Lessons from wraparound care: The future of integrated social services

TaskForce Community Agency recently wanted to try and better understand what wraparound meant today. Here Mike Davis shares the key learnings from their experience evaluating their model of care.

Wraparound is a widely used term in health and social service provision today. However, what it means in practice is less well known. 

From my time at the Department of Health and Human Services, I understood wraparound care to be about supporting our clients at all stages of their “life course journey”. But I was less sure how this operated in practice.  

At TaskForce Community Agency, we had been practising integrated and holistic place-based care with our clients since 1973. However, as we had grown from a small team and client base to over 100 staff and around 7,000 clients per year – we wanted to try and better understand what wraparound meant today.

The timing was ideal as we were in the process of launching our first Youth Hub, where we planned to provide evidence-based wraparound care to our youth clients aged 12 to 25. We also hoped to extend these learnings to our adult services site in Bentleigh. In preparation for this, we partnered with academic experts at Latrobe University and the Burnet Institute to conduct a literature review and evaluation of our wraparound preparedness. 

Here are some of the key learnings from that process:

1. Wraparound care challenges traditional service models

Traditional service and funding models rely heavily on funding a particular activity or episode of care. In these cases, the output is treated as though it is the outcome; and little attention is paid to service integration or to client experience. 

A client facing many intersectional prisms of disadvantage may have to attend one site for drug and alcohol counselling and another site for family services, which derive from separate funding sources. Given that these services may address similar or overlapping issues, an optimal situation for the client and the funder would involve these services being provided at one site from a co-located partner.     

So whereas traditional involves productive efficiency – the most services at the least cost – wraparound care challenges this approach with a call for greater allocative efficiency, distribution of services according to the consumers needs.  

The wraparound model adopts a client-driven approach instead, where services are “wrapped around” the client and their family in their natural environments as a way to improve client outcomes.

This is confronting to the traditional conception of service provision and our challenge is to prove that this approach produces better social outcomes; and is financially more expedient. 

2. Stakeholder engagement is paramount

Semi-structured conversations with our staff and clients formed a significant part of our evaluation. This was never going to be as simple as asking, “Do you enjoy wraparound care?”. We learned here that refining new service models require equal amounts of education and attentive listening. 

We explored our interviewees’ understandings of “wraparound care”, their experiences of and attitudes towards delivering this type of care at TaskForce Community Agency, barriers to effective service delivery and sustained progress in working with their AOD (alcohol and other drug) clients and thoughts on ideal service provision.

A TaskForce counsellor’s perspective indicated a need to embrace a wider perspective in supporting our clients:

“From a wraparound standpoint we should be putting a lot more effort into families and caregivers. Don’t wrap services around the client; wrap a support system around them.” 

Consumers indicated that they were primarily focused on the service for which they came to TaskForce Community Agency for (such as drug and alcohol counselling). However, our report writer noted that several clients were undergoing education or seeking employment as an avenue to maintain abstinence. 

An older client described TaskForce Community Agency as “a place to go when you’ve got nowhere else to turn to” and others noted that:

“Their AOD workers truly cared about their future and would go out of their way to meet clients’ needs, eg through doing remote consultations, being available after hours and even if without a booked appointment.” 

Since starting at TaskForce Community Agency most clients believed they had made progress on their AOD-related issues and seen great improvements to their overall wellbeing.

3. What you do next matters most 

It’s often been said that 90 per cent of the challenge in systems or policy change is not the design, but the implementation. We learned a huge amount from our experience evaluating our wraparound model of care. Much of this learning was about understanding what we know, what we don’t know and what we need to do next to discover the unknowns. 

In our case this led to implementing a number of service improvements. Firstly, we have commenced a data-partnership with Our Community to better understand our existing data sets and where service gaps and opportunities to better support our clients exist. 

And we have implemented some exciting changes:

1. Designing and implementing a Demographic Cover Survey across our organisation.
2. Undertaking a total clinical and performance audit of our Youth Hub over year 1 of operations.
3. Scoping plans and entering into discussions with academic centres of excellence to design additional research and evaluation of year 1 of our wraparound model at our Youth Hub site.

“Overall, our evaluation has shown that TaskForce is an organisation highly valued by their staff and clients. Their aim to deliver wraparound care and improve long-term outcomes of their clients is reflected in all its activities and many of the wraparound indicators are implemented successfully.” 

It is encouraging to note that in late 2018, the Department of Health and Human Services restructured its funding model for children, youth and family services to enable wraparound support for clients.

Further, a recently published paper by Smith et al. on youth wraparound care in Western Australia demonstrated how effective this model can be with its “potential to offer improved clinical outcomes, significant cost savings over time, improved coordination between care providers, and an alternative to detention or incarceration.”

Our Youth Hub setup has enabled us to work closely with our co-located partners including Family Life (family services), Thorne Harbour Health (LGBTI services), Headspace (mental health support) and APM (disability services) to support our diverse mix of clients and their specific needs.  

We are pleased with the growth of our Youth Hub and wraparound care model and believe that this is the way forward for our organisation in the years to come. 

Wraparound enables us to deliver great outcomes in a truly collaborative and client-centred setting. 

To learn more about our wraparound model and Youth Hub contact Mike Davis at miked@taskforce.org.au.