Demystifying and Defining "Wraparound" and ABA

Tonight’s post is one of the many that are floating brewing (get it?! ok, I’ll see myself out for a moment) in my head. As an employee of a human service provider in Western Pennsylvania and as a veteran parent who’s been around the block and back a few times in the “system,” I see, and I am asked, the following questions quite frequently:

“What is wraparound?”

“What is BHRS?”

“What is ABA?”

“What is a BSC? Is that a BCBA?”

“Aren’t ABA and wraparound the same thing?”

Well, the Caffeinated Advocate is here to answer those questions for you and hopefully alleviate confusion that so many parents and caregivers newer to this process experience. I found myself in those shoes in mid 2001 when Christian received his diagnosis of autism (and that’s a story for a future unbelievably powerful and raw blog). I was given handouts and stapled catalogs with the mish mosh of ABCs of our new autism world, this ABA stuff and some kind of wraparound mumbo jumbo. And I hadnt a daggone clue what any of it meant.

I am eternally grateful for Jody, who was a social worker at UPMC Mercy who partnered alongside Dr. Newman, the psychologist who diagnosed Christian with PDDNOS. I called her the day after I went home with my stack of books and papers. I cried – and it was an ugly cry, an EARNED ugly cry – and begged her to explain this new process to me. I remember saying “I feel like I have to be a secretary and a scientist and a researcher and a teacher and a therapist and a case manager and a chaffeur and a warrior and and and … (activate ugly cry once again) I CAN’T DO ALL THIS!”

Praise God, I had her to hold my hand (and hand me tissues when in her presence) through the initial stages of accessing care for Christian. She helped me with making those calls to initiate all of the services that Christian needed to begin his treatment. She assisted me with calling Mon Valley Supports Coordination to obtain a case manager (and if you’re lucky enough to get Val Tkocs, you were sent an angel from the heavens), calling the AIU to schedule an evaluation for Project DART, scheduling an appointment with Dr. Scott Faber to evaluate genetic history and biomedical needs (now with Children’s Institute – and many of my readers are likely current clients or on his never-ending waiting list) … and securing this “wraparound thing.” You know what I’m talking about … I mean the TSS BSC MT BHRS ABA thing. Yeah, that.

As I accepted my new hats as described above, I became an internet night owl. I would eat, sleep and breathe webpages and forums and chat rooms. I felt like it was the only way to bring my son into our world. I knew there was a brilliant boy beyond those gorgeous eyes just waiting to pop out and show everyone what he was made of. Though he wasn’t toilet trained, ate maybe five foods, couldn’t speak in coherent sentences, lined up his toys, flickered ceiling lights and faucet handles, engaged in self injurious behaviors and so much more, he knew his ABCs, his 123s up to 100, every single shape known to man, scripted phrases and jingles from songs and shows and could direct any driver home from any location or direction (and to this day, he is still my human GPS / Google Map Ninja).

I made the call to our first of many providers and said “I need wraparound therapy for my son – you know, ABA.”

Fast forward to our first appointment, I was given a wealth of information, including a clear explanation of what wraparound was, and what ABA was. I learned that there was a definite distinction, and that wraparound is NOT a “therapy.” Say what?! After a few years of intensive services with many angels who became part of our family, I was compelled to give back some of what was so graciously given to me. I applied for my first job in the human services field. I became a parent liaison for a local BHRS (“wraparound” – yes, I’m getting to the meat and potatoes, stay with me!) provider and also provided them with some technical support. I was finally in a position where I could be the “Jody” on the other end of the line to provide a caring ear and to have the chance to clarify a process with loads of red tape and lots of frustration.

Allow me now to demystify these terms for you, and simply:

Wraparound is a process – not a program, not a therapy, not a modality. Wraparound is a process that unites a team of people who essentially “wrap around” the child. This often includes, and is not limited to:

   * parents or caregivers

   * siblings or other immediate family members involved with raising the child enrolled in care (which are some of those individuas referred to as “natural supports”)

   * clinicians from a service provider – including a masters level lead therapist who writes the treatment plan and program, and one or more bachelors level therapists to deliver the one on one therapy defined in the plan (I’m getting to that too)

   * a case manager (which in PA could be a resource coordinator or an administrative case manager)

   * early intervention staff (depending on the age at the time of service entry)

   * teachers

   * paraprofessionals

   * other agency personnel

Speaking of service providers, let’s move onto BHRS. BHRS stands for Behavioral Health Rehabilitation Services. These services are provided to children and teens from birth to 21. BHRS has often been nicknamed “the wraparound program,” as BHRS staff are often seen as leaders of the wraparound team. BHRS is a time-limited service, which at first, sounds scary to parents! I remember being told from the get-go that our staff wouldn’t be around forever. Back in those days, I was petrified and shuddered at the thought. I learned, and thus was able to teach in my “Supporting Families and Siblings” co-facilitated training for clinicians and agency leadership down the road in my next role as a director of family support services, that if the same BHRS staff were in my home for several years without a fade plan in place or without a plan to move onto different (lesser, where possible) levels of care, that my team was doing our family a disservice. The goal of any child’s BHRS team is to fade to natural community supports as soon as he or she is ready to do so. I often hear the argument that some children “may never be ready” for that fade. To that, my reply is that BHRS may not be the right service for them. BHRS was originally designed to address emotional or mental health issues. It was not designed to support individuals with autism. However, over time, the system evolved and it was recognized that co-morbidity in children with autism was common and needed addressed along with skill deficits, social communication barriers and neurological differences that prevented typical development. In the late 90’s as this system truly took off, there was also no “place” for children and teens with a spectrum diagnosis. Therefore, they flew around and around and landed on the BHRS pad regardless of co-morbidity. To this day, autism in many states, including PA, is still supported by BHRS and the wraparound process.

What is ABA, and where does it fall into this crazy downtown Yinzburgh like map? I’m going to keep this simple, even though I could go on for hours (no really, HOURS!). I truly want readers, especially who are parents and newer to all of this mass chaos, to have simple explanations that pave the way for basic understanding in order to move forward. I want to be your “Jody.”

ABA stands for Applied Behavior Analysis, which is a treatment modality (or type of therapeutic approach) often used for not only individuals with autism, but other developmental challenges and behavioral health diagnoses. If you attend Google University, you will likely still find some pages, articles, and blogs that accuse ABA of being the therapy that turns children into robots. It is important to understand – simply put – that ABA is a treatment modality that permits us to study behavior patterns and to then change and shape behaviors of social significance. ABA allows us to address such areas as:

   * social skills
   * communication
   * self help skills or activities of daily living (ADLs, like dressing, toileting, eating, hygiene)
   * fine motor skills
   * gross motor skills
   * reading and some pre-academics

A generic, broad goal of ABA is to achieve generalization across environments. This means a child or teen demonstrates mastery of skills in the home, school, daycare, community setting, or vocational setting. The practice of ABA uses data collected to assess progress and regression.

In PA, a BSC, or Behavior Specialist Consultant is who writes the initial and ongoing treatment plans for the consumer and serves as a team lead. It is now mandated in the state that those BSCs hold a degree in human services and log at least 1000 hours of service in the field before they can treat someone with autism. This credential is known in PA as LBA, or Licensed Behavior Analyst.

A BCBA is not the same thing, though a BSC with their LBA might also be a BCBA. Are you confused yet? Bear with me! A BCBA is a Board Certified Behavior Analyst, which is a masters level clinician who has taken extra college coursework, sat through a (painful – ask anyone who’s been through it) exam, and is held to extensive supervision and continuing education standards set forth by the BACB (ready for your bowl of alphabet soup yet?). The BACB is the Behavior Analyst Certification Board.

There are many other terms and abbreviations I could address, and of course I am happy to if asked through comments and messages. But my main goal this evening was to ultimately answer whether or not ABA and wraparound were one in the same, and throw in a few extra tidbits to give a somewhat clearer picture of a daunting and overwhelming process.

Jody, wherever you are, I hope I made and continue to make you proud in my work calling.

Author: Catherine Hughes

Passionate Advocate. Innovative Storyteller. Engaging Strategist. Author. Editor. Blogger.

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