wraparound research update
Citation: Gifford, E., Wells, R., Bai, Y. & Malone, P. (2014). Is implementation fidelity associated with improved access to care in a school-based child and family team model?. Evaluation and Program Planning. http://dx.doi.org/10.1016/j.evalprogplan.2014.11.005
Abstract (full text not available from NWI): Effective child and family-centered service planning is crucial to addressing vulnerable children's needs. However, there is limited evidence about what facets of these processes improve service use and outcomes. The current study used a Poisson random effects hazard model to test correlations between fidelity to NC's Child and Family Support Team model and time to service receipt, using case management data for 3,396 children served by that program during the 2008-2009 school year. Students were more likely to receive recommended services more quickly when caregivers and the students attended planning meetings, when their plans included services for caregivers, and when child and family team leaders followed up after meetings to verify service receipt. Contrary to the Child and Family Support Team theory of change, match between student needs and the lead agency of the meeting was not associated with the odds of quicker service receipt, nor was attendance by natural supports. Findings from this study demonstrate the potential effectiveness of using case management systems to measure service planning process fidelity, as well as how results thereof can both inform process improvement and potential refinements to models' theories of change.
Citation: Browne, D., Puente-Duran, S., Shlonsky, A., Thabane, L., & Verticchio, D. (2014). A Randomized Trial of Wraparound Facilitation Versus Usual Child Protection Services. The Journal of Behavioral Health Services & Research. Published online before print September 10, 2014.
Abstract (full text not available from NWI): Objective: To evaluate whether the addition of a wraparound facilitator to regular child protection services improved child and family functioning over 20 months. Method: A single blind randomized controlled trial with concealment and stratification across three sites (N = 135 eligible families with substantiated maltreatment). Results: Based on 2 × 2 mixed analysis of variance and intention to treat, both groups improved in child impairments, d = −.60 [−.81, −.39], caregiver psychological distress, d = −.33 [−.52, −.13], and family resources, d = .44 [.27, .62]. No measurable benefit was associated with the intervention (e.g., child impairments, d = .14 [−.12, .52]). However, treatment fidelity analysis revealed that many components of wraparound were either missing or present in both groups. Conclusions: The presence of a facilitator alone did not appear to improve child or family functioning if the various components of wraparound were not adequately implemented.
Citation: Bruns, E., Pullman, M., Sather, A., Brinson, R., & Ramey, M. (2014). Effectiveness of Wraparound Versus Case Management for Children and Adolescents: Results of a Randomized Study. Administration and Policy in Mental Health and Mental Health Services Research. Published online June 29, 2014.
Abstract (full text not available from NWI): In this study, we compared service experiences and outcomes for youths with serious emotional disorder (SED) randomly assigned to care coordination via a defined wraparound process (n = 47) versus more traditional intensive case management (ICM; n = 46) The wraparound group received more mean hours of care management and services; however, there ultimately were no group differences in restrictiveness of residential placement, emotional and behavioral symptoms, or functioning. Wraparound implementation fidelity was found to be poor. Organizational culture and climate, and worker morale, were poorer for the wraparound providers than the ICM group. Results suggest that, for less-impaired youths with SED, less intensive options such as ICM may be equally effective to poor-quality wraparound delivered in the absence of wraparound implementation supports and favorable system conditions.
Citation: LaPorte, T. M., Haber, M. G., & Malloy, J. M. (2014). Wraparound Team Composition, Youth Self-determination, and Youth Satisfaction in Transition Services. The Journal of Behavioral Health Services & Research, 41, 1-18.
Abstract (full text not available from NWI): Wraparound, a team-based planning process for youth and families, has been widely adopted in school-based services for older adolescents and emerging adults with serious mental health conditions transitioning to adulthood. Reservations have been voiced, however, regarding possible drawbacks of teams for these youth, including concerns about difficulties with involving supportive adults, and whether youth might perceive team-based planning as a threat to their developing autonomy. To date, however, no studies have examined the feasibility of involving supports in teams and relationships between team composition and youth’s service experiences. The present study examined the relationships between team composition and youth’s perceptions of self-determination and service satisfaction among 36 youths in seven school-based programs using a specialized form of wraparound for transition services. Findings showed that meeting participation by caregivers and professionals from both inside and outside of schools was common and that regular participation by combinations of these types of adults was related to youth self-determination and satisfaction.
Citation: Wisdom, J., Lewandowski, E., Pollock, M., Arci, M., Shorter, P., Olin, S., Armusewicz, K., Horwitz, S., & Hoagwood, K. (2014). What Family Support Specialists Do: Examining Service Delivery. Administration and Policy in Mental Health and Mental Health Services Research, 41, 21-31.
Abstract (full text not available from NWI): This study describes services provided by family support specialists (FSS), peer advocates in programs for children with serious psychiatric conditions, to delineate differences between recommended components of FSS services and services actually provided. An analysis of qualitative interview and observational data and quantitative survey data from 63 staff at 21 mental health programs in New York identified that FSS and other staff have generally similar ideas about FSS services, and that these perceptions of activities are generally congruent with what FSS actually did. Implications of findings are discussed in the context of developing competencies and quality indicators for FSS.
Citation: Kernan, J. B. (2014). Measuring Wraparound Fidelity to Make Quality Improvements, Community Mental Health Journal [online only].
Abstract (full text not available from NWI): This article reports on the use of the Wraparound Fidelity Index (WFI) to measure wraparound fidelity in Erie County, NY. Use of the WFI highlighted areas of improvement for youth engagement and for the transition phase of wraparound.
Citation: Bruns, E. J., Weathers, E. S., Suter, J. C., Hensley, S., Pullman, M. D., & Sather, A. (2014). Psychometrics, Reliability, and Validity of a Wraparound Team Observation Measure, Journal of Child and Family Studies [online only].
Abstract (full text not available from NWI): Reliable and valid measures of wraparound fidelity are needed to ensure effective implementation. This paper discusses one such instrument, the Team Observation Measure (TOM), by examining its psychometrics, reliability, and validity.
Citation: Mendenhall, A. N., Kapp, S. A., Rand, A., Robbins, M. L., & Stipp, K. (2014). Theory Meets Practice: The Localization of Wraparound Services for Youth with Serious Emotional Disturbance, Community Mental Health Journal, 49(6), 793-804.
Abstract (full text not available from NWI): Using Kansas as an example, this study demonstrates the difficulties of implementing high fidelity wraparound on a large scale. It addresses these challenges by recommending a balance of standardized wraparound practices, localized innovations, and agency compliance with Medicaid.
Citation: Kutash, K., Acri, M., Pollock, M., Armusewicz, K., Serene Olin, S., Hoagwood, K. E. (2014). Quality Indicators for Multidisciplinary Team Functioning in Community-Based Children's Mental Health Services, Adm Policy Ment Health 41(1), 55-68.
Abstract (full text not available from NWI): The current study examined the organizational social context in 21 community-based programs serving youth at-risk for out-of-home care due to emotional or behavioral disorders and their families and program performance on five quality indicators of team functioning in teams that included a family support specialist. Results indicate that programs with higher performance on structures to facilitate teamwork, informal communication mechanisms among team members, and the ability to integrate family support specialists as equal members of the team showed more positive organizational functioning. Implications for the role of quality indicators in health care reform efforts are discussed.
Citation: Serene Olin, S., Kutash, K., Pollock, M., Burns, B. J., Kuppinger, A., Craig, N., Purdy, F., Armusewicz, K., Wisdom J., & Hoagwood K. E. (2014). Developing Quality Indicators for Family Support Services in Community Team-Based Mental Health Care, Adm Policy Ment Health 41(1), 7-20.
Abstract (full text not available from NWI): Quality indicators for programs integrating parent-delivered family support services for children's mental health have not been systematically developed. Increasing emphasis on accountability under the Affordable Care Act highlights the importance of quality-benchmarking efforts. Using a modified Delphi approach, quality indicators were developed for both program level and family support specialist level practices. These indicators were pilot tested with 21 community-based mental health programs. Psychometric properties of these indicators are reported; variations in program and family support specialist performance suggest the utility of these indicators as tools to guide policies and practices in organizations that integrate parent-delivered family support service components.
Citation: Bertram, R. M., Schaffer, P., & Charnin, L. (2014). Changing Organization Culture: Data Driven Participatory Evaluation and Revision of Wraparound Implementation, Journal of Evidence-Based Social Work 11(1-2).
Abstract (full text not available from NWI): Family members and professionals in a Substance Abuse and Mental Health Services Administration Children's Mental Health Systems of Care Initiative in Houston, Texas conducted a participatory evaluation to examine wraparound implementation. Results guided systematic, theory-based program revisions. By focusing through empirically derived frameworks for implementation, the evaluation team identified and generated useful data sources to support and improve wraparound provision. Despite working with a more diverse population in which youth displayed more severe behaviors than in similar grants, after 18 months more families received service and outcomes improved as fidelity scores advanced above the national mean.
Citation: Kutash, K., Garraza, L. G., Ferron, J. M., Duchnowski, A. J., Walrath, C., & Green, A. L. (August, 2012). The Relationship Between Family Education and Support Services and parent and Child Outcomes Over Time, Journal of Emotional and Behavioral Disorders [online only].
Abstract (full text not available from NWI): The purpose of the current study is to contribute to the knowledge base on the use of family education and support (FES) services by examining the longitudinal trajectories of FES receipt and multiple domains of child and family functioning. Using an extant data set of more than 9,000 youth and their caregivers, results indicate that families who received FES on entry into services had greater caregiver strain, and their children experienced greater emotional challenges than families who did not receive FES services. Furthermore, for families who received FES, the longitudinal results revealed an immediate effect of seeking additional services, decreasing caregiver strain 6 months after receipt of FES services, and improving child emotional functioning 6 to 18 months after initial receipt of FES services. The complex, lagged effects in the results are discussed in the context of the theorized cyclical course of family stress as exemplified by the Double ABCX model of adjustment and adaptation. Implications for future research of FES services are discussed, especially the need to develop a functional logic model and an operational definition of FES and its components.
Citation: Bruns, E. J., Walker, J. S., Bernstein, A., Daleiden, E., Pullmann, M. D., & Chorpita, B. F. (2013). Family Voice With Informed Choice: Coordinating Wraparound With Research-Based Treatment for Children and Adolescents, Journal of Clinical Child & Adolescent Psychology [online only].
Abstract (full text not available from NWI): The wraparound process is a type of individualized, team-based care coordination that has become central to many state and system efforts to reform children's mental health service delivery for youths with the most complex needs and their families. Although the emerging wraparound research base is generally positive regarding placements and costs, effect sizes are smaller for clinical and functional outcomes. This article presents a review of literature on care coordination and wraparound models, with a focus on theory and research that indicates the need to better connect wraparound-enrolled children and adolescents to evidence-based treatment (EBT). The article goes on to describe how recently developed applications of EBT that are based on quality improvement and flexible application of "common elements" of research-based care may provide a more individualized approach that better aligns with the philosophy and procedures of the wraparound process. Finally, this article presents preliminary studies that show the feasibility and potential effectiveness of coordinating wraparound with the Managing and Adapting Practice system, and discusses intervention development and research options that are currently under way.
Citation: Shailer, J. C., Gammon, R. A., & de Terte, I. (2013). Youth with Serious Mental Health Disorders: Wraparound as a Promising Intervention in New Zealand. Australian and New Zealand Journal of Family Therapy, 34, 186-213.
Abstract (full text not available from NWI): Youth with serious mental health disorders present with a complexity of challenges for the mental health system, schools, youth justice, care and protection, and their communities. Research shows their needs are best achieved by providing coordinated intensive, multidisciplinary, and individualised services. This article outlines the prevalence and characteristics of youth with serious mental health disorders. It also discusses community-based interventions used in New Zealand and their limitations. It introduces Wraparound, an intensive individualised coordination and care planning process as a promising practice for youth with serious mental health disorders and their families. Key principles and phases underpinning the Wraparound process are presented along with a case vignette to exemplify the process. Its theory of change, the challenges experienced in practice, and a brief overview of the evidence-base are also discussed.
Citation: Polinsky, M. L., Levine, M. H., Pion-Berlin, L., Torres, A., & Garibay, J. (2013). Development and Validation of a Wraparound Parent Partner Fidelity Tool. Social Work Research [advance access published June 04, 2013].
Abstract (full text not available from NWI): Parent partners are parents or caregivers such as foster parents who have had success in dealing with a difficult child in a child welfare, mental health, or probation system and who become key players on Wraparound teams for families with youths with emotional or behavioral disabilities who are in out-of-home care. Although many studies have been conducted on the Wraparound model, none of them have described the parent partner's role and fidelity to the model. The Parent Partner Fidelity Tool (PPFT) was developed to address this gap in Wraparound research; it is the first tool designed to measure parent partner adherence to the Wraparound model and identify parent partner training and support needs. The 28-item PPFT captures parent partner activities related to the four Wraparound phases designated by the National Wraparound Initiative: engagement, planning, implementation, and transition. Similar PPFT versions are completed by Wraparound facilitators, parent partners, and parents/caregivers to provide multiple perspectives on the parent partner’s work. The PPFT pilot testing project was conducted with 14 California Wraparound programs. Analyses of the 585 responses showed good reliability and validity for the PPFT, indicating that it is a psychometrically sound tool.
Citation: Erickson, C. (2012). Using Systems of Care to Reduce Incarceration of Youth with Serious Mental Illness. American Journal of Community Psychology, 49, 404-416.
Abstract (full text not available from NWI): Youth with serious mental illness come into contact with juvenile justice more than 3 times as often as other youth, obliging communities to expend substantial resources on adjudicating and incarcerating many who, with proper treatment, could remain in the community for a fraction of the cost. Incarceration is relatively ineffective at remediating behaviors associated with untreated serious mental illness and may worsen some youths' symptoms and long-term prognoses. Systems of care represent a useful model for creating systems change to reduce incarceration of these youth. This paper identifies the systemic factors that contribute to the inappropriate incarceration of youth with serious mental illness, including those who have committed non-violent offenses or were detained due to lack of available treatment. It describes the progress of on-going efforts to address this problem including wraparound and diversion programs and others utilizing elements of systems of care. The utility of systems of care principles for increasing access to community-based mental health care for youth with serious mental illness is illustrated and a number of recommendations for developing collaborations with juvenile justice to further reduce the inappropriate incarceration of these youth are offered.
Citation: Fries, D., Carney, K. J., Blackman-Urteaga, L., & Savas, S. A. (2012). Wraparound Services: Infusion Into Secondary Schools as a Dropout Prevention Strategy. NASSP Bulletin, 96, 119-136.
Abstract (full text not available from NWI): For more than 20 years, the efficacy of using the wraparound approach to support high-risk youth has been examined in educational and community settings. Few studies show the value of wraparound service from either a school- or community-based agency as a dropout prevention strategy. Findings from a federal research grant project suggest that many high-risk teens reconnect with educational goals once their lives become more stable after receiving wraparound support. A discussion of the barriers that prevent the most needy school-age youth from accessing wraparound service is offered, with suggestions for how school personnel can increase high school graduation rates for their students with the highest needs.
Citation: Painter, K. (2012). Outcomes for Youth with Severe Emotional Disturbance: A Repeated Measures Longitudinal Study of a Wraparound Approach of Service Delivery in Systems of Care. Child & Youth Care Forum, 41(4), 407-425.
Abstract (full text not available from NWI): The purpose of this study was to evaluate outcomes for children ages 5–18 experiencing serious emotional disturbances who received wraparound in a systems of care community funded through a 6-year federal grant from the Substance Abuse and Mental Health Services Administration, Grant # SM54497-06. This study evaluated the following hypotheses. (1) Youths diagnosed with a SED participating in wraparound services will experience improved mental health symptoms, improved functioning, and improved behavioral and emotional strengths. (2) Caregivers of youths diagnosed with a serious emotional disturbance participating in wraparound services will experience decreased levels of caregiver strain. All of the caregiver completed measurement instruments showed statistical and clinical levels of improvement in youth behavioral and emotional strengths, mental health symptoms, and caregiver stress by the 6-month data collection point that was sustained through 24-month.
Citation: Matarese, M., Zabel, M., Hust, J. A., & Bruns, E. (2012, July). Seeing Wraparound Practice through the Lens of Implementation Science. Presented at the System of Care Institutes, Orlando, FL.
Abstract: This presentation covers core theories and concepts of implementation science, and how it is applied to successful implementation of systems of care and the wraparound practice model. Learning objectives include using the lens of implementation science to learn of specific strategies to address the major implementation issues often associated with implementing wraparound, and identifying and addressing implementation barriers and implementation support needs in local or state systems of care.
Citation: Haber, M., Cook, J., & Kilmer, R. (2012). Perceptions of Family Environment and Wraparound Processes: Associations with Age and Implications for Serving Transitioning Youth in Systems of Care. American Journal of Community Psychology, 49(3/4), 454-466.
Abstract (full text not available from NWI): Addressing the unique needs of youth transitioning to adulthood has long been viewed as a priority in implementation of systems of care (SOCs) and wraparound. Developmental research and 'practice-based evidence' suggest that there are differences between transitioning youth and their younger peers in family environment and wraparound team processes. Although these differences are thought to have significant implications for wraparound practice, few studies have examined them empirically. The present research involves two studies examining differences across several age cohorts (i.e., 10-12, 13, 14, 15, 16-17 year-olds) ranging from early adolescent to transitioning youth in: (1) caregiver perceptions of role-related strain and family environment quality, and (2) facilitator, caregiver, and youth perceptions of wraparound processes. In Study #1, older age was associated with higher levels of caregiver strain. In Study #2, age was associated with differences between youth and other team members' perceptions of wraparound processes, such that older youth perceived teams as less cohesive than others on their teams. These findings suggest that transitioning youth and their families merit special consideration in wraparound implementation and underscore the importance of considering the perceptions of transitioning youth in system change and practice improvement efforts.
Citation: Ferguson, C. M. (2012). The implementation of wraparound in California's Title IV-E Child Welfare Waiver Demonstration Project. Children & Youth Services Review, 34(7), 1331-1336.
Abstract (full text not available from NWI): Understanding the implementation of Wraparound in child welfare is essential to its continued use in the field. The purpose of this study was to understand the implementation of Wraparound in regard to organizational and systems-related factors and contexts. Wraparound was implemented and evaluated in five counties as part of California''s Title IV-E Child Welfare Waiver Demonstration Project, from 1999 to 2004. The three areas of inquiry include the models of Wraparound used, important aspects of the implementation efforts, and the interaction between the principles and values of Wraparound and those of the child welfare system. A multiple case study design provided the structure for data collection and analysis. Focus groups with a convenience sample of administrators and direct-service staff from the public agencies and private community-based agencies implementing Wraparound were conducted annually. While the Wraparound models were similar in configuration there were also unique characteristics that developed in response to local conditions. Issues and solutions emerged regarding referrals and case closures, staffing and training, management information systems, funding, and contextual factors. The values and principles of the child welfare departments, group home providers, and families interacted with the values and principles of Wraparound. The results highlight the importance of organization and systems-level characteristics. Building on the solutions developed in California will help to ensure the sustainability of Wraparound.
Citation: Snyder, E. H., Lawrence, C. N., & Dodge, K. A. (2012). The impact of system of care support in adherence to wraparound principles in Child and Family Teams in child welfare in North Carolina. Children & Youth Services Review, 34(4), 639-647.
Abstract (full text not available from NWI): North Carolina is one of a growing number of states to implement family meeting models in child welfare as a way to engage families, while simultaneously addressing complex familial needs and child safety issues. However, much is still unknown regarding how family meetings actually operate in child welfare, underscoring a clear need for further evaluation of this process. Utilizing direct observational data of Child and Family Team (CFT) meetings, collected as part of two separate evaluations of the North Carolina Division of Social Service''s Multiple Response System (MRS) and System of Care (SOC) initiatives, the purpose of the current study was to examine whether the support provided by SOC improved fidelity to the CFT model in child welfare. The observations were conducted using the Team Observation Measure consisting of 78 indicators that measure adherence to ten domains associated with high quality family team meetings (e.g., collaborative, individualized, natural supports, outcomes based, strengths-based). Findings indicate that receiving SOC support in child welfare leads to a more collaborative and individualized decision-making process with families. Meeting facilitators in SOC counties were better prepared for CFTs, and had greater ability to lead a more robust and creative brainstorming process to develop a family-driven case plan. The current study also provides a much needed description of the CFT meeting process within child welfare using a direct observational measure.
Citation: Janet S. Walker & Marlene Matarese. (2011). Using a Theory of Change to Drive Human Resource Development for Wraparound. Journal of Child and Family Services, 20, 791-803.
Abstract: Achieving coherence and integration across staff professional development activities is facilitated when training, coaching and staff evaluation are guided by a clearly articulated program theory or "theory of change" that describes how skillful practice promotes desired outcomes. We focus on a theory of change for wraparound, a widely implemented approach to providing community-based care for children with high levels of mental health and related needs. Training, coaching and staff evaluation efforts within wraparound programs have typically been linked only very loosely to theory. We argue that wraparound's unique history allowed it to evolve with limited theoretical grounding, and we then describe a theory of change for wraparound, focusing on the major causal routes that are hypothesized to lead to outcomes. Finally, we provide an extended illustration of how the theory can provide the basis for a coherent and integrated approach to developing the skills and capacities of staff members playing key roles in wraparound implementation.
Citation: Lucille Eber, Kelly Hyde, & Jesse C. Suter. (2011). Integrating Wraparound into a Schoolwide System of Positive Behavior Supports. Journal of Child and Family Services, 20, 782-790.
Abstract: We describe the structure for implementation of the wraparound process within a multi-tiered system of school wide positive behavior support (SWPBS) to address the needs of the 1–5% of students with complex emotional/ behavioral challenges. The installation of prerequisite system features that, based on a 3 year demonstration process, we consider critical to full operation of the Tier 3 wraparound intervention within a system of SWPBS is also described. We include examples of system implementation benchmarks that occur concurrently with student outcome data and are logically linked to full operation and sustainability of wraparound implementation. Challenges surrounding implementation and proposed advancements are also discussed.
Citation: Janet S. Walker, Michael D. Pullmann, Celeste L. Moser, & Eric J. Bruns. (2012). Does Team-Based Planning "Work" for Adolescents? Findings from Studies of Wraparound. Psychiatric Rehabilitation Journal, 35, 189-198.
Abstract: Human service and educational agencies often convene interdisciplinary teams to work collaboratively with adolescents and their parents or caregivers. However, research on adolescent development suggests that it may be difficult to successfully engage adolescents this kind of team-based planning. This article focuses on wraparound as an example of a team planning process, and uses data from several sources to reflect on questions about whether—and under what conditions—collaborative teams are successful in engaging young people—and their caregivers—in planning.
Citation: Oswaldo Urdapilleta, Ying Wang, Rekha Varghese, Geena Kim, Sirisha Busam, & Carrie Palmisano. (2011). National Evaluation of the Medicaid Demonstration Home- and Community-Based Alternatives to Psychiatric Residential Treatment Facilities: Interim Evaluation Report. Columbia, MD: Impaq International.
Abstract: This Medicaid waiver study finds wraparound cost-effectiveness.
Citation: Katherine E. Grimes, et al. (2011). Pursuing Cost-Effectiveness in Mental Health Service Delivery for Youth with Complex Needs. Journal of Mental Health Policy and Economics, 14, 73-86.
Abstract: This article explores the cost-effectiveness of wraparound, system of care, and related strategies using data from the Mental Health Services Program for Youth in Massachusetts. The study found that outcomes were better and expenses were "no more, and usually less" for youth receiving services through MHSPY (versus usual care).
Citation: Eylin Palamaro Munsell, James R. Cook, Ryan P. Kilmer, Tanya Vishnevsky, & Melissa Strompolis. (2011). The Impact of Child and Family Team Composition on Wraparound Fidelity: Examining Links Between Team Attendance Consistency and Functioning. Journal of Child and Family Services, 20, 771-781.
Abstract: Although a growing body of literature has examined wraparound implementation and fidelity, child and family team (CFT) members' levels of participation and the consistency of their attendance have not been systematically examined. This study explored the relationship between CFT member attendance consistency and the fidelity of wraparound team level implementation processes in a System of Care (SOC). Specifically, utilizing Participant Rating Form (PRF) data collected from caregivers, facilitators, youth, supportive persons, and service providers, as well as meeting attendance records, the relationship between team attendance consistency and fidelity of wraparound implementation was explored. Records for 88 teams, with a total of 2,643 members' ratings of CFT meetings between 2004 and 2009, were examined. Analyses indicate that the structural team factors of attendance consistency and mean team members present relate to CFT members' ratings of team functioning and the degree to which meeting processes are consistent with the tenets of wraparound. Team attendance variables related to the views of meeting functioning by facilitators, service providers, and caregivers, the individuals most often responsible for implementation of the plan of care, but not ratings by youth or supportive persons. These findings have implications for policy and the successful implementation of wraparound, underscoring the relevance of attending to and tracking the composition of the CFT and more actively encouraging consistent meeting attendance. Results also highlight the need to measure structural variables that may have salience in fidelity and implementation assessments and, more globally, the effectiveness of SOCs.
Citation: Dana A. Weiner, Scott C. Leon, & Michael J. Stiehl. (2011). Demographic, Clinical, and Geographic Predictors of Placement Disruption among Foster Care Youth Receiving Wraparound Services. Journal of Child and Family Services, 20, 758-770.
Abstract: The effective delivery of wraparound depends upon the availability of a wide range of community-based services. This study seeks to determine the impact of proximity to resources on the effectiveness of a wraparound program for stabilizing foster care placements among a sample of youth. We present a methodology for deriving proximity scores for individual clients using Geographic Information Systems technology, and incorporate this score into a model for predicting placement disruption among youth in foster care receiving services within a wraparound model aimed at preventing placement disruptions. Cox Regression is used to predict length of time until placement disruption using clinical, demographic, and service proximity measures. Risk of placement disruption is predicted by trauma experiences, risk behaviors, and age, and is reduced by the presence of child strengths and proximity to resources. The impact of proximity to resources on placement disruption varies by land use type, suggesting that proximity exerts a greater impact on youth in rural and suburban areas than in urban areas where wraparound service delivery models may be able to overcome distance and other barriers. Implications for the implementation of wraparound programs as well as service system planning are discussed.
Citation: Janet S. Walker & Becca Sanders. (2011). The Community Supports for Wraparound Inventory: An Assessment of the Implementation Context for Wraparound. Journal of Child and Family Services, 20, 747-757.
Abstract: The wraparound process has emerged as perhaps the most frequently implemented comprehensive approach for planning and providing individualized, community-based care for children and adolescents with serious mental health conditions. Providing comprehensive care through the wraparound process necessarily requires a high level of collaboration across organization and agency boundaries. This need for significant inter-agency or "system-level" collaboration creates a complex implementation environment for wraparound. It is therefore not surprising that creating and sustaining a hospitable implementation environment has proven to be extremely challenging. For the people who are responsible for managing the inter-organizational collaboration, it is not easy to evaluate the adequacy of local system-level support for wraparound and to see exactly what kinds of supports are lacking or where system-development efforts should focus. Furthermore, as system-development strategies are put into practice, it can be difficult to assess whether or not meaningful progress is occurring. The Community Supports for Wraparound Inventory (CSWI) was developed to respond to the need for an assessment of the extent to which a community has developed system-level capacity to implement wraparound. This article reports on a study that evaluated the reliability and validity of the CSWI for use in communities implementing wraparound. Findings indicate that the CSWI shows promise as a reliable, valid and useful tool.
Citation: Vicki Sprague Effland, Betty A. Walton, & Janet S. McIntyre. (2011). Connecting the Dots: Stages of Implementation, Wraparound Fidelity and Youth Outcomes. Journal of Child and Family Services, 20, 736-746.
Abstract: Several necessary system and organizational support conditions for wraparound have been identified (Walker et al. 2003). Yet, the relationship between these necessary system level conditions and wraparound fidelity has only recently begun to be examined. Similarly, few studies have included a measure of wraparound fidelity when examining the relationship between wraparound implementation and youth outcomes. The statewide implementation of a wraparound demonstration grant offers the opportunity to explore these relationships and to identify factors that predict improvement in functioning for youth receiving wraparound. Findings suggest that significant relationships exist between (1) the stage of development of necessary support conditions for wraparound and wraparound fidelity and (2) wraparound fidelity and improvement in youth outcomes. Specific elements of wraparound (i.e., outcomes based and community based) and baseline needs and strengths (e.g., high levels of anxiety and conduct issues, poor functioning at home and in school, judgment, and risks) were found to predict a reduction in youth needs. Other unexpected relationships between youth outcomes and the cultural competence element of wraparound and being multi-racial were also discovered. These findings reinforce the importance of supporting high fidelity wraparound for youth and their families in a recovery focused behavioral health system.
Citation: Eric J. Bruns, April Sather, Michael D. Pullman, & Leyla Faw Stambaugh. (2011). National Trends in Implementing Wraparound: Results from the State Wraparound Survey. Journal of Child and Family Services, 20, 726-735.
Abstract: The wraparound process has been promoted in the children's services field as a mechanism to achieve collaborative service planning and delivery for families of young people with complex emotional and behavioral needs that span multiple agencies. We compared results of two surveys of state children's mental health directors, completed in 1998 and 2008, to derive estimates of the extent of wraparound implementation in the United States and to better understand trends in how wraparound has been implemented and supported over time. Results from 2008 found that 88% of states reported having some type of wraparound program that conformed to the definition and provided an estimate of 100,000 children and families served via wraparound in that year. Between 1998 and 2008, states reported increased application of wraparound standards, a greater number of agencies involved in wraparound initiatives, and more formal evaluations of wraparound initiatives. Results provide substantiation of the widespread implementation of wraparound implementation in the United States, and evidence that the model is becoming more consistently supported by formal implementation structures over time.
Citation: Rosalyn M. Bertram, Jesse C. Suter, Eric J. Bruns, & Koren E. O'Rourke. (2011). Implementation Research and Wraparound Literature: Building a Research Agenda. Journal of Child and Family Services, 20, 713-725.
Abstract: We used the framework identified by the National Implementation Research Network's (NIRN) analysis of 35 years of implementation outcomes literature from diverse fields of endeavor to review the current state of wraparound implementation research. Model definition, model fidelity and intervention outcomes were areas of relatively greater development, while target population, theory base and theory of change, organizational context and readiness, staff selection, training, supervision or coaching, purveyor selection, and program installation were less examined or even overlooked. We conclude with suggestions for building a research agenda on wraparound implementation.
Citation: Eric J. Bruns & Janet S. Walker. (2011). Research on the Wraparound Process: Intervention Components and Implementation Supports. Journal of Child and Family Services, 20, 791-803.
Abstract: This article introduces the Journal of Child and Family Services' Special Issue on wraparound.