Wraparound Milwaukee: Aiding Youth With Mental Health Needs

Outcomes for youth participating in Wraparound Milwaukee have been encouraging. The use of residential treatment has decreased 60 percent since Wraparound Milwaukee was initiated (from an average daily census of 364 youth in placement to fewer than 140 youth). Inpatient psychiatric hospitalization has dropped by 80 percent; in 1998, only 322 days of care were provided. As mentioned above, the average overall cost of care per child has dropped from more than $5,000 per month to less than $3,300 per month. Because the savings have been reinvested into serving more youth, the project now serves 650 youth with the same fixed child welfare/juvenile justice monies that previously served 360 youth placed in residential treatment centers.

Clinical outcomes, as measured by the Child and Adolescent Functional Assessment Scale (CAFAS) (Hodges, 1994), have improved significantly for delinquent youth. CAFAS is used in all Children's Mental Health Services programs to measure changes in the youth's functioning at home, at school, and in the community. With CAFAS, a lower score indicates the youth is functioning more adequately. For a group of 300 delinquent youth enrolled in Wraparound Milwaukee, the average score at the time of enrollment was 74, which is considered in the high range of impairment. By 6 months after enrollment, the average score decreased to 56, in the moderate range of impairment. One year after enrollment, the average score was 48, again a moderate level of impairment.

The reduction in recidivism rates for a variety of offenses for delinquent youth enrolled in Wraparound Milwaukee has been even more encouraging. Data were collected for a period of 1 year prior to enrollment in the project and 1 year following enrollment by the county's Child and Adolescent Treatment Center. The center reviewed court records for 134 delinquent youth enrolled in Wraparound. Table 1 shows the breakdown of the proportion of children committing each type of offense.

Table 1: Recidivism Rates of Delinquent Youth Enrolled in Wraparound Milwaukee (n=134)

Offense1 Year Prior
to Enrollment*
1 Year Post
Sex offenses11%1%
Weapons offenses154
Property offenses3417
Drug offenses63
Other offenses***3115

* Seybold, E. Child and Adolescent Treatment Center. Child and Adolescent Functional Assessment Scale and Child Behavior Checklist (Achenbach and Edelbrock, 1980) data collected and analyzed through July 1999.

** Seybold, E. Child and Adolescent Treatment Center. Data collected and analyzed as of September 1999.

***Primarily disorderly conduct not involving use of a weapon.

The reduction in these reoffense patterns is statistically significant. Although more focused studies on recidivism are needed, the results to date are promising. Continued studies of these youth 2 years following enrollment are planned so the long-range effects of Wraparound can be measured.

Wraparound Milwaukee Case Studies

Michael, a 15-year-old Hispanic, was referred to Wraparound Milwaukee as the result of delinquency charges of party to a crime and attempted arson of a school building. As a result of the charges, Michael was expelled from a Milwaukee public school, and the Probation Department was ready to recommend residential treatment.

Michael is cognitively delayed and has received special education services. At one point, he had a substance abuse problem and was diagnosed with depression.

Michael's Child and Family Team included his mother, grandmother, a mentor, a teacher, a probation worker, and an alcoholism treatment counselor. The team worked on Michael's identified academic needs. They learned that he had poor vision, which contributed to his school problems. Michael enrolled in a specialized learning center to develop his academic skills. Initial testing by the learning center revealed that Michael tested at only a first- and second-grade level in English, mathematics, and reading. After 4 months, he improved his academic performance by two grades.

Michael's mentor introduced him to recreational and other activities and became a positive role model and father figure. Michael's grandmother provided respite care to Michael's mother once a week. Informal service providers included the Council for the Spanish Speaking, which provides substance abuse counseling, and Milwaukee Christian Center and Journey House, which offers neighborhood recreation activities.

After 1 year in Wraparound, Michael has been readmitted to his Milwaukee public school as a freshman and placed in a special education program. He now tests at a fifth- and sixth-grade level in English, mathematics, and reading—an extraordinary improvement. Michael has had no further delinquencies.

Anthony, a 15-year-old African American, originally was placed in Wraparound Milwaukee because of multiple counts of criminal damage to property. He was diagnosed with attention deficit disorder and major depression. Anthony's family strengths included his parents' desire to keep him at home, the number of aunts and uncles who were interested in being resources for him in times of family stress, and his family's motivation for change. Anthony's personal strengths included his outgoing nature, affection for his siblings, desire to find a job, and love for his parents.

His Child and Family Team included his mother, stepfather, aunt, a sibling, an in-home therapist, a probation worker, a volunteer mentor, and his care coordinator. Formal services he received through Wraparound included in-home treatment, day treatment, mentoring, and job coaching. Anthony's aunt provided informal services—Anthony would stay with her during some of his crisis periods.

Anthony has been in Wraparound for 2 years. He has had no further law violations and has been an honor student in the alternative school program. He is returning to a Milwaukee public high school. He is also working with an employment agency in the provider network to obtain a part-time job.

Juvenile Justice - Youth With Mental Health Disorders:
Issues and Emerging Responses
April 2000,
Volume VII · Number 1