuild their homes. Because even though we have families who take advantage of good intentions, we have some families who only ask for financial help when they truly need it, and who are generally hard working people just struggling in a recession. Because even though we worry for our safety, someone has to go to the battlefield to save the fallen, otherwise they’ll never be able to crawl out to save their own skins. Because if we can survive this, we can survive anything. And because as clinicians, it is our jobs to, at times, disregard what was drilled into our skulls about cold and calculated professional conduct, cross the boundaries, and just share the pain and suffering with our clients. Because, in spite of flaws beyond the model’s control, wraparound is the best answer and probably the only answer we have.
At times, I don’t know how to continue with my job. At times, I go home and break down crying and rip the heads of my loved ones off for no good reason. At times, I admittedly just want to come home, crawl under the covers of my bed and never come back out. At times, I can’t wait to go to work because I love my co-workers and they support me and make me laugh when I need to get through it. At times, I can’t wait to see my kids. At times, I get to take my kids to the park or the beach and I love being out in the fresh air. At times, I see a genuine smile on my kid’s face, or hear genuine laughter, and I know this is where I need to be right now. Maybe not forever, but right now, in this moment, with the ups, downs, and way below downs, it’s what’s right.
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