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Wrapping around kids in need

May 1, 2007
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A Missouri provider finds that investing in the front end of services pays off

Families and social workers are faced with many challenges when trying to access services to address abuse, neglect, or mental health concerns. The system is underresourced and disjointed and, unfortunately, this system is where we often find the 5 to 9% of American children who have at least one serious emotional disturbance (SED) and the 896,000 children abused or neglected each year (2002 estimates according to the Child Welfare League of America). Violence, mental disorders, and health problems are just a few of the challenges these children face and, adding to the chaos, many are without a permanent home. More than half a million children are in the foster care system, according to CWLA. These children require customized, attentive care to have a fighting chance at living successfully in the community.

The Missouri Alliance for Children and Families (MACF) helps these neglected, abused, and SED children live safely within a family setting. In 1997, the organization was formed to provide the comprehensive, community-based wraparound care that these children desperately need. Since then, MACF's programs and successful outcomes are conservatively estimated to have saved Missouri more than $16 million by the end of 2006. MACF currently manages 898 cases, more than any other child welfare services provider in Missouri.

Organizational Model

Without proper care, SED, abused, and neglected children are at high risk for a lifetime of residential care or incarceration. This is not only an unfortunate and unnecessary prospect, it's also an expensive one. Therefore, MACF's purpose is twofold: to properly and effectively treat SED, abused, and neglected children, and subsequently to reduce the long-term costs associated with these children growing up to become adults who may require extensive services. Owned by nine of Missouri's most respected children's services agencies, MACF is the only one of its kind in Missouri.

To successfully treat these children, MACF employs low caseloads, increased personalized care, multiple in-home visits per month, and the resources of more than 400 mental healthcare, healthcare, educational, and placement resources (both public and private). With so many resources at hand, MACF can offer wraparound care. Research has shown that this approach, which “wraps” the child in a customized, strategically designed set of treatments and resources, increases the chances that children suffering from neglect, abuse, and SED can live happy, productive lives in the community. Notably, the majority of expenses are at the front end of treatment, when they are most effective and most needed, and later taper off as the child is stabilized.

This funding model is one of the most pivotal differences between MACF and the traditional model of care and an integral reason for the program's success. Children enter care with an average monthly cost of more than $4,000, and when successfully disenrolled the average monthly cost drops to $1,500. This is largely due to using less restrictive community settings and “informal” supports.


Of the 1,400 cases MACF has taken on since its inception in 1997, approximately 65% of children have been placed successfully into a family-like setting in their community. Other children, unfortunately, have been so damaged by their experiences that they may run away or commit a crime. Others age out of foster care prior to the care plan's completion. Yet the MACF Permanency Program has placed more than 200 foster care children in permanent homes with family members or adoptive parents since its inception in 2005 (35 in October and November 2006 alone).

In 2006, MACF was awarded the first Collaborative Leadership Award from Provident, Inc.'s Life Crisis Services division, one of the nation's oldest phone hotlines providing suicide prevention and crisis intervention services. The award recognizes organizations changing the way Missouri supports mental health through collaboration, particularly in the fight against suicide. MACF's efforts to develop crisis safety plans for this high risk group of children was recognized as a distinct contribution to preventing children from reaching a state of desperation that puts them at risk for suicide.


MACF's results indicate that it is emerging as a model program for utilizing a wraparound philosophy that moves children from structured residential care to community-based care. Unfortunately, at this time its services are available only to children in eastern and mid-Missouri. MACF hopes to eventually secure approval and funding from the Missouri Department of Social Services to take its programs statewide. Additionally, a number of agencies from around the United States have begun investigating ways to adapt MACF's model for children in their states, and MACF welcomes the opportunity to share its methods and model with other child welfare groups.

Dick Matt is President and CEO of the Missouri Alliance for Children and Families.