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{Wraparound Services} What are they? How do I apply?

Wraparound Services child running down school hall and how to apply for it
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Wraparound Services

As I’ve navigated my way through the disability community over the past five 11 years, I’ve noticed a trend. That is, NO ONE TELLS YOU ANYTHING! Don’t get me wrong, if you ask, you usually are helped. At least that has been my experience. But how do you even know what to ask for? How can you ask for wraparound services if you don’t even know it exists? And no one sits down with you and says “Here is all the crap you qualify for, have at it.”

So, if you’re like me, you’ve been at therapy appointments or other similar venues, and you see the other kids walking around with this shadow. And you say to yourself–“Self, I guess that’s an older sibling…or a cousin…or a nanny.” Then you hear her say, “Oh, no, I’m the TSS.” And now you’re wondering what the heck a TSS is, right? Luckily right around that time, I was looking into this, someone from K’s school said: “Have you looked into wraparound services?” No, no I haven’t because I have no idea what they are or that they even existed.

Wraparound Services
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Article on Wikipedia explaining Wraparound

So here you go–Wraparound 101. Please note that my information and experience is from Chester County, Pennsylvania–your mileage may vary. Please share this with your special needs parenting friends that you think would benefit from this information.

FIRST AND MOST IMPORTANT! You must ‘meet the criteria for medical assistance’ to get wraparound. So please visit Michele’s post on How to apply for Medical Assistance before you ask about wraparound. Otherwise, you’re just spinning your wheels.

What are Wraparound Services?

First, this varies by state. Of course! Everything varies by state, right? The concept is the same everywhere; how they are implemented will look different.

Behavioral Health Rehabilitation Services (BHRS) or “Wrap Around Services” are designed for children in the state of Pennsylvania who are between the ages of 2 and 21 and meet the criteria for Medical Assistance. The child must also have a primary psychiatric diagnosis, and be at risk for a more restrictive placement. Ok, let’s focus on those bolded words. This doesn’t mean that your child has to be mentally ill, there are children who have a diagnosis of “Behavior Problem-Other.”

The goal of wraparound is to assist the child with behavior problems, so essentially there has to be some negative behavior going on. And when looking at your child–remember that shutting down, withdrawal, anxiety–those are all negative behaviors. It’s not just for outbursts, tantrums, and violence which is what most people think of. If your child has a diagnosis of ASD, MR or some other similar items, that’s kind of a shoo-in for the services. But don’t be discouraged if they don’t.

Who qualifies for Wraparound?

I’m going to try to thoroughly, yet as briefly as possible, explain the process. This is from the PA state’s website:

“Wraparound or BHRS services fall under the Pennsylvania Department of Public Welfare guidelines for Behavioral Health Rehabilitation Services. Wraparound Services are short-term and intended for children with severe emotional or behavioral problems who are at risk for removal from their homes or communities.”

Please know that there can be, depending on who you are with, a negative stigma associated with Wraparound. That description from the state doesn’t help, in my opinion. Many children who receive these services have SED issues, maybe ODD, maybe drug & alcohol. So it is often seen as only the “bad kids” get wraparound. I don’t believe that there are truly any bad children, so this is quite untrue in my opinion. Lots of kids get wraparound services, it’s just that those who act out or are violent are the more visible children in a community, which is unfortunate. It’s a fantastic resource and you should use it if you need it.

Great, so how do I get a TSS?

{Please note, these services are not available in every state. You’ll have to poke around online or ask your pediatrician.}

First, contact your IU and ask them who is in charge of the wraparound services. You can also ask at your school, as many APSs provide this service contractually. That person should give you a list of people in your community and some may, in fact, work for the IU. The Chester County IU does have a wraparound department. Choose one and call them. Tell them you want to make an initial intake appointment for wrap-around services. If one of your child’s teachers or therapists suggests this, it’s not a bad thing!

At your first appointment, it’s pretty in-depth but at the same time, usually informal. You’ll have lots of forms to fill out (again!) and have to tell your story all over again. This person then evaluates all that information and the situation and determines if it is appropriate for you to proceed in the process.

If it is determined that your family is not a good fit, ask what the next steps are for you to take–what other options you have as far as alternative services or appeals.

If you do qualify, your child’s next appointment will be with a psychiatrist or psychologist. Wraparound services can only be prescribed by a Psychiatrist or a Psychologist. Usually, at the end of that meeting, he/she will tell you what their determination will be and what they will be prescribing. It will be for a set number of hours with one or more of the following professionals–BSC, TSS, MT.

A skilled staff person works with the child for a specified number of hours per week in his/her home, school, and/or community.

Different Wraparound Service Providers

Behavioral Specialist Consultants (BSC), Mobile Therapists (MT), and Therapeutic Staff Support (TSS) work together to provide the following services:

  • Formulation and implementation of behavioral treatment plans
  • Collaboration with and transfer of skills to parents, school staff, and other caregivers
  • Specialized treatments targeting symptoms of various childhood mental health disorders such as Attention Deficit Hyper-Activity Disorder, Oppositional Defiant Disorder, and Anxiety Disorders
  • Specialized Autism treatment

And that’s really it. The BSCs and MTs work to develop the behavior support plan, and the TSS is there to help you implement the plan.

Wait! You’re not over all of the hurdles yet. Of course, since there are insurance companies involved, there’s another step.

You will have another meeting. This time it’s with the first person you met (usually, anyway-the person who did your intake) and the person who represents the insurance company. Oh yay! Now you have to essentially “make your case” all over again to them. Then this person takes all the information back to the insurance company, and they decide if they are going to pay for all of the services you’ve been prescribed. If they do a full or partial denial, there is an appeals process.

Trust me it’s a very nail-biting process, and we made it all to that last meeting, and then we got a letter that was asking for clarification and more information. Ugh! So we had to wait an extra few weeks for our determination.

Once you make it through all of that and get on a roll……you get to do it all over again, at least annually. Services are never prescribed for more than a year at a time.

Please note that TSSs are NOT babysitters, caregivers and in fact are NOT ALLOWED to do diaper changes, feeding, stuff like that. That’s nursing, a separate entity. Wraparound is strictly for behavior issues, not medical. You may qualify for in-home nursing assistance. Ask your IU or child’s school for more information.

This is an older post that was recently updated and fixed to correct links.

 

Wraparound Services child running down school hall and how to apply for it
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