Effective Strategies for:
Working with
High Risk Youth
What is Wraparound
Milwaukee?
Program which offers support and services to
families with children with emotional,
behavioral or mental health needs
Care Management Organization
Family Friendly
Traditional and Non-traditional mental health
services
Utilizes Wraparound approach across all
systems
What Wraparound Milwaukee
Offers to Families
Administrative Services
Care Coordination
Provider Network/Community Resources
Families United of Milwaukee
Mobile Crisis Team
Specialized Clinical Oversight
Youth and Families in
Wraparound Milwaukee
Identified By Child Welfare or Juvenile Justice
Children and Adolescents with Severe Emotional Disturbance
Families with Complex Needs
Youth at Risk of Placement in a Residential Treatment
Center, Psychiatric Hospital, or Corrections
580 - 620 Families Enrolled
158 Designated High Risk
115 Designated Juvenile Sex Offender
High Risk Defined as Having a
History of:
Sexual misconduct
Victim of sexual assault
Homicide or aggravated assault
Fire setting
Multiple psychiatric hospitalizations
Gender of Youth in Program
MALE
75%
FEMALE
25%
Current Enrollees - 2006
Age of Youth in Program
10-12 13-15
9% 48%
6-9
1%
16-17
Current Enrollees - 2006
42%
Ethnic Representation of Youth
HISPANIC
7%
AFRICAN-
AMERICAN OTHER
69% 6%
CAUCASIAN
18%
Current Enrollees - 2006
Custody of Children at Intake of
Wraparound Enrollees
MOTHER
52%
FATHER
7%
RELATIVE
5%
BOTH
GUARDIAN
PARENTS
7%
15% OTHER STATE
3% 11%
Current Enrollees - 2006
Family Income
$35,000 $15-25,000
8% 26%
$25-35,000
13%
Current Enrollees - 2006
Initial Court Orders of Youth
CHIPS
36%
CHIPS/
DELINQUENT
2%
JIPS 2%
DELINQUENT
60%
Current Enrollees - 2006
DSM-IV Diagnoses of Youth in
the Program
70
60
PERCENTAGE WITH DIAGNOSIS
50 63
40
39
30
39
20
26
25
21
10 24
11
11
0
CD/ODD DEPRESV ADHD ANXIETY AODA LEARNING MOOD ADJUST.
DISORDER DISORDER RELATED DISABILITY DISORDER DISORDER
Current Enrollees - 2006
Child Issues at Intake
PHY. DISABILITY 18%
ADJ. SEX OFFENDER 22%
FIRESETTER 23%
HX OF PSYCH HOSPITAL 24%
SEXUAL ABUSE VICTIM 27%
SUICIDAL BEHAVIOR 33%
AFFECTIVE ILLINESS 41%
AODA ISSUES 42%
HISTORY OF SEXUAL MISCONDUCT 45%
RUNAWAY BEHAVIOR 46%
ADHD 59%
SEVERE AGGRESSIVENESS 70%
SCHOOL/COMMUNITY CONCERNS 87%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100
%
Current Enrollees - 2006
PERCENTAGE WITH ISSUE
Family Issues at Intake
PREVIOUS HOSPITALIZATION 10%
ADJUDICATED PHYSICAL ABUSE 12%
DEVELOPMENTAL DISABILITY 16%
FELONY CONVICTION 16%
CHILDREN IN FOSTER CARE 18%
NON-ADJUDICATED ABUSE 26%
NEGLECT 30%
SEVERE MENTAL ILLNESS 34%
DOMESTIC VIOLENCE 39%
OOH PLACEMENT 39%
INCARCERATION 54%
SUBSTANCE ABUSE 56%
ABANDONMENT BY PARENT 59%
0% 10% 20% 30% 40% 50% 60% 70%
FAMILIES EXHIBITING CONCERNS
Current Enrollees - 2006
Specialized Services for High
Risk Youth:
1. Juvenile Sex Offenders – goals are to successfully
integrate into community with no recidivism.
2. Mobile Urgent Treatment Team for Foster Care – goal
is to decrease multiple or failed placements.
3. Mobile Urgent Treatment Team for Milwaukee Public
Schools – goals are to decrease school violence, failed
placement and increase attendance.
4. FOCUS – Provides the court system an alternative to
corrections. Goals are to decrease recidivism and
increase school attendance.
5. Professional Foster Parent Pilot – goals are to decrease
runaway behavior for young women and promote
reunification with family.
Activities Initiated to Assist Us in
Enhancing Our Approach to Working
with this Population:
Good data collection
Utilization of specific risk and needs
assessment
Education and training of system partners,
especially court officials
Training and ongoing consultation for care
coordinators, clinicians and family members on
best practices, treatment and risk management
Activities Initiated (cont’d)
Ongoing evaluation and policy team review of
legal and mental health responses
Collection and dissemination of outcome data
Enhancement of community based services, ie:
specialized treatment foster care, crisis
stabilization, more culturally diverse out patient
and in-home providers
Enhancement of community based resources to
support parents in providing supervision and
structure for youth
What are the Care Coordinator’s roles and
responsibilities with “high risk” youth?
Establish rapport with parent(s) and all children
Use good judgement---consult---collaborate and
support team in using available resources
Attend the Community Safety and Resource
Development- High Risk Review with specialized
psychologist
Take advantage of continuing education; learn about
providers with specialization
“Best practice” safety planning
Have RCCY-based providers to complete the JSO
Progress Report Form and attach to prior
authorization (Risk assessment tool)
Report all critical incidents and changes in placement
Safety planning outline
Team meeting
Determine recording duties (chart)
Start with family strengths-list resources
Need for safety planning-risks to whom?
Establish goals
Brainstorm strategies, engage youth
What’s needed to make it work? Develop resources.
Incentives and consequences
Keep It Simple
Finalize plan and have all parties sign
Review/revise regularly & as changes occur
Best practices in the SAFETY
DOMAIN
Individualized, not formula
Context-specific (often more than one)
Developed as a team, with consultation as
needed, shared
responsibility/accountability
Proactive, preventative
Details relevant Family Rules
Preventive education needs and strategies
Not just paperwork
Which interventions have been found to
work best with “high risk youth”?
Promote improved relationships with
parents, family, healthy peers and adults
(multi-systemic)
Solution-focused (small change is all that
is needed, expect cooperation)
Find the talent and promote it
Forge durable connections with school,
recreational programs and religious
institutions (pro-social influences).
Program Outcomes
Utilization of Residential Treatment
90% Reduction
May 1996 - 370 Placements
Currently - 70 Placements
Psychiatric Hospitalization
Yearly Utilization Dropped
From 5,000 to 148 Days (for Enrolled Youth in 2005)
Juvenile Correctional Placements
100 Fewer Placements Annually
Service Utilization/ Placements
Currently 115 youth adjudicated for sexual
misconduct enrolled.
41 Family Home
11 Relative
13 Foster Care
24 Group Home
19 RCCY
Caregiver, Care Coordinator, & Youth Reported
Improvement In Functioning For Clients
75
CBCL 2005 Data
70
YSR
INSTRUMENT RAW SCORE
CAFAS
65
60
55
50
45
INTAKE 6-MONTH 12-MONTH
Child Behavior Checklist (CBCL), n=159; Youth Self-Report (YSR), n=140; Child & Adolescent
Functional Assessment Scale (CAFAS), n=225.
Mobile Urgent Treatment for
Foster Families
Began in Dec. 2005
Provides assessment and stabilization
Year One – change of placement requests down 45 –
50%
Year Two – 50% youth maintained in foster home
17% moved to treatment foster homes
15% back home
12% enrolled in Wraparound Milwaukee
6% moved to a new home
N=143
SPECIFIC OFFENSE TYPES THREE YEARS PRIOR TO
ENROLLMENT & THREE YEARS FOLLOWING DISENROLLMENT
IN WRAPAROUND MILWAUKEE
50 3-YEARS PRIOR TO 2005 Data
ENROLLMENT
45
49 3-YEARS FOLLOWING
40 44 DISENROLLMENT
35 39
30 35
25
26
20 22
15 19
17
17
10 12
11
5 7
0
PROPERTY OTHER ASSAULTS* SEX OFFENSES* WEAPONS DRUG
OFFENSES* OFFENSES* OFFENSES* OFFENSES**
Other offenses consist primarily of Disorderly Conduct (58%) & Obstructing Justice/Fleeing (29%)
*Reductions are significant at a p < .01 level using a Chi-Square comparison.
**Increase is significant at a p < .01 level using a Chi-Square comparison.
n = 842
Reduction in Legal Offense Referrals & Adjudications During
Enrollment & After Disenrollment for Clients in the Wraparound
Milwaukee Program
2 .5 1 YEAR PRIOR TO ENROLLMENT
DURING ENROLLMENT/PER YEAR
1 YEAR FOLLOWING DISENROLLMENT
2
2.07
1 .5
LI T
A A E N M B PER C EN
VER G U ER
1.36
1.18
1
0.95
0 .5
0.62 0.51
0
OF F E NS E S U
A D J D IC A T IO N S
Offenses Adjudications
n=828. Reductions are significant at the p<.001 level of significance using a repeated measures
analysis of variance.
Data through 12/31/2005
WRAP JSO SEXUAL OFFENSE RECIDIVISM
DURING AND AFTER ENROLLMENT
100 NO KNOWN
OFFENSE
90
KNOWN
80 OFFENSE
70
96
PERCENTAGE
60 89
50
40
30
20
10
11 4
0
DURING ENROLLMENT 1-YEAR FOLLOW-UP
N=202 DURING ENROLLMENT, 100 1- YEAR FOLLOW-UP
For More Information About
Contact:
Mary Jo Meyers, M.S.
Asst. Proj. Director
Wraparound Milwaukee
mmeyers@wrapmilw.org
(414) 257-7521
The hope of a better
future lies in investing
in the health and well
being of our children