Wraparound Blog

New Analyses Shine Light on National Trends in Wraparound Fidelity

February 23, 2025 | NWI

The origins of “Wraparound” as a term for team-based, family- and youth-driven care coordination are not 100% clear. But we do know that Wraparound’s roots go back at least 40 years, if not more.

During those 40-plus years, Wraparound’s use has expanded substantially in the U.S. and globally. More and more systems of care are also using standardized measures of quality and fidelity, helping grow Wraparound’s evidence base. Wraparound is now being used for many types of individuals with complex needs – not just youth and families.

Reference to Wraparound as a service model and system strategy seems to be ever-increasing across the U.S. and the world. But what is happening with respect to Wraparound fidelity and outcomes? Is Wraparound heading in the right direction?

Last month, the National Wraparound Implementation Center (NWIC) hosted a webinar at which the University of Washington (UW) Wraparound Evaluation and Research Team (WERT) presented results from a new analysis of over 4,400 surveys of parents and caregivers using the Wraparound Fidelity Index, Short Form (WFI-EZ). These results, presented with additional detail, are also available in a new report from WERT.

Data were collected by 132 sites in 31 states and large systems of care across the U.S. While UW WERT has analyzed its national fidelity dataset before, these are the first such results since the COVID-19 pandemic. Among some of the findings:

  • Wraparound fidelity falls short of established benchmarks. The “national mean” for the WFI-EZ Total Fidelity score was found to be 71% of total possible fidelity. However, based on analyses of fidelity scores that achieve positive youth/family outcomes, UW WERT has proposed a benchmark for “high fidelity” of 80%, and a benchmark for “adequate” total fidelity as 75%.
    • Caregiver satisfaction was found to be 79% of total possible – above the benchmark for “borderline” (75%) but well below the benchmark for “high” satisfaction (>92%).
  • While many states and local initiatives struggle to implement Wraparound with high or even adequate fidelity, others were found to exceed “adequate” and reach “high” fidelity. Thus, the “national means” found in these analyses do not necessarily reflect the range of implementation quality being achieved across different states and systems, many of which are doing an admirable job.
  • Caregiver perceptions of fidelity are trending in the wrong direction. National means for total fidelity and for three of the five Wraparound key elements are lower than the last time we analyzed our fidelity results (2017). The decline in average total fidelity (from 73% to 71%) suggests that Wraparound implementation has worsened overall. Ongoing research by UW WERT and NWIC will aim to identify what may be causing this decline. Are policy and fiscal environments becoming less hospitable? Is it turnover and other workforce stressors? Or something else?
  • Certain critical indicators of Wraparound fidelity were found to be particularly low. Items assessing meaningful engagement of natural supports, having the right members on Wraparound teams, teams’ understanding of families and their needs, and purposeful transition planning were all lower than average for the WFI-EZ overall.
  • Caregiver-reported institutional placement decreased, but use of emergency departments for mental health problems rose 31%. These and other trends in outcomes found from these analyses results mirror current trends in youth and family systems of care, including lack of availability of both institutional and community-based services.

UW WERT will continue to feed such results back to the field, including results of surveys of youth and care coordinators, as well as from other fidelity measures such as the Document Assessment and Review Tool (DART). Along the way, the NWI and NWIC will continue to try to make sense of these results and use them to improve our support to the national Wraparound community.

In the meantime, we invite you to read this new report and ask how your organization or system of care might use its own data to identify areas for improvement and work together with your partners to achieve them. No matter how ambitious the benchmarks for “high fidelity” may seem, the current report shows that high-fidelity Wraparound can be achieved. Training and Technical assistance from groups like NWIC and UW WERT can help get your program or system there.

When it comes to improving outcomes for youth and families, however, outside help can’t substitute for visionary leaders and community partners working together to do whatever it takes to build effective systems. Our most vulnerable youth and families deserve nothing less.