Latest Wraparound Research
This page highlights recent Wraparound research. For a quick review of the research on Wraparound's effectiveness updated in 2024, see this Wraparound research summary. For a more in-depth discussion, see the full-text comprehensive review of Wraparound research from 2017. For additional resources, access the NWI's resource library and browse "Wraparound overall > research and evaluation."
Measurement characteristics of the Wraparound Fidelity Index Short Form: Results from a statewide implementation
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 and the Health Professions, 46, 320-333.
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.
Factor structure, reliability and validity of the Wraparound Fidelity Index Short Form (WFI-EZ)
Citation: Bruns, E. J., Olson, J. R., Parigoris, R. M., Parker, E. M. & Walker, J. S. (2023). Factor structure, reliability and validity of the Wraparound Fidelity Index Short Form (WFI-EZ). Journal of Child and Family Studies 32, 1855-1868.
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.
Cost and utilization impacts of a Medicaid managed care organization’s behavioral health Wraparound program
Citation: Chi, W., Nguyen, B. T., Kent, S. T. & Sylwestrzak, G. (2022). Cost and utilization impacts of a Medicaid managed care organization’s behavioral health Wraparound program. Administration and Policy in Mental Health and Mental health Services Research, 49, 658-669.
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.
Watch Me Rise: An evaluation of Wraparound with homeless youth with a child welfare history
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.
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.
Education-centred formal Wraparound Services in support of school-aged students with complex support needs: A systematic review
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, 47-60.
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.
Understanding racial-ethnic disparities in Wraparound care for youths with emotional and behavioral disorders
Citation: Stenersen, M. R., Kelly, A., Bracey, J., Marshall, T., Cummings, M. Clark, K., & Kaufman, J. (2021). Understanding racial-ethnic disparities in Wraparound care for youths with emotional and behavioral disorders. Psychiatric Services, 73, 526-532.
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.
Evidence Based Practice in Systems of Care for Children with Complex Mental Health Needs
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).
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.
Paths Toward Sustainable State and County Systems of Care
Citation: Holt, W., Hahn, T., Ireland, A., Daley, T., & Rosenblatt, A. (2021). Paths Toward Sustainable State and County Systems of Care. The Journal of Behavioral Health Services & Research. [Online First.]
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.
Systematic Review and Meta-analysis: Effectiveness of Wraparound Care Coordination for Children and Adolescents
Citation: Olson, J. R., Benjamin, P. H., Azman, A., Kellogg, M. A., Pullman, M. D., Suter, J. C., & Bruns, E. (2021). Systematic Review and Meta-analysis: Effectiveness of Wraparound Care Coordination for Children and Adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 60, 1353-1366. [Online First.]
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.
Influences of Inner and Outer Settings on Wraparound Implementation Outcomes
Citation: Olson, J. R., Azman, A., Estep, K. M., Coviello, K. A., Robshaw, S., & Bruns, E. (2021). Influences of Inner and Outer Settings on Wraparound Implementation Outcomes. Global Implementation Research and Applications, 1, 77–89.
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.