Today marks three years since Aaron’s death. The start of our fourth year without him and four of my birthdays without hearing his voice. He always called for any birthday or holiday, and every single Sunday. His absence still feels like a gut punch and I still wake up crying.

This week he came to me in a dream … he was five or six still with that white blonde hair, about the age of this picture but at the end of a summer playing outside. He was coming up a set of stairs I was going down, I dropped down and sat holding him telling him how sorry I was and how much I love him, until I woke. I tried going back to sleep, to that hug but I just could not get back there. It is a metaphor for much of our time together.

I so want to have been smarter back then and not so willing to trust people who thought they knew what to do. It was an era when behavioral and medical models reigned, and neither of those did us any good.

Way back then, in the 1980s, we were sending massive numbers of youth to residential treatment centers (RTCs) for long periods of time at great expense with relatively limited success. In 1982 the first Unclaimed Children study by Jane Knitzer found that two thirds of all children with severe emotional disturbance were not receiving what they needed. Aaron certainly was not. The Child and Adolescent Service System Program (CASSP) was funded in 1984 (about the time this picture was taken) and it was based on six core principles which said that mental health services for children and youth with or at risk of developing severe emotional disturbance should be child-centered, family-focused, community-based, multi-system, culturally competent, and in the least restrictive settings possible. Systems of care and wraparound grew out of CASSP and began as an effort redirect resources to wrap around youth in their communities. Karl Dennis did work with families in really hard circumstances on the streets of Chicago, and from him we got the principle of persistence, which means we do not give up on youth and families in wraparound, ever. About the same time, Alaska who had been shipping their youth to RTCs in the lower 48 states only to have their progress unravel once they came home, decided to bring them all home. They hired John Vandenberg to help.

Wraparound done well is a miracle. But what does “done well” mean, and how do we get there? 35 years later lots of programs claim wraparound but many do not produce much in the way of outcomes for youth and families. Done well is perhaps best measured by how well those programs live up to the core principles of wraparound. Those are as follows:

1. Individualized This is the difference between wraparound and traditional practices in which the director selects several evidence based practices and commits their resources to those. Traditionally, then when little Aaron and his family come to their intake, they select which of their practices they believe is closest to fitting Aaron’s needs and give him that service, or if they decide none of their services fit, they turn he and his family away. Aaron had providers who knew behavioral techniques and so that was what they provided, whether it fit or not (it didn’t). Others, especially after Straight, realized that they did not know what to do for him and turned us away. Instead, wraparound identifies the strengths and needs of an individual child and family, and creates individualized supports to fit them.

2. Strengths Based My favorite principle! This principle begins with the idea that “even the most troubled youth have unique talents, skills, and other resources that can be marshaled in the service of recovery and development” (Cox, 2006, p287-9). it is about identifying child and family strengths and broadening them by creating enabling niches for them to experience themselves as competent and successful. As a parent, I thought that I needed to catch Aaron up to some standard and when he got close to succeeding at each of the milestones toward whatever goal, I raised the bar, thinking that I was helping him advance. But what it really meant was that he always experienced himself as not quite able to reach the goal. He was brilliant but that was not his lived experience. From a strength based perspective we should have spent a lot more time relishing his gift for language, perhaps finding a poet to mentor him. We could have leaned into football which he loved and as a big kid, he was good at. We could have expanded on the little job that he loved in my friend Betty’s art shop. He had so many gifts that we gave too little attention.

3. Culturally Competent This principle speaks to the importance of respect for individual family culture. It means I do not get to push my white suburban ethos onto everyone else. I meet families where they are and honor their norms. As a family, it means when I need to say fuck this, you don’t get to tell me that my language offends you. It means seeking to understand the street culture that Aaron chose to live in and our families accommodations to maintain a relationship with him.

4. Family Voice and Choice This is about being Family Driven and Youth Guided/Driven. That means NOTHING happens without family and youth voice. They are part of setting their own goals and developing their own plans, those are not prepared in advance by providers. Families have support from other knowledgeable families who have walked in their shoes and know the ropes. Families and youth are part of developing supports and services at the systems level, and they provide oversight to assure that services are meeting their needs and those of other families and youth. We had no one in our community who knew about the changes that were happening in children’s mental health. They did not know wraparound and all they could give were interventions that fit us like a tight pair of wool underwear.

5. Team based This means that all planning and progress monitoring happens in the child and family team meetings. Those start weekly and it is in the team meeting that strengths are identified and goals and activities planned to create spaces for those to grow. It is where plans are developed to address needs. Providers do not come with predetermined goals or a pre-approved slate of services in high fidelity wraparound, but rather they facilitate the team’s identification of strengths, needs, resources and strategies that are tailored to those. I imagine sometimes who might have been on Aaron’s wrap team and what we might have come up with. There was the young priest who would sometimes take him to play pool, my friend who owned an art shop and created a little job for him, my art teacher who never forgave us for moving away with him, his grandparents, his football coach … we had people who would have been happy to help Aaron and our family succeed. But none of us knew what to do. That brings us to natural supports.

6. Natural Supports 50% of the team are natural supports, which means they are people identified by the family who are brought into the team to provide a sustainable network long after the professionals have moved on. They may be extended family members, neighbors, teachers, pastors, coaches or anyone else that the family identifies and who are willing to provide support. Activities that the child and family team choose to build on strengths are often embedded in community rather than professionally driven “services”. For my youngest son, Ben, his support was a lawn mower repair man who took him in and not only taught him to repair lawn mowers, but also to weld. Through his mentorship, Brian helped Ben forge an identity from his interest in mechanics. That identity enabled him to persevere through school as a young man with severe dyslexia.

7. Collaboration Families like mine who are involved in multiple agencies have one plan. This means that the school, mental health agency, juvenile justice and even child protective services all need to figure out how to get to the same meeting. This is a stark contrast to the common practice of running families to multiple meetings each with their own mandates (and whose demands are often in conflict with one another). This occurs best within systems of care which create overarching connections between child serving agencies. They may also create joint structures such as flex funds which child and family teams can access to pay for nontraditional supports to meet needs. We were in so many systems; school, juvenile justice, and mental health. None of them spoke to each other and each had independent sets of competing demands.

8. Community based Wraparound is an alternative to residential treatment centers and hospital based care. Instead the idea is to WRAP supports around the child and family in their community. This was so different that the solutions offered us … it just would not have occurred to anyone that I knew to use the people and activities all around us as opportunities.

9. Persistence No child or family is kicked out of wraparound, EVER. We don’t blame them if what we are doing is not working, we just shift strategies. Aaron was kicked out of everything he was ever in. Unfortunately we did not know about wraparound for Aaron, and neither did anyone else in our community. We were either not invited in the first place or Aaron was soon on his way out.

10. Outcome-based Wraparound teams do constant progress monitoring, If what we are doing is not working, we do something else. Done well, wraparound does not continue forever … children and families should be making progress … if not we double down and figure out what needs to happen differently.

I started this post a bit over two weeks before the pandemic began to disrupt my and everyone else’s habits and routines. I worry about the Aarons I know today. Are they getting what they need? Are the already limited resources dedicated to them going to be siphoned away? How do we maintain the community relationships and routines, and enable them to experience and build their strengths? Are their child and family teams meeting and working through the challenges we are living through? Are we applying these 10 wraparound principles in the midst of this upheaval?

How are the children?