National Wraparound Initiative's Wraparound Blog

New Research Shows Hospitable Organizations and Systems Are Critical to High Quality Implementation of Wraparound

March 22, 2025 | NWI

Because Wraparound is a system-level intervention that requires policy and funding changes and cross-system coordination, successful implementation requires purposeful action by provider organizations and the systems within which they are embedded. As a result, Wraparound has been observed to take more time to implement than many other types of evidence-based treatments (EBTs) for youth with complex behavioral health needs. But how long does implementation typically take? And what factors affect the pace and quality of implementation?

The Wraparound Evaluation and Research Team (WERT) has just published a research article in Psychiatric Services (available online beginning March 27, 2025) that confirms Wraparound takes longer to implement than other EBTs. The study also showed how specific activities within organizations and systems influence both the amount of time it takes to implement Wraparound as well as the completeness and quality of implementation.

This study examined implementation in 10 states that used one of two state-level administrative structures to implement Wraparound: Care Management Entities (CMEs, 4 states) and Community Mental Health Centers (CMHCs, 6 states). We used the Stages of Implementation Completion (SIC) tool to assess the degree to which each state completed organization-level and system- or state-level activities that are necessary to implement Wraparound, along with the amount of time it took to complete them. ¹  In addition, we gathered fidelity data with the Coaching Observation Measure for Effective Teams (COMET) to assess the degree to which Wraparound was implemented with adherence to its underlying practice model.

Results showed that states that used CMEs completed more implementation activities than states where Wraparound was provided by CMHCs. States that used CMEs also implemented the majority of activities more quickly and had higher mean fidelity scores as measured by the COMET than CMHC states.

Compared to other complex cross-system EBTs, Wraparound took significantly more days to implement pre-implementation activities (560 days compared to 336 days for other EBTs) and implementation activities (959 days compared to 712 days). Importantly, differences between Wraparound and other EBTs were smaller for CME states.

Which activities take the longest? The study showed that system-level activities (such as engaging state leaders) and organization-level activities (such as conducting implementation reviews) account for much of the slow pacing of implementation.

Finally, the team asked whether the pace of implementation activities influenced fidelity. Interestingly, analyses showed that taking longer to complete pre-implementation activities (such as identifying stakeholders and gaining their buy-in and developing detailed implementation plans) was associated with better Wraparound fidelity. Conversely, states that took longer during the implementation phase (e.g., hiring staff, establishing systems to monitor fidelity) showed significantly poorer fidelity.

The findings of this study indicate that interventions with a strong systems-level focus, such as Wraparound, require considerable time to implement. However, a hospitable administrative structure (in this case using a CME) helped shorten the time and resulted in better adherence to the Wraparound practice model.

Results also showed that states that take time early in the planning process to organize systems and providers and develop clear implementation plans implement care of higher quality and are more expedient in later implementation stages.

All these results underscore the importance of careful planning and management of system and organizational level activities required to make Wraparound implementation happen. For a high-level overview of these details, you can see the NWI’s monograph on Wraparound Implementation Standards. For more intensive support to system-level implementation of care coordination, the National Wraparound Implementation Center uses a technical assistance process and associated measures that focus on key activities organized by the same three implementation phases: Pre-Implementation, Implementation, and Sustainment.

By creating strategies to facilitate coordination of implementation activities within and across these contexts, administrators and providers can facilitate provision of better Wraparound and other supports for our young people and their families.