Box 3
Example of Integrated System of Care for Children with Serious Emotional Disturbance

• Program: Wraparound Milwaukee
  
• Goal: To offer cost-effective, comprehensive, and individualized care to children with serious emotional disturbance and their families. The children and adolescents served by the program are under court order in the child welfare or juvenile justice system, and 64% are African American.
  
• Features: Provides coordinated system of care through a single public agency (Wraparound Milwaukee) that coordinates a crisis team, provider network, family advocacy, and access to 80 different services. The program's $30 million budget is funded by pooling child welfare and juvenile justice funds (previously spent on institutional care) and by a set monthly fee for each Medicaid-eligible child (the fee is derived from historical Medicaid costs for psychiatric hospitalization or related services).
  
• Outcomes: Reduced juvenile delinquency (Figure 2), higher school attendance, better clinical outcomes, lower use of hospitalization, and reduction in cost of care (Annual Report, 2001). Program costs $4,350 versus $7,000 per month per child for residential treatment or juvenile detention.
  
• Biggest Challenge: To expand the program to children with somewhat less severe needs who are at risk for worse problems if they are not recognized and treated.
  
• How Other Organizations Can Adopt: Encourage integrated care and more individualized services by ensuring that funding streams can support a single family-centered treatment plan for children whose care is financed from multiple sources.
  
• Contact Point: Bruce Kamradt, Project Director, Wraparound Milwaukee
  
• Sites: Milwaukee and Madison, Wisconsin; Indianapolis, Indiana; and the State of New Jersey

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