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."
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Child and Family Team Meeting Characteristics and Outcomes in a Statewide System of Care
Citation: Schreier, A., Horwitz, M., Marshall, T., Bracey, J., Cummins, M., & Kaufman, J. S. (2019). Child and Family Team Meeting Characteristics and Outcomes in a Statewide System of Care. American Journal of Community Psychology, 63,(3/4), 487–498.
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.
Falling Through the Cracks: How Service Gaps Leave Children with Neurodevelopmental Disorders and Mental Health Difficulties Without the Care They Need
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.
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.
A Longitudinal Evaluation of Wraparound’s Impact on Youth Mental Health Service Use
Citation: Cosgrove, J. A., Lee, B. R., & Unick, G. J. (2019). A Longitudinal Evaluation of Wraparound’s Impact on Youth Mental Health Service Use. Journal of Emotional and Behavioral Disorders. Published online: April 15, 2019.
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.
Intensive community treatment and support “Youth Wraparound” service in Western Australia: A case and feasibility study
Citation: Smith, W., Sitas, M., Rao, P., Nicholls, C., McCann, P., Jonikis, T., …Waters, F. (2019). Intensive Community Treatment and Support “Youth Wraparound” Service in Western Australia: A Case and Feasibility Study. Early Intervention in Psychiatry, 13(1), 151–158.
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.
Facilitating a Therapeutic Environment: Creating a Therapeutic Community Using a “Wraparound” Intervention Program With At-Risk Families
[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., & Rosa Naveh, A. (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. https://doi.org/10.1177/1066480718795121
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.
Infusing parent-child interaction therapy principles into community-based wraparound services: An evaluation of feasibility, child behavior problems, and staff sense of competence
Citation: Wallace, N.M., Quetsch, L.B., Robinson, C., McCoy, K., & McNeil, C.B. (2018). Children and Youth Services Review. 88(C), 567-581.
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.
Impact of a Web-Based Electronic Health Record on Behavioral Health Service Delivery for Children and Adolescents: Randomized Controlled Trial
Citation: Bruns, E.J., Hook, A.N., Parker, E.M., Esposito, I., Sather, A., Parigoris, R.M., Lyon, A.R., & Hyde, K.L. (2018). Impact of a Web-Based Electronic Health Record on Behavioral Health Service Delivery for Children and Adolescents: Randomized Controlled Trial. Journal of Medical Internet Research, 20(6).
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.
Exploring attrition, fidelity, and effectiveness of wraparound services among low-income youth of different racial backgrounds
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: The Journal of Collaborative Family Healthcare, 35(4), 430-438.
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.
Psychotropic polypharmacy among youths with serious emotional and behavioral disorders receiving coordinated care services
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.
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.
Do high fidelity Wraparound services for youth with serious emotional disturbances save money in the long-term?
Citation: Snyder, A., Marton, J., McLaren, S., Feng, B., Zhou, M. (2017). Do high fidelity Wraparound services for youth with serious emotional disturbances save money in the long-term? The Journal of Mental Health Policy and Economics, 20, 167-175.
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.