Journal Articles
Adapting Community-Based Wraparound for Use as an Intensive Intervention in Schools
Abstract: Multi-Tiered System of Supports and Positive Behavioral Interventions and Supports frameworks focus on providing effective Tier 1 (universal), Tier 2 (selected), and Tier 3 (individualized) strategies to meet all students’ behavioral and emotional needs. However, there are few Tier 3 models that provide support spanning home, community, and school for students with serious emotional and behavioral challenges (SEBC). This U.S. study used expert and local input to (a) develop practice guidelines and implementation supports for a school-based Wraparound care planning and coordination model and (b) evaluate school feasibility and readiness to implement systems, practices, and data.
Citation: Soon, K., Suter, J. C., Linkous, O., Davis, C. A., & Bruns, E. J. (2025). Adapting community-based wraparound for use as an intensive intervention in schools. Journal of Positive Behavior Interventions, 28(2).
Abstract: In response to the growing need to monitor fidelity to the Wraparound process, a variety of instruments have been created and tested. In this study, the authors present the results of several analyses designed to better understand the measurement characteristics of the Wraparound Fidelity Index Short Form (WFI-EZ), a multi-informant fidelity instrument. The results from our analysis of 1027 WFI-EZ responses indicate that the internal consistency of the instrument is very good, although the negatively worded items did not appear to function as well as positively worded items. Results from two confirmatory factor analyses were unable to validate the original domains identified by the instrument developers, but for certain outcomes the WFI-EZ demonstrated deseriable predictive validity. Preliminary evidence is also provided that WFI-EZ responses likely differ by respondent type. We conclude by discussing the implications of using the WFI-EZ in programming, policy, and practice considering the findings of our study.
Citation: Attell, B. K., Singleton, A. C., McLaren, S. A., & Moses, G. (2023). Measurement Characteristics of the Wraparound Fidelity Index Short Form: Results from a Statewide Implementation. Evaluation & the health professions, 46(4), 320–333.
Factor structure, reliability and validity of the Wraparound Fidelity Index Short Form (WFI-EZ)
Abstract: The current study presents results from a series of studies that collectively assessed the factor structure, reliability, and validity of the Wraparound Fidelity Index, Short Form (WFI-EZ), a four section, multi-informant, self-report measure. Analyses of a sample of 10,955 caregivers of youth who received Wraparound and completed the WFI-EZ found a four-factor solution that aligned well with previous theories of change for Wraparound, with factors focused on team membership, team process, inclusion of natural supports, and intermediate outcomes, including increased family assets and more effective services and supports. Results indicate the WFI-EZ is a reliable and valid measure of Wraparound fidelity, while also pointing to opportunities for future refinement, further research, and opportunities for improving Wraparound training and implementation support.
Citation: Bruns, E.J., Olson, J.R., Parigoris, R.M. et al. Factor Structure, Reliability, and Validity of the Wraparound Fidelity Index Short Form (WFI-EZ). J Child Fam Stud 32, 1855–1868 (2023).
Abstract: This study examined the impact of a wraparound program for adult Medicaid managed care organization members with serious mental health or substance use disorders on health care costs and utilization. This retrospective observational study used 2013-2018 claims data collected from a large Medicaid managed care organization operating in multiple states. We used an intention-to-treat difference-in-difference study design to examine the association of the wraparound with costs and utilization. Adult Medicaid members with an emergency department (ED) or inpatient visit for a behavioral health condition (index visit) were eligible for the study. Outcomes included all-cause and behavioral health-related costs and utilization during follow-up after the index visit’s admission date. Outcomes were calculated overall, as well as separately by inpatient, ED, and outpatient/wraparound settings.
Citation: Chi, W., Nguyen, B.T., Kent, S.T. et al. Cost and Utilization Impacts of a Medicaid Managed Care Organization’s Behavioral Health Wraparound Program. Adm Policy Ment Health 49, 658–669 (2022).
Watch Me Rise: An evaluation of Wraparound with homeless youth with a child welfare history
Abstract: Older youth involved with child welfare experience disproportionate rates of homelessness after leaving custody compared to youth with no child welfare history. More intervention programs for this population are needed. Watch Me Rise (WMR) was developed as part of an initiative to build evidence for interventions that prevent homelessness among youth and young adults who have a child welfare history. WMR is based on High Fidelity Wraparound (Wraparound) and was implemented in a shelter that serves homeless youth (ages 18-24) in order to prevent them from experiencing recurring homelessness. The present study was part of a formative evaluation of youth outcomes in WMR and looks at preliminary findings within the first six months of enrollment in the program. A total of 87 youth enrolled in WMR during the evaluation period and results indicate youth housing stability improved within the first six months of youth enrolling in WMR. Youth also demonstrated improvements in life domain functioning and employment/employment readiness. Although several other outcomes were not achieved or the results were inconclusive, the study highlights important insights for working with and studying this important population. Implications for the implementation of WMR or Wraparound with homeless youth who have a child welfare history are discussed.
Citation: Lindquist-Grantz, R., Downing, K., Hicks, M., Houchin, C., & Ackman, V. (2022). Watch me rise: An evaluation of wraparound with homeless youth with a child welfare history. Children and Youth Services Review, 141, Article 106587.
Abstract: The aim of this systematic review was to map the peer-reviewed literature (2009-2019) relating to school involvement with wraparound models in the support of students with complex needs. Specific research questions addressed explored the evidence base of the efficacy of wraparound with these students and barriers and enablers in the provision of wraparound services. Database searches were conducted and a total of 50 articles were identified. The analysis revealed eight different aspects of wraparound efficacy, with mixed results. Nine factors were identified as having a positive enabling, or disabling, effect on the provision of effective wraparound services. The wraparound programs were varied in their nature and in their successful implementation, with time to allow the program to mature and adherence to the 10 principles of the wraparound process emerging as enabling factors for wraparound success.
Citation: Cumming, T. M., Strnadová, I., Lee, H. M., & Lonergan, R. (2022). Education-Centred Formal Wraparound Services in Support of School-Aged Students With Complex Support Needs: A Systematic Review. Australasian Journal of Special and Inclusive Education, 46(1), 47–60. doi:10.1017/jsi.2022.1
Abstract: Objective: Systems of care (SOCs) were developed to increase access to and quality of care for children with emotional and behavioral difficulties and their families through the provision of coordinated, community-based, culturally competent, family-driven services. SOCs focus on wraparound care that is individualized to meet each family’s needs. Previous research has illustrated significant disparities in outcomes of non-wraparound care on the basis of youths’ race-ethnicity. This study aimed to fill a research gap by examining disparities in outcomes for families receiving wraparound care coordination within an SOC. Results revealed the positive impact of care coordination on the health and well-being of youths and caregivers across racial-ethnic groups.
Citation: Stenersen, M. R., Kelly, A., Bracey, J., Marshall, T., Cummins, M., Clark, K., & Kaufman, J. S. (2022). Understanding Racial-Ethnic Disparities in Wraparound Care for Youths With Emotional and Behavioral Disorders. Psychiatric services (Washington, D.C.), 73(5), 526–532.
Evidence Based Practice in Systems of Care for Children with Complex Mental Health Needs
Abstract: Community-based social work with families and youth with complex behavioral health needs highlights challenges to incorporating empirical evidence into routine practice. This article presents a framework for integrating evidence in community-based Systems of Care for these children and their families. Based on this review, this article proposes the Evidence-Based Practice in Systems of Care (EBP in SoC) model. The model describes how to incorporate evidence into every aspect of community-based SoCs for children with mental health concerns. Discussion of the model will focus on implications of using the framework for practitioners, mental health organizations, communities, and state and federal administration and policymaking.
Citation: Graaf, G., Accomazzo, S., Matthews, K., Mendenhall, A., & Grube, W. (2021). Evidence Based Practice in Systems of Care for Children with Complex Mental Health Needs. Journal of Evidence-Based Social Work, 18(4), 394–412.
Paths Toward Sustainable State and County Systems of Care
Abstract: The Substance Abuse and Mental Health Services Administration’s Children’s Mental Health Initiative (CMHI) Cooperative Agreements support the development of children’s systems of care (SOCs). The National Evaluation of CMHI interviewed representatives from Mental Health Authorities (MHA) and Medicaid agencies in 25 state, county, and municipal jurisdictions in the FY13 and FY14 grant cohorts in grant years 2 and 4. This paper analyzes funding for five services (wraparound planning; intensive care coordination; family peer support; youth peer support; and flexible funding) that are a core part of SOCs, and grantee descriptions of sustainability strategies and challenges. The analysis found that, of the five pathways described in the literature: securing Medicaid coverage; obtaining state MH system funding; braiding funding with other child-serving systems; modifying payment structures to support workforce development; and redeploying funds from higher cost to lower cost services, grantees most frequently used Medicaid coverage, often combined with MHA funding.
Citation: Holt, W., Hahn, T., Ireland, A. et al. Paths Toward Sustainable State and County Systems of Care. J Behav Health Serv Res 48, 517–536 (2021).
Abstract: Wraparound is a common method for coordinating care for children and adolescents with serious emotional disorders (SED), with nearly 100,000 youths served annually in the United States. The current systematic review and meta-analysis estimated effects on youth outcomes (symptoms, functioning, school, juvenile justice, and residential placement) and costs. Results indicate positive effects for Wraparound, especially for maintaining youths with SED in the home and community. However, many studies showed methodological weaknesses, and fidelity measurement was largely absent, suggesting a need for additional research. Nonetheless, the results should aid decisions around resource allocation, referral practices, and system partnerships among child psychiatrists and other behavioral health professionals.
Citation: Olson, J. R., Benjamin, P. H., Azman, A. A., Kellogg, M. A., Pullmann, M. D., Suter, J. C., & Bruns, E. J. (2021). Systematic Review and Meta-analysis: Effectiveness of Wraparound Care Coordination for Children and Adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 60(11), 1353–1366.
Influences of Inner and Outer Settings on Wraparound Implementation Outcomes
Abstract: The current study evaluated the influence of outer setting drivers on implementation of Wraparound care coordination for youth with complex behavioral health needs. Data were drawn from two sources. First, we examined the impact of outer setting drivers on Wraparound implementation by comparing Wraparound implementation in states that used Community Mental Health Centers (CMHCs) versus Care Management Entities (CMEs). Wraparound fidelity data were compiled for a sample of 1174 direct service providers within 9 states. Second, we compared workforce development efforts across CMHCs and CMEs within a separate sample of 813 administrators and practitioners. Results of multilevel models found that CMEs were associated with higher overall fidelity scores than CMHCs [b = .219, t(5.47) = 3.26, p = .020] even after accounting for state-level covariates and the clustering of individual practitioners within organizations. Furthermore, compared with CMHC staff, those employed by CMEs reported higher competence with the Wraparound model and attended more Wraparound-related trainings. Staff employed by CMHCs were more likely to change practices than their CME counterparts. These findings suggest possible influences of outer settings on Wraparound implementation.
Citation: Olson, J.R., Azman, A., Estep, K.M. et al. Influences of Inner and Outer Settings on Wraparound Implementation Outcomes. Glob Implement Res Appl 1, 77–89 (2021).
Innovation in Child Welfare: Factors Affecting Adoption of Empirically Supported Interventions
Abstract: This article examines barriers and supports to innovation and utilization of ESIs in child welfare. Despite a push to utilize evidence-informed practice there has been little research on unique challenges of implementing empirically supported interventions (ESIs) in child welfare. This study addresses that gap by identifying factors affecting adoption of three ESIs introduced to the child welfare system in Hawai’i: Intensive Home-based Services, Family Wraparound, and Safety, Permanency, and Well-being. Findings suggest workload, time commitment, and perceived risk of the interventions should be addressed during the implementation of new programs in child welfare, and that the caseworker’s social system can be targeted to improve relative advantage of new interventions. This study aims to contribute to knowledge on successful implementation of ESIs in child welfare to improve essential services for children and families.
Citation: Agner, J., Barile, J. P., Chandler, S. M., & Berry, M. (2020). Innovation in child welfare: Factors affecting adoption of empirically supported interventions. Children and Youth Services Review, 119, Article 105580.
A Longitudinal Evaluation of Wraparound’s Impact on Youth Mental Health Service Use
Abstract: Wraparound is a care coordination model that has shown effectiveness for serving children and youth with significant emotional and behavioral health needs and their families. The current study evaluates a statewide wraparound demonstration with the goals of reducing the use of residential care and increasing access to outpatient mental health services among youth at risk of residential placement. More than 5 years of linked public systems data were analyzed using longitudinal panel data modeling to estimate wraparound treatment effects on service use over time. Findings show that wraparound enrollment decreased the use of residential treatment and increased the use of outpatient therapy, consistent with the goals of the demonstration. Implications are discussed for wraparound’s effectiveness as a statewide care coordination model, the importance of quality implementation of wraparound, and the current study’s methodological contributions to the wraparound literature.
Citation: Lee, B. R., Bright, C. L., Svoboda, D. V., Fakunmoju, S. B., & Barth, R. P. (2019). Outcomes of empirically supported treatment interventions for youth aging out of foster care: A review of the literature. Residential Treatment for Children & Youth, 36(3), 231–255.
Abstract: Addressing the mental health needs of children and youth is a priority. One way to operationalize the provision of support for children and youth with severe mental health needs is through the wraparound approach. Wraparound is a highly individualized person and family centred planning process which utilizes a clearly articulated practice model, and is led by trained wraparound facilitators. This research examined the fidelity of implementation of the wraparound approach for two youths with severe mental health needs in two rural schools in the province of Manitoba, Canada. Adherence to the guiding principles and primary activities of the wraparound approach were measured using the Wraparound Fidelity Index 4.0 (WFI-EZ), a self-report tool that was administered with caregivers, wraparound facilitators and team members. Facilitation skills and teamwork also were examined through the independent observation of wraparound planning meetings using the Team Observation Measure (TOM-2). These fidelity measures determine model adherence, which has been associated with improved behavioral outcomes for children and youth with severe mental health needs, and quality improvements in service provision. The findings of low average-to-average overall fidelity are encouraging given that these school-based settings are in the emergent stage of wraparound implementation, and demonstrate their ability of schools to adhere to many of the key elements of the wraparound approach. Areas of high fidelity and low fidelity are discussed, and recommendations for quality improvements in wraparound implementation in school-based settings are proposed.
Citation: Bartlett, N. A., & Freeze, T. B. (2019). Examining wraparound fidelity for youth with mental health needs: An illustrative example of two rural Canadian schools. International Journal of Special Education, 33(4), 846–868.
Abstract: Positive Behavior Support (PBS) was introduced to community-based providers in Kansas in 2012 in response to a federally funded initiative to reduce the placement of youth in psychiatric facilities. As core project activities concluded in 2016, researchers investigated the impact of this comprehensive PBS initiative on youth, families, mental health centers, and other stakeholders. This paper describes how qualitative interviews and focus groups were used to investigate the perceptions of families, advocates, and implementers involved in wraparound (WA), regional interagency collaboration, and the addition of PBS services. Themes reflected the changes occurring over time in statewide WA implementation and how state funding for the PBS effort was used as part of regional interagency collaboration to continue supporting principles outlined in systems of care.
Citation: Matthews, K., Enyart, M. & Freeman, R. Putting the Pieces Together: Perceptions of Longitudinal Wraparound, Systems of Care, and Positive Behavior Support Implementation. Community Ment Health J 55, 932–941 (2019).
Randomized Control Trial Findings of a Wraparound Program for Dually Involved Youth
Abstract: Wraparound care coordination for youth with serious emotional and behavioral challenges has been implemented in every state and in many child-serving contexts, but evidence from rigorous effectiveness studies is scarce. We conducted a 20-month longitudinal randomized control trial of a pilot Wraparound program for youth in foster care and involved in the juvenile justice system (n = 24), comparing outcomes with youth receiving community “treatment as usual” (TAU; n = 23). Youth in both groups experienced significantly improved outcomes, including fewer arrests and greater residential stability. Wraparound youth were less likely to be rearrested (odds ratio [OR] = 0.59, 95% confidence interval [CI] = [0.17, 2.04]), and survival analysis found they went longer before doing so than TAU youth. Wraparound youth were also more likely to be educationally on track than TAU youth by the end of the study (OR = 4.09, 95% CI = [1.89, 18.72]). Although these findings were nonsignificant at p < .05 due to small sample sizes, effect sizes were medium to large, and no such trends were found for the TAU group. Implications for Wraparound’s implementation and effectiveness, as well as the strengths and limitations of conducting a randomized control trial in “real-world” systems, are discussed.
Citation: Coldiron, J. S., Hensley, S. W., Osher, T. W., & Bruns, E. J. (2020). Randomized control trial findings of a wraparound program for dually involved youth. Residential Treatment for Children & Youth, 27(4), 287–308.
Interagency Collaborative Care for Young People with Complex Needs: Front‐line Staff Perspectives
Abstract: Interagency collaboration and the “integration” of health and social care services are advocated to address the increasingly complex needs of at‐risk youth and to reduce barriers to accessing care. In New Zealand, Youth‐One‐Stop‐Shops (YOSSs) provide integrated health and social care to young people with complex needs. Little is known about how YOSSs facilitate collaborative care. This study explored the collaboration between YOSSs and external agencies between 2015 and 2017 using a multiple case study method. This paper reports qualitative focus group and individual interview data from two of four case sites including six YOSS staff and 14 external agency staff. Results showed participants regarded collaboration as critical to the successful care of high needs young people and were positive about working together.
Citation: Morgan S, Pullon S, Garrett S, McKinlay E. Interagency collaborative care for young people with complex needs: Front-line staff perspectives. Health Soc Care Community. 2019;27:1019–1030.
Child and Family Team Meeting Characteristics and Outcomes in a Statewide System of Care
Abstract: Systems of care (SOC) have relied on the wraparound care process to individualize community‐based services for children and youth with serious emotional and behavioral difficulties. A core element of wraparound care is Child and Family Team meetings (CFTs), which are designed to give youth and families a leadership role in developing and guiding their plan of care. The National Wraparound Initiative (NWI) has identified Practice Standards regarding CFT implementation. This study examined CFT characteristics and the association between those characteristics and youth and family outcomes in a statewide SOC. Results indicated that a higher number of CFTs was associated with poorer outcomes, while a higher percentage of natural supports at meetings was associated with better youth outcomes. Number of days to the first CFT was associated with greater caregiver strain. Implications for CFT implementation within wraparound are discussed.
Citation: Schreier, A., Horwitz, M., Marshall, T., Bracey, J., Cummins, M. and Kaufman, J.S. (2019), Child and Family Team Meeting Characteristics and Outcomes in a Statewide System of Care. Am J Community Psychol, 63: 487-498.
Abstract: Children with neurodevelopmental disorders are at increased risk of developing mental health difficulties, and when neurodevelopmental and psychiatric disorders do co-occur, children and their families frequently face multiple barriers as they try to access services and resources. A literature review indicates that there is a lack of specialized mental health services for patients with a dual diagnosis, and the resulting inadequate level of community supports has placed the burden of care on families. Four clinical vignettes illustrate how children and their families trying to access support face barriers, including bureaucratic processes, lack of respite, out-of-home service obstacles, and limited specialized training for care providers. Policy changes are needed to ensure a wraparound approach to care based on integrative interagency and cross-agency practices.
Citation: Ono, E., Friedlander, R., & Salih, T. (2019). Falling through the cracks: How service gaps leave children with neurodevelopmental disorders and mental health difficulties without the care they need. British Columbia Medical Journal, 61(3), 114–124.
A Longitudinal Evaluation of Wraparound’s Impact on Youth Mental Health Service Use
Abstract: Wraparound is a care coordination model that has shown effectiveness for serving children and youth with significant emotional and behavioral health needs and their families. The current study evaluates a statewide wraparound demonstration with the goals of reducing the use of residential care and increasing access to outpatient mental health services among youth at risk of residential placement. More than 5 years of linked public systems data were analyzed using longitudinal panel data modeling to estimate wraparound treatment effects on service use over time. Findings show that wraparound enrollment decreased the use of residential treatment and increased the use of outpatient therapy, consistent with the goals of the demonstration. Implications are discussed for wraparound’s effectiveness as a statewide care coordination model, the importance of quality implementation of wraparound, and the current study’s methodological contributions to the wraparound literature.
Citation: Cosgrove, J. A., Lee, B. R., & Unick, G. J. (2020). A Longitudinal Evaluation of Wraparound’s Impact on Youth Mental Health Service Use. Journal of Emotional and Behavioral Disorders, 28(3), 156-166.
Abstract: Multiple services are often needed to address the needs of young people with complex emotional or behavioural needs. The Youth Wraparound model of service aims to provide all health and supportive services from one coordinating agency. While this has been researched overseas, there are currently few examples of this described in the Australian psychiatric context. A single‐case study design is presented with an evaluation of the clinical outcome and economic costs. There were significant reductions in the number of admissions to emergency departments, mental health wards and secure units, and improvements in mental health and well‐being. Yearly average time in institutional settings reduced from 69% to 7%. Cost savings in health utilization were estimated at $2,326,790. The Youth Wraparound model has the potential to offer improved clinical outcomes, significant cost savings over time, improved coordination between care providers, and an alternative to detention or incarceration.
Citation: Smith W, Sitas M, Rao P, et al. Intensive community treatment and support “Youth Wraparound” service in Western Australia: A case and feasibility study. Early Intervention in Psychiatry. 2019;13:151–158.
Abstract: This article will focus on how the wraparound model of intervention was applied to a treatment program for children and families at risk. The program was naturally developed during a decade of therapeutic work with families in the Center for Children and Parents in Sderot, Israel. This article illustrates the theoretical assumptions underlying the critical principle on which the wraparound intervention is based and its application to the idea of the therapeutic community as a “facilitating environment.” We will share our experiences as to how the cooperation of a therapeutic community acts as a role model and contributes to the healing of at-risk families and preventing out-of-home placement. Practical issues related to the difficulties in developing a therapeutic community, and also several “best practice strategies” for establishing a therapeutic community as a facilitating environment, will be described. [Note: Although it may not entirely reflect the NWI model of Wraparound, this article describing a program in Israel offers an interesting perspective on Wraparound.]
Citation: Mana, A., & Naveh, A. R. (2018). Facilitating a therapeutic environment: Creating a therapeutic community using a “wraparound” intervention program with at-risk families. The Family Journal, 26(3), 293–299.
Abstract: The current study examined the implementation of Parent-Child Interaction Therapy (PCIT) adapted to address problem behaviors of children (ages 2–9) through a home-based service program (i.e., wraparound). The current adaptation of PCIT was implemented by community-based wraparound clinicians and compared to treatment as usual (TAU). Results indicated a significant drop in child behavior problems for children receiving PCIT-informed services compared to TAU. In addition, PCIT-informed clinicians significantly increased their sense of competence. Feasibility and future directions regarding integration and expansion of this approach are discussed.
Citation: Smith, W., Sitas, M., Rao, P., Nicholls, C., McCann, P., Jonikis, T., James, J., Cohen, S., Ellis, J., & Waters, F. (2018). Intensive community treatment and support “Youth Wraparound” service in Western Australia: A case and feasibility study. Early Intervention in Psychiatry, 13(4), 940–948.
Abstract: Electronic health records (EHRs) have been widely proposed as a mechanism for improving health care quality. However, rigorous research on the impact of EHR systems on behavioral health service delivery is scant, especially for children and adolescents. The current study evaluated the usability of an EHR developed to support the implementation of the Wraparound care coordination model for children and youth with complex behavioral health needs, and impact of the EHR on service processes, fidelity, and proximal outcomes.
Citation: Bruns E, Hook A, Parker E, Esposito I, Sather A, Parigoris R, Lyon A, Hyde K. Impact of a Web-Based Electronic Health Record on Behavioral Health Service Delivery for Children and Adolescents: Randomized Controlled Trial, J Med Internet Res 2018;20(6):e10197, DOI: 10.2196/10197
Abstract: Introduction: Wraparound services (i.e., community-based collaborative care) for children with severe mental health needs have been reported as effective. Yet, no attention has been given to aggregating treatment results across racially and economically diverse groups of youth. While controlling for socioeconomic status (i.e., free/reduced lunch status) this study explored potential racial disparities in response to wraparound services. Method: Data from a diverse statewide sample (N = 1,006) of low-income youth (ages 6–18 years) identified as having a serious emotional disturbance were analyzed for differences in wraparound attrition, fidelity, and effectiveness.Results: African American youth receiving free/reduced lunch failed to complete wraparound services at significantly higher rates when compared to Caucasian youth. For those who met treatment goals (i.e., completed services), mean intervention fidelity scores showed services to be implemented similarly across youth. Furthermore, wraparound services resulted in improvements in mental health functioning, though racial background and attrition status impacted exit scores.Discussion: Collaborative community-based mental health services improve youth outcomes and physicians and school personnel should strive to be part of these teams. Further research is needed to more closely examine the challenges of helping youth to meet the goals associated with their wraparound services. Relatively higher service attrition rates in low-income African American youth warrants further investigation.
Citation: Yohannan, J., Carlson, J. S., Shepherd, M., & Batsche-McKenzie, K. (2017). Exploring attrition, fidelity, and effectiveness of wraparound services among low-income youth of different racial backgrounds. Families, Systems, & Health, 35(4), 430–438.
Abstract: Objective: The study examined differences in psychotropic polypharmacy among youths with serious emotional and behavioral disorders who received coordinated care services (CCS) that used a wraparound model and a matched sample of youths who received traditional services. Methods: A quasi-experimental design compared psychotropic polypharmacy one year before and one year after discharge from CCS. The cohort was youths with serious emotional and behavioral disorders who were enrolled in CCS from December 2009 through May 2014. The comparison group was youths with serious emotional and behavioral disorders who received outpatient mental health services during the same time. Administrative data from Medicaid, child welfare, and juvenile justice services were used. A difference-in-difference analysis with propensity score matching evaluated the CCS intervention by time effect on psychotropic polypharmacy.Results: In both groups, most youths were male, black, and 10–18 years old, with attention-deficit hyperactivity disorder (54%−55%), mood disorder (39%−42%), depression (26%−27%), and bipolar disorder (25%−26%). About half of each group was taking an antipsychotic. The percentage reduction in polypharmacy from one year before CCS enrollment to one year after discharge was 28% for the CCS group and 29% for the non-CCS group, a nonsignificant difference. CCS youths excluded from the analysis had more complex mental health needs and a greater change in polypharmacy than the CCS youths who were included in the analytic sample. Conclusions: Mental health care coordination had limited impact in reducing psychotropic polypharmacy for youths with less complex mental health needs. Further research is needed to evaluate the effect on psychotropic polypharmacy among youths with the greatest mental health needs.
Citation: Wu, B., Bruns, E.J., Tai, M., Lee, B.R., Raghavan, R. & dosReis, S. (2018). Psychotropic polypharmacy among youths with serious emotional and behavioral disorders receiving coordinated care services. Psychiatric Services. Published online: March 15, 2018.
Abstract: Background: Treating youth with serious emotional disturbances (SED) is expensive often requiring institutional care. A significant amount of recent federal and state funding has been dedicated to expanding home and community-based services for these youth as an alternative to institutional care. High Fidelity Wraparound (Wrap) is an evolving, evidence-informed practice to help sustain community-based placements for youth with an SED through the use of intensive, customized care coordination among parents, multiple child-serving agencies, and providers. While there is growing evidence on the benefits of Wrap, few studies have examined health care spending associated with Wrap participation and none have examined spending patterns after the completion of Wrap. Merging health care spending data from multiple agencies and programs allows for a more complete picture of the health care costs of treating these youth in a system-of-care framework. Aims of Study: (i) To compare overall health care spending for youth who transitioned from institutional care into Wrap (the treatment group) versus youth not receiving Wrap (the control group) and (ii) to compare changes in health care spending, overall and by category, for both groups before (the pre-period) and after (the post-period) Wrap participation. Methods: The treatment group (N=161) is matched to the control group (N=324) temporally based on the month the youth entered institutional care. Both total health care spending and spending by category are compared for each group pre- and post-Wrap participation. The post-period includes the time in which the youth was receiving Wrap services and one year afterwards to capture long-term cost impacts. Results: In the year before Wrap participation, the treatment group averaged $8,433 in monthly health care spending versus $4,599 for the control group. Wrap participation led to an additional reduction of $1,130 in monthly health care spending as compared to the control group in the post-period. For youth participating in Wrap, these spending reductions were the result of decreases in mental health inpatient spending and general outpatient spending. Discussion: Youth participating in Wrap had much higher average monthly costs than youth in the control group for the year prior to entering Wrap, suggesting that the intervention targeted youth with the highest mental health utilization and likely more complex needs. While both groups experienced reductions in spending, the treatment group experienced larger absolute reductions, but smaller relative reductions associated with participation. These differences were driven mainly by reductions in mental health inpatient spending. Larger reductions in general outpatient spending for the treatment group suggest spillover benefits in terms of physical health care spending. Further analysis is needed to assess how these spending changes impacted health outcomes. Implications for Health Policies: Wrap or similar programs may lead to reductions in health care spending. This is the first study to find evidence of longer-term spending reductions for up to a year after Wrap participation. Implications for Further Research: Randomized trials or some other source of plausibly exogenous variation in Wrap participation is needed to further assess the causal impact of Wrap on health care spending, outcomes, or broader system-of-care spending.
Citation: Snyder A, Marton J, McLaren S, Feng B, Zhou M. Do High Fidelity Wraparound Services for Youth with Serious Emotional Disturbances Save Money in the Long-Term? J Ment Health Policy Econ. 2017 Dec 1;20(4):167-175. PMID: 29300703.
Abstract: Wraparound is a frequently implemented approach for providing individualized, community-based care for children and adolescents with serious mental health conditions and, typically, involvement in multiple child-and family-serving systems. Both Wraparound’s principles and its theory of change stress the importance of youths’ active participation throughout. However, research focusing on the experiences of youth in Wraparound indicates that they are often not particularly engaged in the process or participating actively with their teams, and the findings point to a lack of alliance between the young people and their teams. This article describes a randomized study testing the Achieve My Plan (AMP) enhancement for Wraparound, which is intended to increase young people’s satisfaction, active engagement and self-determined participation in Wraparound, as well as their alliance with the team. Study findings showed that, relative to youth who received “as usual” Wraparound, young people who received Wraparound with the AMP enhancement participated more – and in a more active and self-determined manner – with their teams. They also rated their alliance with their Wraparound teams significantly higher. Furthermore, adult team members in the intervention condition rated team meetings as being more productive, and they were more likely to say that the AMP meetings were “much better than usual” team meetings. Findings support the idea that it is possible – using a low-cost, low-“dose” intervention – to enhance young people’s self-determination and their engagement in Wraparound without detracting from team functioning or the satisfaction of other team members.
Citation: Walker, Janet S.; Seibel, Celeste L.; and Jackson, Sharice, “Increasing Youths’ Participation in Team-Based, Treatment Planning: The Achieve My Plan Enhancement for Wraparound” (2017). School of Social Work, Faculty Publications and Presentations. 170.
Abstract: Effective coordination of mental health care is critical in Medicaid wraparound model programs for youth. This study examined participation over time in mental health services for youth diverted or transitioned from residential care to a Medicaid wraparound demonstration program. Youth in wraparound had more sustained use of mental health outpatient clinic services than did propensity score matched youth who were not in wraparound. However, the rate of outpatient clinic follow-up after inpatient discharge was no greater in wraparound. Routine assessment of wraparound programs’ impacts on receipt of mental health care may inform the development of Medicaid wraparound program performance standards.
Citation: Blizzard AM, Glos LJ, Stephan SH, Medoff D, Slade EP. Impacts of a Medicaid Wraparound Model Demonstration Program on Youth Specialty Mental Health Services Use. J Behav Health Serv Res. 2017 Jul;44(3):373-385. doi: 10.1007/s11414-016-9520-0. PMID: 27306371.
Caregiver perceptions of Parent Peer Support Services within the Wraparound Service Delivery Model
Abstract: This qualitative study examined caregivers’ perceptions of Parent Peer Support (PPS) services, embedded in the Wraparound service delivery model for youth with severe emotional and behavioral disturbances (SEBD), to identify potential engagement facilitators and barriers. Interview questions examined caregivers’ expectations about PPS, reasons for accepting or refusing PPS, and caregivers’ perceived impact of PPS. Caregivers indicated that PPS provided several benefits for themselves, youth in the care, and their families. However, potential barriers to ongoing engagement included perceived intrusiveness, as well as misalignment between services offered and caregivers’ needs.
Citation: Gopalan, G., Horen, M.J., Bruns, E. et al. Caregiver perceptions of Parent Peer Support Services within the Wraparound Service Delivery Model. J Child Fam Stud 26, 1923–1935 (2017).
A Comprehensive Review of Wraparound Care Coordination Research, 1986 – 2014
Abstract: This is an authors’ manuscript of a literature review published in the Journal of Child and Family Studies. This article reviews 206 Wraparound-related publications. Among these were 123 empirical studies – 22 of which were controlled studies. The article discusses the findings of these studies and highlights future Wraparound research needs. View article from the publisher.
Citation: Schurer Coldiron, J., E. J. Bruns and H. Quick (2017). A Comprehensive Review of Wraparound Care Coordination Research, 1986–2014. Journal of Child and Family Studies: 1-21. doi:10.1007/s10826-016-0639-7
Walker and Ossowski describe findings of a study to determine consensus around best practices in Wraparound facilitation and an online training booster developed as a result. The presentation recording is available from the NWI YouTube channel and a PDF version of the slides is linked below. To watch the recording, please access https://youtu.be/ZidHbkv85fo
Walker, J. S., & Ossowski, J. (2016, March 15). Booster module on facilitating family-/youth-driven conversation: Results of initial user testing [Conference presentation]. 29th Annual Research and Policy Conference on Child, Adolescent and Young Adult Behavioral Health, Tampa, FL. National Wraparound Initiative.
Poster presented at the 29th Annual Research & Policy Conference on Child, Adolescent and Young Adult Behavioral Health, March 2016, Tampa, FL. Presented work by the Wraparound Evaluation and Research Team (WERT) at The University of Washington’s Division of Public Behavioral Health and Justice Policy (UW PBHJP), Henderson Behavioral Health(HBH), ChildNet [a Department of Children and Families (DCF) contractor], and Florida’s Department of Juvenile Justice’s (DJJ) 17th Circuit to evaluate care coordination and case management services delivered to 65 “crossover” youth (dually involved with child welfare and juvenile justice) in Broward County, Florida.
Citation: Coldiron, J., Hensley, S., & Thomas, S. (2016, March). Results from year one of a randomized control trial of high-fidelity wraparound for dually involved youth [Poster presentation]. 29th Annual Research & Policy Conference on Child, Adolescent and Young Adult Behavioral Health, Tampa, FL. National Wraparound Initiative.
Poster on work by FidelityEHR to develop an EHR implementation and training model grounded in a Readiness for Change approach, and partnership with the University of Washington, Wraparound Evaluation and Research Team (WERT) on a National Institute of Mental Health (NIMH) Small Business Technology Transfer (STTR) Phase II grant to increase collaboration with Wraparound service organizations in the field. 29th Annual Research & Policy Conference on Child, Adolescent and Young Adult Behavioral Health, March 2016, Tampa, FL.
Citation: Hyde, K., Curry, M., Haley, J., Bergerson, K., Bruns, E., & Hook, A. (2016, March). Readiness for change: FidelityEHR implementation and training model for wraparound service organizations [Poster presentation]. 29th Annual Research & Policy Conference on Child, Adolescent and Young Adult Behavioral Health, Tampa, FL. National Wraparound Initiative.
Poster on work by FidelityEHR to develop an EHR implementation and training model grounded in a Readiness for Change approach, and partnership with the University of Washington, Wraparound Evaluation and Research Team (WERT) on a National Institute of Mental Health (NIMH) Small Business Technology Transfer (STTR) Phase II grant to increase collaboration with Wraparound service organizations in the field. 29th Annual Research & Policy Conference on Child, Adolescent and Young Adult Behavioral Health, March 2016, Tampa, FL.
Citation: Hensley, S., Estep, K., & Matarese, M. (n.d.). Differences in wraparound training and coaching outcomes as a function of system context [Conference presentation]. National Wraparound Initiative.
This presentation reviews results of User Experience (UX) testing of an Electronic Behavioral Health Record, and the way in which that feedback is used to modify the system. 29th Annual Research & Policy Conference on Child, Adolescent and Young Adult Behavioral Health, Tuesday, March 15, 2016, Tampa, FL
Citation: Bruns, E. J., Hook, A. N., Hyde, K. L., & Bergerson, K. (2016, March 15). User testing to refine an electronic behavioral health record for wraparound: FidelityEHR user testing [Conference presentation]. 29th Annual Research & Policy Conference on Child, Adolescent and Young Adult Behavioral Health, Tampa, FL. National Wraparound Initiative.
Conference presentation on use of administrative CANS data for benchmarking and outcomes monitoring in state-wide Wraparound initiatives. Presented at the 29th Annual Research & Policy Conference on Child, Adolescent and Young Adult Behavioral Health. March 14, 2016. Tampa, Florida.
Citation: Bruns, E. J., Estep, K., Hensley, S., & Lyons, J. S. (2016, March). Using administrative CANS data for benchmarking and outcomes monitoring in statewide wraparound initiatives [Conference presentation]. 29th Annual Research & Policy Conference on Child, Adolescent and Young Adult Behavioral Health, Tampa, FL. National Wraparound Initiative.
Increasing meaningful youth engagement and participation in Wraparound: Findings from a randomized study. Conference presentation at the Conference presentation at the 29th Annual Research & Policy Conference on Child, Adolescent and Young Adult Behavioral Health. March 14, 2016. Tampa, Florida.
Citation: Bruns, E. J., Hensley, S., Pullmann, M. D., Sather, A., & Estep, K. (2016, March). AMP: Measuring and supporting wraparound practice quality through data visualization and feedback [Conference presentation]. 29th Annual Research & Policy Conference on Child, Adolescent and Young Adult Behavioral Health, Tampa, FL. National Wraparound Initiative.
The policy and funding context for Wraparound: New findings from the Community Supports for Wraparound Inventory. Conference presentation at the 29th Annual Research & Policy Conference on Child, Adolescent and Young Adult Behavioral Health. March 14, 2016. Tampa, Florida.
Citation: Walker, J. S., & Mehess, S. (2016, March). New findings from the Community Supports for Wraparound Inventory [Conference presentation]. 29th Annual Research & Policy Conference on Child, Adolescent and Young Adult Behavioral Health, Tampa, FL. National Wraparound Initiative.
Report on user testing of an interactive video and web-based booster training for core Wraparound skills. Conference presentation at the 29th Annual Research & Policy Conference on Child, Adolescent and Young Adult Behavioral Health. March 14, 2016. Tampa, Florida.
Citation: Walker, J. S., & Ossowski, J. (2016, March 15). Booster module on facilitating family-/youth-driven conversation: Results of initial user testing [Conference presentation]. 29th Annual Research & Policy Conference on Child, Adolescent and Young Adult Behavioral Health, Tampa, FL. Portland State University.
Wraparound is Worth Doing Well: An Evidence-Based Statement
Wraparound is worth doing well: An evidence-based statement. In E. J. Bruns & J. S. Walker (Eds.), The resource guide to Wraparound. Portland, OR: National Wraparound Initiative.
Citation: Bruns, E. J. (2015). Wraparound is worth doing well: An evidence-based statement. In E. J. Bruns & J. S. Walker (Eds.), The resource guide to wraparound. National Wraparound Initiative.
Poster: Parent Engagement and Family Peer Support Services in Wraparound
Parent Engagement and Family Peer Support Services in Wraparound. Baltimore, MD: University of Maryland School of Social Work, The Institute for Innovation and Implementation.
Citation: Gopalan, G., Horen, M. J., Pardue-Kim, M., & Meteyer, S. (2015, March). Parent engagement and family peer support services in wraparound [Poster presentation]. 28th Annual Research & Policy Conference on Child, Adolescent and Young Adult Behavioral Health, Tampa, FL. University of Maryland School of Social Work, Institute for Innovation and Implementation.