2019Year End Report

Wraparound Milwaukee System of Care

2019 Wraparound Milwaukee System of Care Year End Report i Wraparound Milwaukee Vision, Mission A Leader of Change and Values in Action

Vision To help build healthy and strong communities by enhancing children and families’ ability to meet life’s challenges and to foster resiliency and hope for a better future.

Mission 1. To serve each youth and family with respect and dignity acknowledging their strengths, needs, and preferences. 2. To partner with the agencies that work with families to create one plan for a better life. 3. To support youth and their families to remain safely in their homes and communities. 4. To provide quality care that is culturally responsive to the diverse needs of the families we serve. 5. To provide leadership in creating lasting resources for families in their communities.

Values in Action Wraparound Milwaukee’s history and practice is driven by a steadfast commitment to core values. When questions arise, problems occur, and decisions need to be made, going back to these core values helps guide how Wraparound Milwaukee Wraparound Milwaukee was established in 1994 Wraparound uses a mix of local, state and federal funds responds. In addition, each of these values represent set of practices that have proven to be the most effective in promoting as part of a six-year, $15 million federal grant from the that are pooled to create a flexible source of funding to meaningful and sustainable success for Wraparound Milwaukee’s most important clients — the children and families. U.S. Department of Health and Human Services’ Center for best meet the needs of children, youth, and their families. Wraparound Milwaukee System of Care: Mental Health Services. Milwaukee County was one of 10 The primary sources of funding for Wraparound are the sites around the country to receive grant funding. Wisconsin Department of Children and Families, the Division of Milwaukee Child Protective Services, and the Never gives up — Is Family Centered/Youth Guided Since it was first established, Wraparound Milwaukee has Milwaukee County Division of Youth and Family Services. providing unconditional care significantly improved outcomes among the over 12,000 children and adolescents it has served. Its target population Wraparound Milwaukee continues to serve as a resource is children, youth, and young adults who are residents to mental health professionals around the world on of Milwaukee County and have complex emotional, issues of operating a successful system of care program, Builds collaborative behavioral, and mental health needs. Wraparound provides responding to countless requests for information, and partnerships and breaks Builds on Strengths a strength-based, individualized approach to working with presenting at multiple conferences and forums annually. down system barriers children and youth and their families. Participants receive These and other opportunities serve both as recognition Wraparound flexible, comprehensive, family-focused care. Services are of the accomplishments of Wraparound Milwaukee as coordinated through a team of formal (professional) and well as a chance for other sites to take the lessons learned Milwaukee informal (including the youth and family) supports that from Milwaukee and apply them to their own program Identifies and addresses plan and create the most effective continuum of services development. the most critical needs designed to support the child or youth in a safe and Applying the Wraparound philosophy, Wraparound Is community-based and integrated way in the community. Milwaukee continues to grow, adding new and innovative is strategically financed Nationally recognized as a model program, Wraparound programs and approaches to service delivery in response to Milwaukee is administered by Milwaukee County’s community needs. Values cultural diversity and family norms Behavioral Health Division, which contracts with over For more information go to: http://Wraparoundmke.com 120 organizational partners that provide direct services.

1 2019 Wraparound Milwaukee System of Care Year End Report 2019 Wraparound Milwaukee System of Care Year End Report 2 Executive Summary Success A Letter From The Director Stories

Dear Friends,

It is 2020, as I write this narrative for 2019 and reflect upon the previous year. My heart and mind compel me to focus the essence of this letter on racial equity and the inclusion of social determinants of health in the work that we do. In 2019, Milwaukee County Executive, Chris Abele, declared racism a public health crisis which provided us with further impetus to begin our work in earnest in playing a more deliberate and focused role in changing the health indicators for our youth and families. Leia is a smart and ambitious 18-year-old woman who The Johnson family is a dynamic and complex The purpose and design of the Annual Report is to provide to the community a Brian McBride, Director loves surrounding herself with others. Leia spent most machine that consists of three very strong-willed and glimpse of the characteristics of the children, youth, families served, program of her life in the system (with WRAP involvement since unique females, two sisters and a guardian. Bonnie outcomes, major achievements, and changes during the year. In the following the age of 10), which empowered her to advocate for is the adoptive guardian, who is the head of the pages of this report, you will find our yearly data. While this report reflects Milwaukee County and the Children’s herself and protect the ones she loves. The challenges household and does so on her own. She creates a safe Community Mental Health Service and Wraparound Milwaukee data, there are many other cities throughout this that Leia faced growing up were not easy. Moving from environment for both girls to grow into independent country that struggle with the overwhelming needs of their respective communities, very similar to ours and are one placement to another, being sent out of state and women. Dinah has been enrolled in the Wraparound challenged by analogous demographic and outcome data. By focusing on social determinants of health and leading having to deal with different people coming in and out REACH program for the past couple of years. She has with our Wraparound values and strengths, Milwaukee County will become the healthiest county in Wisconsin. of her life for 18 years, made her resilient. Her extensive faced a lot of adversity in her young life and had trauma history and challenges she faced, made her often resorted to running away or self-harming Recent years and grant awards have afforded us the opportunity to expand and develop specialized programs stronger as a person. to escape the stressors of everyday life. Dinah has to extend the continuum of care under the Wraparound umbrella. Work we’ve started began with collectively Leia learned to become an advocate for herself and made progressive strides moving forward to find developing a purpose statement: to partner with families and communities to join collective expertise and was not embarrassed by her mental health and healthy coping mechanisms to help work through resilience to strengthen individuals, homes, and neighborhoods. We feel it encompasses our past and vision for embraced who she is. She learned to utilize her team her big emotions. She has a team that consists of the future and is aligned with Milwaukee County’s vision. for support to help her through challenges. As time five individuals that each offer her different types of More work will continue toward achieving racial equity. IT MUST CONTINUE. The partnerships we’ve made went on, the team was able to help Leia find family support. Dinah has made her own unique connections and relationships with each team member, allowing throughout the years is invaluable and I thank every person who has positively impacted the lives of children members such as her aunt, whom she can trust to her to learn about herself and what support best and families in our community. The journey we are on together is important and I look forward to taking it with help her through her issues and frustrations. The team fits her. The family has also been strengthened all of you. was able to finally place Leia with her aunt and they continue to do well. through this process, understanding that each of their individual strengths contributes to the strength Leia will now be graduating from high school and is of the family. looking forward to attending college. Leia has learned n to accept her challenges, learned to surround herself with a strong support system and has found her voice. Leia’s spirit animal is the panda bear, who is a jovial and peaceful creature. n Read another success story on page 18.

3 2019 Wraparound Milwaukee System of Care Year End Report 2019 Wraparound Milwaukee System of Care Year End Report 4 Serves a Diverse Group of Children and Families

YOUTH SERVED GRADE DISTRIBUTION ETHNICITY OF YOUTH SERVED Graduated College 1% 0.3% 0.3% Average Daily Total Youth High School 1% 4% Program Enrollments (incl: GED, Census Served 14% HSED) n African American 6% Pre-kindergarten n Caucasian Wraparound/ –Grade 5 694 1,132 n Hispanic/Latino REACH/O-YEAH 19% n Bi-Racial n Asian n Native American Comprehensive 2,172 14% Community 224 224 Grades 9–12 Grades 6–8 67% n Other/Unknown Services 49% 19+25+49+6+1+A 25% 66+13+4+2+1+A Wraparound/REACH/CCS/O-YEAH serves youth across all Wraparound Milwaukee Leads the Way grades pre-k through college. DISENROLLMENTS Gender, Age, and Ethnicity Five-year Strategic Plan With an eye toward evolution in best practice, and commitment by Wraparound HIGHEST PREVALENCE The children and youth served to growth, the Children’s Community Services and Wraparound Milwaukee come from diverse backgrounds. The economic, Wraparound OF WRAPAROUND YOUTH Milwaukee embarked upon the process of creating a 5-year 296 experiential, and ethnic diversity of the children and families BY ZIP CODE strategic plan. Recent years brought about incredible expansion served require Wraparound and its partners to effectively 53225 and specialized program development that allowed us to extend operate culturally competent, flexible programs and services REACH 268 Milwaukee Far the continuum of care under the Wraparound umbrella; the next to meet the needs of participants. This results in a highly North West Side 53218 step in an iterative process was to assess the near and distant innovative and adaptable approach to working successfully Milwaukee Center future, and collectively wrestle with the complex questions with children with exceptional challenges. The gender and O-YEAH 77 around “how did we come to be, who are we, and who will we racial distribution have been relatively stable across time. become?” while managing the balance of growth and fidelity. 53209 Comprehensive Through a series of think-tank sessions, soul searching, and 80 Glendale/ Community Services 36 GENDER Brown Deer tough conversations, we collectively concluded that our 51 78 purpose is “to partner with families and communities to join Wraparound/ collective expertise and resilience to strengthen individuals, REACH/O-YEAH 56 homes, and neighborhoods”; a purpose we feel honors our AVERAGE AGE 58 history and intentionally cultivates our path toward the future. The six initiatives we have prioritized to move us toward a Female 34% 52 future state include: 1) Positioning ourselves as thought and Wraparound 53206 practice leaders in integrative and holistic care. 2) To be leaders 12.4 Male 66% Milwaukee in the sustainable development of a dynamic and sophisticated Center REACH workforce. 3) To influence state and local policy in favor of 14.8 68 serving children and families in their homes and communities. Comprehensive 34+66+A 4) To be a national leader in progressive community-based Comprehensive Community care across the lifespan. 5) To expand fiscal streams to allow Community Services 15.4 Services for greater flexibility in program development. 6) Be inclusive 53216 and equitable practice leaders for those who serve and those served. Each of these high level initiatives are broken down into Female 32% Milwaukee Center 53208 53215 respective goals, benchmarks and active efforts toward timely O-YEAH 20.6 Milwaukee Central/West and collaborative achievement over the next 5 years. 32+68+A Male 68% Center Milwaukee 5 2019 Wraparound Milwaukee System of Care Year End Report 2019 Wraparound Milwaukee System of Care Year End Report 6 Addresses Complex Issues

Presenting Behavioral Health WRAPAROUND TOP CONCERNS OF O-YEAH YOUTH Diagnoses and Concerns of ON COURT ORDERS Children/Youth School Concerns 80% Mental Illness in Family Our children and youth have an array of mental Wraparound 72% health concerns that translate into one or more diagnoses. REACH 44.1% Severe Aggression 68% These complex needs coupled with potential challenges in 4.6% the home, school and community highlights the imperative Significant Losses 65% for a cross-system’s approach to care. Efforts on behalf the Sleep Concerns/Nightmares 58% child & family are always done in concert with the family who is leading the way. Bullied by Peers 56% Not on Court Orders Suicidality 52% 44 51.3% +51+5+A Alcohol & Drug Abuse in Household 51% YOUTH OFTEN PRESENT A CONSTELLATION OF CONCERNS PREVALENCE OF DIAGNOSES THAT CROSS HOME, SCHOOL & COMMUNITY Wraparound/REACH Diagnosis Wraparound REACH O-YEAH CCS School Concerns 95% ADHD 155 258 32 83 Severe Aggression 91% Conduct Disorder 118 75 18 – Attention 85% Anxiety Disorder 94 159 34 57 Feelings of Sadness 81% Depressive Disorder 81 108 38 48 Bullying/Peer Interactions 76% Mood Disorder 61 130 19 51 Significant Losses 76% Thought Disorder – – – 84 Sleep Concerns/Nightmares 71%

Comprehensive Community Services Wraparound Milwaukee Leads the Way School Concerns 75% Community Outreach Feelings of Sadness 68% During 2019, there were a total of 144 outreach activities/opportunities, including 46 Community-wide Resource Fairs, Severe Aggression 67% 29 presentations (Aurora, Rogers, and Columbia St. Mary’s Hospitals, Sojourner Family Peace Center, & the West Allis Health Department), 5 specific trainings, entitled “Recognizing and Responding to Psychosis” to the Milwaukee Fire Department Attention 66% Community Paramedics, Carmen H.S. Social workers, & to Community Health Workers. Additionally, there were 49 distinct locations in which brochures were distributed to physician offices, dental providers, and pharmacies. Significant Loss 61% It feels like Everyone’s The struggle I’m struggling saying get is real. The largest and most visible initiative has been Serious Mental Illness (SMI) Campaign in alone. over it.

Let’s change We can So is the that starting help make hope. Bullying/Peer Interactions 60% which signage raising awareness to mental health concerns, targeting young adults 18-23, today. it better.

Behavioral Behavioral Behavioral Health Health Health BHD Division BHD Division BHD Division For a partner, A Division of the Department of For a partner, A Division of the Department of For a partner, A Division of the Department of call (414) 257-7607. Health & Human Services call (414) 257-7607. Health & Human Services call (414) 257-7607. Health & Human Services were displayed on the sides of buses and inside bus shelters from October to March 2019. WRAPAROUND WRAPAROUND WRAPAROUND Sleep Concerns/Nightmares 58% MILWAUKEE MILWAUKEE MILWAUKEE Brochures in both English and Spanish can be found on the Wraparound website: http://wraparoundmke.com

7 2019 Wraparound Milwaukee System of Care Year End Report 2019 Wraparound Milwaukee System of Care Year End Report 8 Ensures Voice and Choice Collaborative and Builds on Family Strengths and Community-Based

Recognized as a national leader in wraparound programming, Wraparound Milwaukee has developed SERVICES USED IN 2019 an extensive network of organizations that provide a comprehensive, flexible array of services to the children, Top 5 in youth, and families enrolled in the program. Services vary by Wraparound/REACH/O-YEAH the needs of the child or youth, and the provider network is designed to ensure services can be highly individualized and Crisis Stabilization 65% targeted to address particular specified needs or goals in a In-Home Therapy 49% child’s life. Community-based services are provided through, on average, 110 organizations in Wraparound’s provider Transportation 44% network (WPN), representing approximately 106 different Individual/Family Therapy 37% types of services. Many of the agencies provide multiple services. Fourteen new vendors and 4 new services were Youth Support Services 19% added as follows: • Home-Based Behavioral Management Aide Top 3 in Comprehensive • Nutrition-Dietary Management Services Community Services (CCS) • Certified Parent Peer Specialist Psychotherapy 79% • Community Improvement & Job Training Children and their families will typically utilize three or four Individual Skill Development 70% different services during enrollment in Wraparound. Other Peer Support 31% than care coordination, the services most frequently used in 2019 were crisis prevention and stabilization, therapy (in-home and office-based), and youth supports. 40% Additionally, Wraparound provided 63 “out of network” of Youth/Families Accessed services in order to ensure that the unique needs of the Flexible/Discretionary Funds A critical element of Wraparound is that care Family Satisfaction Matters to child/family would be met. planning and services are coordinated to address multiple Wraparound In 2019, Wraparound Milwaukee provided over $45 million issues facing families, as well as the enrolled youth. Despite to support these and other community-based services and Flexible Funding Meets Unique A key accountability component of Wraparound is surveying many challenges faced by families, they always bring out-of-home care. Wraparound Milwaukee’s fee-for-service families about their satisfaction with the care coordinator and Critical Family Needs strengths to the process. Wraparound Milwaukee works approach gives families a broad choice of providers while and provider services. (Refer to subsequent sections of this with families through their respective Child and Family still maintaining uniform performance expectations for all Another important feature of Wraparound Milwaukee is report for 2019 results.) Teams to build on those strengths and create solutions that organizations in the provider network. The leading “cost the availability of flexible funds — discretionary funds — that help them address other difficulties in their lives. In addition, Wraparound Milwaukee has a complaints and centers” (excluding Care Coordination which everyone can be accessed by youth/families through their Care Coordinator to purchase services or goods to meet a youth/ In 2019, Wraparound Milwaukee introduced a new model grievances system in which any family, adult, or child may received) for Wraparound were placements, family need or enhance the Plan of Care. These funds, often for providing family support and advocacy through the express a concern or file a formal grievance. The complaint crisis services, group and , and in-home therapy. strategically accessed on a one-time or emergency basis, Youth & Family Team. Parent Peer Supports (PPS) are process provides an opportunity for Wraparound leadership can help the youth/family meet immediate needs that may imbedded within teams to provide direct assistance to to become engaged in resolving conflicts or clarifying Wraparound Care not fall within the category of services provided within the individual families as determined and needed by the family expectations, so problems do not reoccur. More information Coordination Agencies Wraparound network. These small investments often pay big and the Youth & Family Team. These Parent Peer Supports about the nature and resolution of the complaints is dividends in terms of maintaining family/housing stability, are individuals who themselves personally have had available in the Quality Assurance section of this report. • AJA Counseling • Alternatives in Psychological incentivizing a youth’s behavior, providing opportunities for and/or through their own children have lived experience. Consultations, S.C. • La Causa, Inc. • Lad Lake youth to become engaged in pro-social community activities, Presently, this model is being launched through one Care • Pathfinders • Saint A’s • St. Charles Youth and and supporting educational gains critical to long-term success. Coordination Agency. Family Services • Willowglen Community Care • Wisconsin Community Services

9 2019 Wraparound Milwaukee System of Care Year End Report 2019 Wraparound Milwaukee System of Care Year End Report 10 Outcome- Based

A Plan of Care with Wraparound is designed to and youth leaving the program is tracked as a part of BEING TRUE TO THE WRAPAROUND PROCESS improve outcomes for the child and family. By supporting assessing program effectiveness. Permanency is considered a child’s ability to succeed at home, in school and in achieved if the child: lives at home with a parent or relative, HAS RESULTED IN THE FOLLOWING OUTCOMES the community, the flexible services provided through is in a subsidized guardianship, is in sustaining care, has Wraparound also help achieve another important goal in been adopted, or lives independently. SYMPTOMOLOGY PERMANENCY the program: keeping children in the community instead of At disenrollment, an account is made of the total needs Of the 211 Youth institutional care. met (average 2.36 for Wraparound/REACH and 2.2 for Average Percent of Change for both Wraparound & 89% Completing Program O-YEAH), the feelings related to school and social and As part of an ongoing data-driven quality assurance REACH Youth — from process, Wraparound has historically assessed the family functioning. See overall disenrollment progress in Enrollment to Disenrollment effectiveness of its services and approach by tracking chart below. RECIDIVISM several measures, including: • Reported improvement in a child’s functioning abilities, DISENROLLMENT PROGRESS CBCL (FAMILY) 5 Year Average: 16% as measured by the Child Behavior Checklist (CBCL) and External the Youth Self Report (YSR), from enrollment to Youth & Behavioral Change -13.85% disenrollment Family SCHOOL ATTENDANCE Strength Driven • Children achieving permanency, as measured by the Based Internal 83% percentage of children leaving the program who are able Behavioral Change 5.5% to live in a variety of home environments rather than Collaboration in other settings (i.e. foster care, care, and residential care) YSR (YOUTH) FAMILY & YOUTH SATISFACTION Care Coordinator Family Survey: • School enrollment External • Family satisfaction with services Behavioral Change 12.15% 4.3/5.0 • Reduction in recidivism Average 4.0/5.0 Provider Network Services: Internal Child and Youth Functioning Behavioral Change 12.5% 3.9/5.0 Academic Achievement & A critical goal of Wraparound is to help children and youth improve their ability to successfully function at home, in Meeting Special Needs school, and in the community. The Child Behavior Checklist Given that school issues are identified as a concern by the (CBCL) is completed by the child’s parent or primary vast majority of families, coupled with the importance manifestation determinations related to behavior problems, In addition, to receiving feedback on Care Coordination caregiver and the Youth Self Report (YSR), completed by that successful school engagement plays in a child’s life, and (6) Problem-solving with school staff related to Services, a targeted satisfaction survey for network youth provides information about internal and external Wraparound Milwaukee continues to increase its emphasis disciplinary hearings and expulsion. providers is administered quarterly to youth and families. behavioral issues a child has at the time of intake and on school attendance and engagement issues. Since 2003, In 2019 1,805 surveys were completed representing 98 during enrollment. These include symptoms of depression, Wraparound Milwaukee has supported educational advocacy Family Satisfaction Provider Agencies. anxiety, withdrawal, social problems, rule breaking and services as a necessary component of the program. Staff aggressive behavior. from the Education Liaison Department actively promote Family satisfaction is a final important indicator of positive school engagement and academic success for Wraparound’s success. Each year, as part of Wraparound’s Achieving Permanence for Youth Wraparound children by: (1) Attending Child and Family extensive quality assurance program, family and youth are Team Meetings, (2) Ensuring students receive proper encouraged to complete a variety of surveys throughout the Permanency is a critical federal and state statutory goal for evaluations under the Individuals with Disabilities Education course of their involvement, including a disenrollment survey. children and youth served in the child welfare and juvenile Act (IDEA) or Section 504 of the Rehabilitation Act of 1973, Wraparound/REACH family satisfaction return rate is 7.9% justice systems. Wraparound shares the responsibility with (3) Attending initial special education evaluation meetings, at one month, 6.2% at 6 months and 62.6% return on the its partners in the child welfare and juvenile justice systems (4) Participating in annual Individualized Educational Plan Disenrollment Progress Report. to help children and youth and their families achieve the (IEP) meetings as well as IEP Review meetings, (5) Attending goals in their permanency plan. Placement of all children

11 2019 Wraparound Milwaukee System of Care Year End Report 2019 Wraparound Milwaukee System of Care Year End Report 12 Care Coordination — Quality Assurance — the Heart of Successful Relationships and Planning Ensuring On-going Quality Improvement

All children and youth served receive care In 2019, there was a total of 556 training hours. Examples coordination services through a care coordinator who of training efforts in 2019 include: facilitates the care planning team that identifies and • Four new Care Coordinator Certification trainings, builds on the strengths of the child and family. The care each training including 16 modules totaling 438 hours, coordinator works with a team of individuals, including training approximately 93 new Care Coordinators, family members, people who provide informal support to Transition Coordinators and Professional Foster Parents. the child and family (e.g. friends, neighbors, and community Participation in these trainings assures fidelity to the members), and professional service staff. The team develops Wraparound philosophy and process. a Plan of Care (POC) based on the needs and strengths of • Twenty hours of ongoing Inservice training included such the individual child and family, creates a safety plan, and topics as: Self-Care, Teen Dating Violence Awareness works with the child and family to create realistic goals and Prevention, Family Advocacy, Commercial Sexual and strategies to meet identified needs. While the team Exploitation of Children, Team Meeting/Plan of Care creates the Plan of Care early in the Wraparound process Facilitation, Special Education Advocacy, Suicide, (within the first 30 days), that plan is reviewed and adapted Childhood Development and the work of the Office of to the changing needs and circumstances of the child or Violence Prevention. youth, with an overall benchmark of holding monthly team meetings 85% of the time. In 2019 Care Coordinators • Nine medication Lunch and Learns were held by the approached that goal, with a rate of 75% holding monthly Wraparound Milwaukee Wellness Clinic psychiatrists at Child and Family Team Meetings. each of the Care Coordination agencies. The goal was to enhance the overall knowledge base of medications, The Wraparound Network includes nine different their side effects, and supplementing medication with organizations, as listed on page 10, that provide care Ensuring fidelity to system of care principles and the specific time frame and trying to capture at least one therapeutic interventions in order to assist youth to coordination. In 2019 Wraparound Milwaukee provided benchmarks, tracking program utilization and costs, and record from each Crisis Stabilizer. overcome stigma and enhancing consistency with a on-going and re-certification training for coordinators and using outcome indicators to improve quality is a strong medication routine and commitment to taking them. Complaints & Grievances are processed through Quality other key staff and system partners on a wide variety of part of Children’s Community Mental Health Services Assurance. Its purpose is to provide a timely means to topics, ensuring that the quality of training and ongoing • New this year, were 4 Family Luncheons where questions and Wraparound Milwaukee’s program. This work is done resolve complaints and grievances, to educate enrollees or support for care coordinators is one of the highest priorities about Wraparound could be asked and camaraderie could through a Quality Assurance (QA)/Quality Improvement representatives about appropriate use of the Wrapround for Wraparound Milwaukee. be fostered. (QI) team. In 2019, Children’s Community Mental Health Milwaukee program and to use enrollee and provider • To assure fidelity to the Wraparound process, 3 Level I& II Services and Wraparound Milwaukee long-time Quality suggestions to improve Wraparound Milwaukee. Five formal trainings educated providers to the philosophy & process, Assurance Director, Pamela Erdman retired after 25 years of complaints and 17 Administrative Concerns (i.e. higher-level the team approach and trauma informed care. All 14 new service within Wraparound Milwaukee. concerns that Administration documents but no outcome vendors received individual orientation to Wraparound During 2019, the Quality Assurance Team, in conjunction identifier of substantiated/unsubstantiated is given) were Wraparound Milwaukee Leads the Way policies, procedures and overall functioning. Additionally, with Behavioral Health Division Compliance Department, received. One complaint outcome was appealed; therefore, 5 Provider Forum Meetings were held in 2019. conducted a crisis review of: a grievance was filed. The outcome was upheld. The topics Visits from other Sites/Programs, Technical of the complaints & concerns included billing, HIPAA, policy, • Four crisis de-escalation workshops were held for 28 crisis Care Coordination and Group Homes Assistance, Presentations client safety and professionalism with most filings against stabilizers. A review of personnel records, training, and supervision From January through May 2019, four separate groups of visitors Service Providers and Care Coordinators. The resolutions records were reviewed for approximately 30% of staff. The from Wisconsin, Oregon and came to Wraparound included redirecting, coaching and retraining. The total review was looking for adherence to DHS 34 requirements. Milwaukee in order to gather information and receive technical number of formal complaints (5) represents .2% of the assistance about our system of care programs. Their needs Crisis Stabilization Agencies entire population served in 2019 (2,127). encompassed a wide variety of topics including fiscal structure, Approximately 5% of youth served charts were reviewed, intake, screening & enrollment processes, quality assurance, along with those staff assigned had their personnel record, court & family advocacy, system partners, training & coaching, training, and supervision reviewed. During the chart review, and mobile crisis services. Furthermore, a training program was referral forms, consent, and progress notes were reviewed. created and rolled out in collaboration with Sojourner Family The charts were randomly selected from youth who had Peace Center, RISE Youth & Family Services and La Causa Inc. a consistent crisis stabilizer for at least 2 months during

13 2019 Wraparound Milwaukee System of Care Year End Report 2019 Wraparound Milwaukee System of Care Year End Report 14 Program Highlights — Meeting Needs at the Time of Need

Under the Comprehensive Community Services (CCS) Owen’s Place umbrella, Wraparound Milwaukee is focusing on a major Owen’s Place is a drop-in Clubhouse/Resource Center for mental health concern: psychosis. Psychosis typically O-YEAH, open to all young adults in the community. It is emerges in adolescence through young adulthood. Early designed to assist young adults whose mental health needs identification and treatment are critical to the youths’ may be impacting on their ability to lead an independent prognoses and their overall future health and well-being. life. An average of 250 young adults visit Owens Place each Wraparound is trying to close the gap of early diagnosis month. Programs of Owen’s Place in 2019 included: through two distinct groups, those youth who have experienced their first episode of psychosis (FEP) (less than two years) and youth who are at high risk for psychosis (CHR-P). These two programs together will fill a continuum LIFE SKILLS SUPPORT & of need for adolescence and young adults who are at risk or • Job Corps PERSONAL Information experience psychosis in Milwaukee County. Session GROWTH Wisconsin Health News article on CORE! • Interviewing Skills • Community Traps and https://wisconsinhealthnews.com/2019/01/04/ Workshop Self-Destruction Solution LA Causa’s Healthy milwaukee-countys-core-program-seeks-to-empower- • Resumé Workshop Relationship Event youth/ Visit the Milwaukee County website where there is • Judge Joe Donald • R.I.S.E. UP!! Workshop information on first episode psychosis and how to access Career Session the CORE program. • LGBT MKE “Real Talk” Safe • Job & Resource Fair & Sound • Associated Bank • FREE HAIRCUTS!!! CORE(FEP) CHR-P Referrals Total Served from MPS & EVERYDAY • New Year—New Beginning 126 Community • Health & Wellness 55 DROP-IN Information Session New New • Stop in to get Enrollments Enrollments Children’s Mobile Crisis Wraparound Wellness Clinic 63 14 some community LEISURE SKILLS resources including Children’s Mobile Crisis (CMC)—responding to youth in crisis Wraparound Wellness Clinic—provided medication • Popcorn Social employment & 24/7. In 2019, CMC provided service to 1,765 youth seen management and wellness care. Family Intervention & housing • Movie & Snack Night for the first time and hundreds of others seen during crisis. Service Provided to • GAME NIGHT Under its auspices the Treatment Response Team (TRT), in Wrapround, REACH & Clinic Attendance Support Services (FISS) collaboration MPD in Districts 5 & 7, identify and support CCS Programs FISS is designed to assess and provide services to families child victims of traumatic violence. experiencing life challenges with their adolescent child Campus Housing 3,880 2,891 age 12-18. Its program goal is to strengthen the parent/ Beginning in 2015, O-YEAH partnered with Journey House 5 Highest guardian’s ability to support their adolescent in the Referrals to Referral to provide supported apartments for young adults that Incident Average/Month Average Attendance home, community and school. The FISS program has two TRT Disposition 323 were enrolled in O-YEAH and in need of stable housing. Types 74.5% components: Assessment to determine eligibility for FISS In 2019, O-YEAH and Journey House sponsored a total of and Case Management, using Wraparound philosophy Domestic Violence 10 apartments. Young adults can live in these apartments 62% successful and a coordinated Service Team approach with the goals 466 initial contact with Comprehensive Community under a modified rental agreement with a monthly rent family of providing stabilization, and sustainable connections to payment schedule. Using a Housing First model, young Services (CCS) community resources. Battery adults can live in these apartments for up to 18 months Comprehensive Community Services (CCS) for youth while working on school and employment goals and 43% increase Sexual Assualt Up 50% from 2018 provides an across the lifetime, voluntary program that since 2015 72 Families learning the skills to live a successful independent life. 427 Youth Endangering Safety provides support and services to Milwaukee County youth, Receiving Case Assessments Journey House is projected to add 10 more apartments in Management young adults and their families, who are coping with a 2020. mental health or substance abuse diagnosis. In 2019, the CCS Program served a total of 385 youth and young adults.

15 2019 Wraparound Milwaukee System of Care Year End Report 2019 Wraparound Milwaukee System of Care Year End Report 16 Special Initiatives and Projects

Performance Improvement The second study question looked at how many people, model to assure that Wraparound principles and values as Project (PIP) when appropriate, continued to the next step of the well as processes have been woven into the development One more success story: process, in-depth screening. The results revealed that over of this model. Lastly, a summary of the YLOL (Youth Wraparound Milwaukee engages in one Performance 98% of the callers set appointments for screening. The Living Out Loud) program that had been developed Jada is a vibrant young lady that benefitted from Improvement Project per year as mandated by the Medicaid outcomes of this study support the use of the Resource & through a SAMSHA Grant for working with youth that years of support from Wraparound REACH. She was Contract with the State of Wisconsin. The project must Referral Line. It is deemed an effective and efficient way have been involved in sex trafficking. originally enrolled in REACH after several bullying focus on a clinical or administrative issue that the program to link families to individualized services which should incidents at school that led to self-harming behaviors • An analysis of the Trauma Response Team work is wants to further explore in an effort to engage in a quality happen at the very first contact. Indicated, as well, is and academic difficulties. In remembering how she felt conducted to monitor the effectiveness of providing, in improvement endeavor that impacts on client care. the importance of brief, intensive engagement with the at that time, Jada describes feelings of hopelessness partnership with MPD, support to children and families family through motivational interviewing, providing stress and poor self-esteem. She had been told by classmates In 2019 the Performance Improvement Project was entitled who have been exposed to violent . and teachers that due to her intellectual and Resource & Referral Line. Milwaukee County Behavioral and coping support strategies and providing detailed and • A Department of Milwaukee Child Protective Services Health Division in collaboration with the Disability Services creatively presented support service information. This all emotional disabilities that she would never graduate (DMCPS) Education Liaison Status Research Project Division created a single point of entry for referral to can be provided by this viable approach, the single front high school. She felt isolated and defensive, did not is conducted annually to analyze program growth services for youth and their families. This single front door door, deemed as best practice. have many friends, and wanted to give up. and service delivery patterns. This data was analyzed point of entry was the first step in creating a structure that Upon Jada’s REACH enrollment, she remembers across three distinct age groups in order to address age is more user friendly for the consumer, but still effective Research Activity initially resisting the guidance of her team. She felt appropriate needs. and efficient. Given this new collaborative system of As a data driven program, Wraparound Milwaukee like nobody could help her, stating that it was her receiving referrals, it was felt that studying how families • The Wraparound researcher published an article, entitled, collects and analyzes data to assure accountability and against the world. Over time, Jada continued to felt about this Referral Line approach was critical to O-YEAH: a Wraparound Community-based Program for responsiveness to the Wraparound model. Below are a few struggle and decided to open up to her team. The most supporting and continuing this model. Transition-Age Youth and Young Adults in Focal Point, highlights from 2019. important discovery that boosted her self-esteem 33, 2019; the research journal of the Research and A satisfaction survey was offered and completed by 238 was getting her involved in art. While she blossomed • Wraparound was very visible on the national stage, Training Center for Pathways to Positive Futures. She callers into the Resource & Referral Line. Ninety percent artistically, Jada still struggled greatly with academics. presenting three research studies at the 32nd Annual also presented on a national webinar platform that (90%) of the callers indicated an overall call satisfaction She switched schools many times and many educators Research & Policy Conference on Child, Adolescent, and is sponsored and funded by the Substance Abuse and rating of ≥ 4.5/5.0, reaching the threshold necessary that stated that they did not believe Jada was capable of Young Adult Behavioral Health. The first, celebrated and Mental Health Services Administration (SAMHSA) through would represent satisfaction and success. The outcome earning a diploma. Still, Jada persevered and allowed summarized the outcomes of the 10 years of the O-YEAH the Child, Adolescent and Family Branch, Center for detail of the survey revealed that people felt emotionally the team to advocate for her education. Jada pushed program, evaluating the progress made and the lessons Mental Health Services. The title of the presentation was positive about the call and felt that the useful information herself to work hard academically and modify her learned as the program has been evolving across time. The Approaches to Evaluating Services for Youth and Young was provided and finally that the process was also efficient. behavior in order to find success. second was reporting out at the newly created Leadership Adults of Transition Age. Today, Jada describes herself as a hopeful young Collaborations with other lady that feels like she can accomplish anything she PRAISE AND ACCOLADES TO CARE COORDINATORS/TEAM MEMBERS puts her mind to. She is very talented at painting, FROM OUR FAMILIES AND YOUTH! programs in the Behavioral drawing, and designing and found a real passion for Health Division (BHD) and it. At the Wraparound Talent Show in 2019, Jada sold “My care coordinator is “My Wraparound team never “I have a care “I’m lucky to have such a the Department of Health and several pieces of her artwork. Anyone who meets always on top of things gives up on my daughter. No coordinator who never great care coordinator. He’s Jada can see how she expresses her identity through Human Services (DHHS) fun clothing, bright makeup, and creative hairstyles. and she gets the job done! matter how many times she gives up. Never lets me always got my back and In 2019, Wraparound Milwaukee participated in 13 Currently, Jada is on track to graduate with her high She always talks to me makes mistakes, which we down. Never throws in speaks up for me when I Behavioral Health Division and/or Department of Health school diploma at 19 years old in the spring of 2021. This upcoming accomplishment has only reinforced and my son in a very polite all make mistakes. The team the towel. I wish every don’t know the right words and Human Services (DHHS) committees and workgroups as BHD/DHHS moves forward with its strategic plans for Jada’s determination to persevere. and respectful manner and is there for her and does family in Milwaukee had to say what’s on my mind. the future, which includes an integration of services across Jada is a shining example of why Wraparound listens, I mean really listens, not judge her. They give her a social worker in their He sticks up for me in court departments in order to provide more seamless and more employees commit themselves to engaging with to us. She’s really helped my the unconditional care she lives that cares as much and lets people know the user friendly services across the age groups. In addition, youth in need of support. It has truly been a privilege Wraparound engaged in ongoing meetings with the to be a part of her journey and to now see the bright son get back on track!” needs.” about my family.” other side of the story.“ BHD Contract Management, Network Services and future she has ahead. Compliance area. n

17 2019 Wraparound Milwaukee System of Care Year End Report 2019 Wraparound Milwaukee System of Care Year End Report 18 Unique Wraparound Milwaukee System of Care Funding Programs and Services

Revenue Sources Wraparound Milwaukee is the Behavioral Health Division entity that manages the public-sector, community- A unique feature of Wraparound Milwaukee is its ability to “blend” funding from multiple sources and create based mental health system for Medicaid eligible children, a service-funding mechanism that allows the cost-effective investment of those funds on an individualized basis. adolescents and young adults (ages 5-23) in Milwaukee County who have serious mental health or emotional needs. Serving as Wraparound’s funds come from four different sources: the umbrella body for a number of programs, all programs rely on care coordination, offer a range of support services, and promotes parental and youth choice, family independence, and provides trauma informed care for children and youth in the context of DHS — Medicaid — Capitation their family and community. Wraparound — Referrals are received from the Delinquency DHS — Medicaid — Fee for Service (crisis) and Court Services Division and the Division of Milwaukee Child Wraparound Protective Services for those youth who are either placed out DMCP — Division of Milwaukee Child Protective Services — Case Rate of home and outside of their community or are at risk of being placed. It provides cost-effective, community-based alternatives Milwaukee to residential treatment placements, juvenile correctional Milwaukee County Human Services (DYFS) — Delinquency — Fixed Funding placements, and psychiatric hospitalization. Reaching, Engaging and Assisting Children & Families Grants and Other Miscellaneous Sources (less than 2%) (REACH) — Referrals come directly from families, schools, service providers and the Childrens Mobile Crisis (CMC). Youth generally are not involved in the Juvenile Justice system or the Division of Childrens Mobile Crisis (CMC) — Provides 24/7 crisis Child Protective Services program. Under the same practice model, intervention services to any family in Milwaukee County with a youth and families receive the same type of supports and services child who is experiencing a mental health emergency in which as those in Wraparound program, with the exception of placement the behavior of the child threatens his/her removal from home, a Wraparound Milwaukee Continues to be Cost-Effective services. community placement and/or, school. The team can also provide short-term case management and can link the child and family to The total paid All of Children’s Community Mental Health Services and Wraparound Milwaukee provided $45,528,244 Comprehensive Community Services (CCS) — An option crisis stabilization and community resources. in support/services. for families in Milwaukee County which provides support and services to youth and young adults who are coping with either a Trauma Response Team (TRT) — In collaboration with the Milwaukee Police Department, Childrens Mobile Crisis (CMC) Listed below are monthly program cost comparisons as it relates to the provision of services for the same high-risk, mental health and/or substance abuse diagnosis. As a voluntary community based program, CCS addresses needs throughout a provides support services to children & their families when they high-need population. person’s lifespan, with a coordinated and comprehensive array of have witnessed or have been exposed to potentially traumatic recovery, treatment and psychosocial rehabilitation services. events such as serious accidents, sudden death, shootings, violence, or domestic violence. Older Youth and Emerging Adult Heroes (O-YEAH) — Supports older youth and young adults (age 16-23) who are Wraparound Wellness Clinic — Provides medication Psychiatric/Inpatient management and overall wellness care and education for the Hospitalization $46,131 experiencing emotional and behavioral challenges to successful transition to adulthood. In addition to mental health services, mental and physical health of children and youth in Wraparound Milwaukee. Corrections $13,935 there is a focus on life skills, housing and employment/training. Additional Associated Resources Family Intervention and Support Services (FISS) — Targets adolescents who are exhibiting behavioral issues in home • Owens Place — A community drop-in resource center for Residential Care $12,313 and community, but have not been diagnosed. This is a voluntary young adults age 16-24 whose mental health needs may be assessment short term intervention program aimed at stabilization impacting their ability to become independent. and prevention and is designed to assist families in preventing Group Home $6,493 • M.O.V.E. Wisconsin — A youth-run organization designed court and system involvement. to empower adolescents and young adults to advocate for Family Advocacy Services — Run by families with lived Wraparound Milwaukee themselves around causes that are important to them and experience, this provider offers family support, advocacy services, System of Care $2,609 their respective community. family-run support groups, and family events. They also train Coordinated Opportunities for Recovery and Empowerment providers, and are the voice of families on committees and in the $0 $10000 $20000 $30000 $40000 $50000 (CORE) — Comprised of clinical high risk for psychosis and first community. episode with psychosis, serves 10-23 year olds. Services included: Educational Liaisons — Serves youth & young adults involved in Care Coordination, Individual Therapy, Employment and Education Wraparound Milwaukee System of Care. Addresses school issues Support, Peer Support and Medication Management. including placement, special education needs & services and Professional Foster Parent (PFP) — Provides a transitional home possible suspensions and expulsions. environment for youth with a history of running away. Foster Provider Network & Community Resources — Wraparound Special appreciation is given to Dana James, MS, as the Director of the Wraparound Milwaukee Quality Assurance program parents are licensed/certified as both treatment foster parents Milwaukee has a broad benefit plan of over 100 different mental and care coordinators. Serving one girl in a home at a time, the and to other QA team members who are dedicated to gathering on-going data and information to hold ourselves accountable. health, social and supportive services. This network of community ultimate goal is to help the youth achieve permanency with their agencies and individual providers provides a variety of options for Without their efforts, this report would not be possible. More importantly, we would not have been able to maintain the never- respective family. every service type, giving families considerable choice for their child and their family. ending quest to improve outcomes for children and families.

19 2019 Wraparound Milwaukee System of Care Year End Report 2019 Wraparound Milwaukee System of Care Year End Report 20 Building Community 2019 through Personal Connections Provider Network

Adkins Counseling Services, LLC Grateful Girls–Safe Haven II New Horizon Center, Inc. AJA Counseling Center Grateful Girls–Transition (Child Placing Agency) Allendale Association Hale-Richlen Center for Psychiatry (The) New Leaf Therapies, LLC Alternatives In Psych. Consult. Harmony Social Services CPA, Inc. Norris Adolescent Center American United Taxicab Service Harper House–NEHEMIAH PROJECT North Shore Psychotherapy Associates Angels Counseling & Therapy Service Honey Creek Counseling and Park West Social & Psychotherapy Services Anu Family Services, Inc. Recovery Services, LLC Pathfinders Milwaukee, Inc. Ascent for Life, Inc. Hopgood Youth Home Pathways Counseling Center Behavioral Consultants, Inc. Horizon Healthcare, Inc. Positive Outlook Clinical Services, LLC Bell Therapy House of Jabez, LLC Professional Services Group, Inc. Benevolence First, Inc. House of Love Youth Homes, PsyCare–Milwaukee LLC Inc. House of Love II BLOOM: Center for Art & Psychological Assessment Services, LLC Integrated Therapies Human Development Center, Inc. Psychological Purposes Bracy Psychological Service & Inspiring Young Women, Inc. Rae of Hope Empowerment Stress Mgm Institute Integration Healing Alivio Integral Rawhide, Inc. Butterflyz, LLC dba Building Integrity Family Services, LLC Revive Transitional Living Center I Youth Assessment Center Jackson, Denis Ian, Ph.D. Revive Transitional Living Center II Butterflyz, LLC dba Home Away From Home Jewish Family Services, Inc. Revive Youth and Family Center I Children’s Hospital of Wisconsin Journey House Revive Youth and Family Center II Children’s Service Society of WI (CSSW) JW Transportation, LLC Right Turn II Childynamics, LLC Kane Communications Right Turn, Inc. Chileda Institute, Inc. Wisconsin Council on Children and Riley’s Adult Family Home Choices to Change Families DBA Kids Forward RISE Youth and Family Services, LLC –Choices Group Home for Girls La Causa, Inc. Riverstone Counseling and Choices to Change, Inc. Lad Lake–St. Rose Stages –Changes Group Home Crisis Services, LLC Lad Lake, Inc. Choices to Change, Inc. Robert Half Technology –Eagles Nest Group Home Lad Lake–St. Rose (Synthesis Developers) Choices to Change, Inc. Language Source LLC Running Rebels Community Organization –Washington House Lawson’s Transportation, LLC SaintA, Inc. Column Rehab Services LifeStriders Therapeutic Riding Center SEA Group Community Harbor, LLC. Lutheran Counseling & Family Services of WI Sebastian Family Psychology Practice Connecting Youth Group Home Lutheran Soc. Serv. Of Servant Manor Strategies, Inc. Courage House WI & Upper Mich., Inc. Servant Manor, Inc.–Trotter House Creative Counseling of Milwaukee Lutheran Social Services–Homme Servant Manor, Inc.–Servant Manor Home Y&F Programs DCS Transport Services, LLC Sixteenth Street Community Mahleah Calderon Diorio Consulting & Assessments, LLC Health Centers, Inc. MD Therapy Dominion Behavioral Health Services, LLC Spahn Clinical Services Med Group Transportation, LLC Eau Claire Academy St. Charles Youth and Family Serv. Medical College of WI (MOU) Star 1 Limousine, LLC

Resources Educates LLC Milwaukee Academy/Clinicare Exodus Family Services, LLC SWITS, Ltd. Milwaukee Center For Independence Express Yourself Milwaukee, Inc. THRIVE Treatment Services, LLC Milwaukee Center for Tomorrow’s Future, LLC Family Options Counseling, LLC Independence Home Care Tomorrow’s Future, LLC–Phase II Family Strong, LLC MindStar Counseling, LLC True American Transport, LLC Family Works Programs, Inc. Mt. Castle Transitional Living Services V.I.C. Living Center, LLC Forward Choices, LLC Multicultural Trauma & Addiction Tx Ctr Wauwatosa Therapies, LLC Fresh Start Counseling Center Myles Logistics Willowglen Academy–Wisconsin, Inc. Genesee Community Services, LLC Navarro Professional Counseling Goodwill Industries Services, LLC Wisconsin Community Services, Inc. Grateful Girls, Inc. New C.H.O.I.C.E.S, LLC Young Consulting and Assessments, LLC

Resilience Grateful Girls–Safe Haven New Concept Self Dev. Ctr/CSS

21 2019 Wraparound Milwaukee System of Care Year End Report 2019 Wraparound Milwaukee System of Care Year End Report 22 Wraparound Milwaukee System of Care 9455 Watertown Plank Road Milwaukee, WI 53226 • Phone: (414) 257-7611 Fax: (414) 257-7575