2009 Winner
Milwaukee County, Wisconsin
Innovations in American Government Awards*
Innovations in American Government Awards*

Wraparound Milwaukee is a community-based system of care that provides comprehensive, highly individualized, family-directed services to youth with serious emotional and mental health needs and their families. Part of Milwaukee County’s Department of Health and Human Services, the program is the first government-operated managed care service designed to treat emotionally disturbed youth in the home setting. This approach stands in stark contrast to most of the country’s treatment models, which often unnecessarily institutionalize youth and limit family participation.

Milwaukee County launched Wraparound Milwaukee in 1995 with funds from a federal grant. Annually, the program now serves 1,300 youth with mental health disorders, attention deficit disorder, and learning impairments that prevent normal functioning in the home, school, or community. Over 50 percent of these children come from families at or below the federal poverty line. Eligible youth are already being treated by two or more social service systems and are often in the process of being transferred to residential treatment centers, correctional facilities, or psychiatric hospitals.

Wraparound Milwaukee attempts to reduce costly and arguably ineffective residential care options by offering a host of individualized treatments that allow youth to stay with their families. Care options and services include tutoring and afterschool programs; group care; recreational, arts, and camp programs; and, substance abuse treatment. Additionally, the program encourages family members to play a more active role in the treatment process as members of the care planning team.

In a unique arrangement, the state's Bureau of Milwaukee Child Welfare, the county's Delinquency and Courts and Behavioral Health Divisions, and the State Division of Heath Care Financing, provide funding for the program. Pooling the funds from these agencies allows for maximum flexibility and creates a sufficient funding source to meet the comprehensive needs of the families served. Wraparound Milwaukee is the nation's first public-benefits corporation run by a government entity. Because the government acts as the single payer for all mental health and social services, families receive a unified care plan operated by a single case manager regardless of which services are used.

Wraparound Milwaukee has greatly improved services to emotionally disturbed. The average daily residential treatment population averaged 375 youth in 1996 and dropped to 90 in 2008. The reduction in the demand for psychiatric inpatient care was even more dramatic, going down from 5,000 days of care to under 200 days during the same period. Officials believe that such reduced utilization of costly inpatient and often last-resort services allows mental health workers to focus more on improved treatment. Clinical scores incorporating feedback from youth, families, and clinicians note an average 20-point improvement of clinical health indicators of treated youth.

The program has also achieved significant cost-savings, largely due to the program's lessened use of residential options. In 2007, it cost over $8,000 to treat a child in a residential treatment center, while it cost about $4,000 to treat a child in the community. In the last three years, over 20 communities across the country have consulted Wraparound Milwaukee for technical assistance with implementing their own reforms.

*This program was the winner of the special Annie E. Casey Innovations Award in Children and Family System Reform.