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A system of care is a coordinated network of community-based services and supports that are organized to meet the challenges of children and youth with serious mental health needs and their families. Families and youth work in partnership with public and private organizations so services and supports are effective, build on the strengths of individuals, and address each person's cultural and linguistic needs. A system of care helps children, youth and families function better at home, in school, in the community and throughout life¹.

In January 2008, the Texas Integrated Funding Initiative Consortium voted to adopt the 10 Principles of Wraparound as developed and endorsed by the National Wraparound Initiative.

¹A system of care is accomplished through using a Wraparound individual planning approach or process.  Wraparound has traditionally been defined by a set of principles about how family members, people in their support system, and service providers should work together to support the family or individual who needs help. During the Wraparound process, a team, guided by a facilitator, creates an individualized plan of care to improve the life of a child or youth and his or her family. Wraparound team members—the identified child/youth, parents/caregivers and other family and community members, mental health professionals, educators, and others—meet regularly to design, implement, and monitor a plan to meet the unique needs of the child and family. Though this may sound relatively simple, actually implementing this process to provide a high-quality wraparound process is challenging.

Ten essential elements are needed for a high-quality wraparound program:

1. Wraparound must be based in the community.
2. Services and supports must be individualized, built on strengths, and meet the needs of children and families across life domains to promote success, safety, and permanence in home, school, and community.
3. The process must be culturally competent, building on unique values, preferences, and strengths of children and families, and their communities.
4. Families must be full and active partners in every level of the wraparound process.
5. The wraparound approach must be a team-driven process involving the family, child, natural supports, agencies, and community services working together to develop, implement, and evaluate the individualized service plan.
6. Wraparound child and family teams must have adequate, flexible approaches, and flexible funding.
7. Wraparound plans must have a balance of formal services and informal community and family resources.
8. An unconditional commitment to serve children and families is essential.
9. The plan should be developed and implemented based on an interagency, community-based collaborative process.
10. Outcomes must be determined and measured for the system, for the program, and for the individual child and family.

Many times the word “wraparound” is used broadly describing unrelated programs or practices than the intended use within the context of serving children with serious mental health needs.  There are efforts underway among national wraparound programs and researchers to ensure that the fidelity of the wraparound model and evidence-based practice are described and used effectively.  One of those initiatives is the national wraparound initiative: http://www.nwi.pdx.edu/ .

The Wraparound process that includes a individual child and family planning team, is an important component of the overall System of Care or systems change process that is needed to change the paradigm to include families of children with serious mental health needs as true partners with service providers to develop and follow a community plan to better serve these children and families.  Rather than building services and programs that community programs/providers speculate that are needed by children with complex needs, working directly with the families and the youth with complex needs ensures that an array of traditional and non-traditional services are available for this population thereby preventing or lessening the higher-cost in-patient treatment options.

The Wraparound process addresses individual service planning needs while the System of Care, addresses a whole community “systems change” to develop a system to provide better outcomes for children and youth with serious mental health needs and their families.  The System of Care approach is grounded through the support of federal initiatives through the Substance Abuse and Mental Health Services Administration (SAMHSA) under the United States Department of Health and Human Services.

Background in Texas

In the late 1980’s, efforts were launched in Texas to introduce the federal Child and Adolescent Service System Program (CASSP) principles as the standard for children’s services. State block grants were awarded from legacy agency Texas Department of Mental Health/Mental Retardation, now Department of State Health Services, to community mental health centers through the Texas Children’s Mental Health Plan to support the development of children’s services in an effort to address the needs of children with serious emotional disturbance (SED).  The recognition that serving children could not be done in isolation but requires cross system planning and coordination resulted in the establishment of Community Resource Coordination Groups (CRCGs) across the state in the early 1990’s.  Child welfare, juvenile justice, education, mental health and community-based agencies have often worked together on local or state children’s mental health initiatives, with varying results, for many years.  Texas' first exploration into blended funding for children's services occurred in 1996, when the Texas Department of Mental Health and Mental Retardation and the Texas Health and Human Services Commission conducted a pilot study supported by a Robert Wood Foundation grant, to determine the effectiveness of community-based service options in decreasing the use and duration of residential treatment.  Travis and Brown Counties comprised the initial Texas Integrated Funding Initiative (TIFI).  This foundational work was influential in the success of Austin Travis County’s 1998 application to the division of the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA) for federal funds to build a System of Care model of service delivery.  In 1999, the Texas Legislature passed Senate Bill 1234 expanding the system of care effort through funding of TIFI to support more communities by launching a system of care service delivery approach.  In 2002, El Paso and Ft. Worth became the next cohort of Texas sites funded by SAMHSA to develop Systems of Care communities.  In October 2005, Harris County became the newest Texas community to assume a key role in mental health system transformation for children and families in Texas.

¹Building Systems of Care: A Primer, Sheila A. Pires, Humans Service Collaborative, Washington, DC, supported by Child, Adolescent and Family Branch; Center for Mental Health Services; and Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services:

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Last Updated: 12/1/11