Influences of Inner and Outer Settings on Wraparound Implementation Outcomes
July 10, 2021 | NWI
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.