VR-SFP Chapter 12: Wellness Recovery Action Plan (WRAP)

Wellness Recovery Action Plan (WRAP) is an evidence-based system that is used worldwide by individuals who are experiencing mental health and other kinds of wellness challenges. It is a unique form of mental health support that is peer-led and self-directed. WRAP elements and strategies are trademarked by the Copeland Center for Wellness and Recovery (Copeland Center) to help adults with a mental health disability to identify and learn:

• triggers;
• early warning signs that their mental health is worsening;
• wellness tools such as coping strategies; and
• resources to use when things are breaking down.

WRAP is a strategy that helps counselors establish customer stability for possible employment and cannot be provided simultaneously with other therapies.

Customers referred to WRAP must be experiencing difficulties in one or more of the following areas:

• Unable to manage their own recovery
• Self-identifying the need for the service
• Developing self-advocacy skills to increase independence
• Developing and maintaining relationships
• Participating in activities within the community
• Adjusting to physical changes or limitations
• Learning from peer modeling to take increased responsibility for his or her own recovery

WRAP services are for customers who:

• are at least 18 years of age;
• have a  disability such as schizophrenia, major depression, bipolar disorder, or another severely disabling psychological disorder that meets the diagnostic criteria specified in the DSM-5;
• have substance abuse disorders or developmental disorders that co-occur with another diagnosable severe mental illness;
• have functional impairments resulting from a mental illness that substantially interferes with or limits two or more major life activities;
• require crisis resolution, long-term support, and treatment to manage the mental illness; and
• are adjusting to or considering physical lifestyle changes.

12.3.1 Service Definition

The Copeland Center's WRAP process and concepts must be followed in the implementation of WRAP with vocational rehabilitation (VR) customers. The customer curriculum is found in the WRAP Recovery Book. The full WRAP curriculum must be offered in its entirety.

Coursework includes structured lectures, group discussions, personal examples from the lives of the WRAP facilitator and participants, individual and group exercises, and homework assignments. The customer is provided at least 20 hours of services in an individual or group setting.

Coursework must include wellness tools that allow the customer to move forward in recovery by:

• developing natural supports;
• learning appropriate coping skills;
• developing self-management skills;
• identifying uncomfortable and distressing feelings and/or behaviors; and
• developing crisis plans.

WRAP services must include instruction in the following areas:

• Wellness—what an individual is like when he or she is presenting at his or her "best" by the customer's definition
• Wellness Toolbox—a general list of strategies that an individual knows will help keep him or her well. These strategies might also include negative environments, events, and individuals the customer should avoid.
• Daily Maintenance—a list of responsibilities that a customer must do daily, weekly, or monthly to stay well, such as:
  • establishing a consistent routine;
  • taking medication at the same time each day;
  • going to bed at the same time each day;
  • getting out of bed at the same time each day; and
  • exercising at the same time each day.
• Triggers—external events or circumstances that make a customer feel less well.  A customer writes down his or her personal triggers and then writes an action plan of what to do if these triggers were to occur.
• Early Warning Signs—the subtle internal signs of change that indicate to an individual that well-being is becoming compromised. A customer writes a list of these personal signs of change with an action plan of what to do if they occur.
• When Things Are Breaking Down—feelings and behaviors that indicate to an individual that his or her condition is more serious and immediate action is needed to prevent things from worsening. A customer writes a list of signs that things are breaking down and an action plan of what to do if that occurs.
• Crisis Plan—a comprehensive plan, written when the individual is well, telling others how he or she would like to be cared for when self-care is no longer possible. There are several sections to this plan and individuals are encouraged to adapt it to their needs in a time of crisis.
• Post-Crisis Plan—a plan of how others will know when they no longer need to take over the care of the customer. It also includes a plan for reducing support as the customer starts to take back responsibilities and recover from the crisis and reintegrate into a productive life within the community setting. The ratio between customers and WRAP facilitators cannot be greater than eight customers to one WRAP facilitator.

WRAP services can be provided remotely when the VR counselor has indicated approval of remote service delivery on the VR3380, Wellness Recovery Action Plan (WRAP) Referral. For more information refer to VR-SFP 3.4.8 Remote Service Delivery.

Any request to change the WRAP Service Description, Process and Procedure, or Outcomes Required for Payment must be documented and approved by the VR director, using the VR3472, Contracted Service Modification Request form, before the change is implemented. For more information refer to VR-SFP 3.4.11 Contracted Services Modification Request.

12.3.2 Process and Procedure

A WRAP provider receives a VR3380, Wellness Recovery Action Plan (WRAP) Referral. The provider also receives a service authorization and documentation, such as medical and/or psychological reports, case notes, vocational testing, housing, and/or employment data collected by VR that prepare the provider to better work with the customer.

WRAP training must consist of a minimum of 20 hours of instruction and be individualized to the customer's needs and abilities. Instruction can range between four to eight weeks, with meeting times ranging between two to four hours per day or can be provided in a three-day configuration, depending on the participation abilities of the customer.

The WRAP trainer is responsible for:

• providing or coordinating all reasonable and necessary accommodations to ensure full access and participation for each customer;
• contacting the customers to notify them of the dates and times for the classes;
• facilitating a minimum of 20 hours of training in the eight areas defined in the service definition using the Copeland Center's WRAP process and concepts;
• using various instructional approaches to meet the customer's learning styles and preferences;
• supplying materials necessary for the customer to engage in training;
• completing the VR3381, WRAP Report; and
• maintaining attendance records and documentation as proof that the training was administered and that it covered all required training topics.

All documentation must be available for review by VR staff members upon request.

12.3.3 Outcomes Required for Payment

The WRAP trainer documents in descriptive terms all the information required by the service description on the VR3381, WRAP Report, including evidence that:

• the training was provided without exceeding the ratio of eight customers to one WRAP trainer;
• the training was provided in the environments approved by the VR counselor on the VR3380, Wellness Recovery Action Plan (WRAP) Referral;
• the attendance record confirms that the customer participated in a minimum of 20 hours of training;
• the training included the eight required elements described in the service definition;
• all necessary accommodations, compensatory techniques, and special needs were provided, as necessary for the customer, to participate in training;
• various instructional approaches were used to meet the customer's learning styles and preferences;
• all supplies were provided so that the customer could participate in the training; and
• customer satisfaction and delivery of service as described in the VR-SFP was verified by the customer's signature on VR3381, WRAP Report, or with VR staff contact with the customer.

For information on acceptable signatures refer to VR-SFP sections 3.2.14 Documentation and 3.2.16 Signatures.

Payment for WRAP is made when the VR counselor approves a complete, accurate, signed, and dated:

• VR3381, WRAP Report; and
• invoice.

VR does not authorize payments or associated fees for any excused or unexcused absences or holidays.

12.3.4 Wellness Recovery Action Plan (WRAP) Service Fee

A provider cannot collect money from a VR customer or the customer's family for any service charged in excess of VR fees. If VR and another resource are paying for a service for a customer, the total payment must not exceed the fee as specified in the VR Standards for Providers manual.