Latest Wraparound Research

This page highlights recent Wraparound research. For a quick review of the research on Wraparound's effectiveness, see this 2017 summary of rigorous research, or for a more in-depth discussion, see the full-text comprehensive review of Wraparound research. For additional resources, access the NWI's resource library and browse "Wraparound overall > research and evaluation."

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.

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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.

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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. [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.

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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.

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Innovation in Child Welfare: Factors Affecting Adoption of Empirically Supported Interventions

Citation: Agner, J., Barile, J. P., Chandler, S. M., & Berry, M. (2020). Innovation in Child Welfare: Factors Affecting Adoption of Empirically Supported Interventions. Children & Youth Services Review, 119.

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.

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A Longitudinal Evaluation of Wraparound’s Impact on Youth Mental Health Service Use

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: 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.

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Examining Wraparound Fidelity for Youth with Mental Health Needs: An Illustrative Example of Two Rural Canadian Schools

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: 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.

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Putting the Pieces Together: Perceptions of Longitudinal Wraparound, Systems of Care, and Positive Behavior Support Implementation

Citation: Matthews, K., Enyart, M., & Freeman, R. (2019). Putting the Pieces Together: Perceptions of Longitudinal Wraparound, Systems of Care, and Positive Behavior Support Implementation. Community Mental Health Journal, 55(6), 932-941.

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.

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Randomized Control Trial Findings of a Wraparound Program for Dually Involved Youth

Citation: Coldiron, J. S., Hensley, S. W., Parigoris, R. M., & Bruns, E. J. (2019). Randomized Control Trial Findings of a Wraparound Program for Dually Involved Youth. Journal of Emotional and Behavioral Disorders. [Online First.] Doi: 10.1177/1063426619861074

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.

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Interagency Collaborative Care for Young People with Complex Needs: Front‐line Staff Perspectives

Citation: Morgan, S., Pullon, S., & McKinlay, E. (2019). Interagency Collaborative Care for Young People with Complex Needs: Front‐line Staff Perspectives. Health & Social Care in the Community, 27(4), 1019–1030.

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.

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