National Wraparound Initiative's Wraparound Blog

New National Institute of Mental Health Grant Supports Development and Testing of Text-Based Outcomes Monitoring System for Wraparound

May 13, 2022 | Eric Bruns

Multiple research studies have documented the potential for positive effects of routine outcomes monitoring (ROM) in health care and behavioral health services.

Defined as “session-to-session measures of client progress to evaluate and improve treatment outcome,” ROM is also a core component of Wraparound care coordination as trained and supported by the National Wraparound Implementation Center (NWIC) and others.

At every Wraparound meeting, for example, the team should review and/or collect data on the family’s own rating of progress toward meeting their priority need(s) and vision for the future. Collecting such information can reinforce when recognizable progress is being made or highlight elements of a plan of care that need to be revised. ROM can improve the alliance among Wraparound team members, aid in supervision, and help a Wraparound provider organization be alerted when a youth, caregiver, or family is “off track” or experiencing an otherwise unknown crisis. Furthermore, when aggregated, such data can help identify provider organizations or other units that are achieving positive outcomes – or need attention to improve the quality of their care.

As described in this wonderful review by some of the world’s leading researchers on ROM, however, significant barriers impede actual implementation of ROM. Barriers include financial burdens, time burdens, competing stakeholder needs, and staff turnover, among many others.

In Wraparound, even though being “outcomes-based and data informed” may be our most important principle, our experience indicates consistent collection of progress and process data is rare. Fidelity data confirm this problem.

In an attempt to overcoming practical barriers to ROM in Wraparound, the University of Washington Wraparound Evaluation and Research Team (UW WERT) has partnered with 3C Institute on a recently awarded grant to develop and test a “mobile Routine Outcomes Monitoring” (mROM) system specific to Wraparound.

The proposed SMART-Wrap (Short Message Assisted Responsive Treatment for Wraparound) product will use brief prompts sent by text that can be read and responded to in a matter of seconds. Data would then be sent securely to a dashboard linked to UW WERT’s WrapStat system for review by the family’s care coordinator and others responsible for providing effective Wraparound support. If necessary, the system will send alerts to helpers, which could be when a family is in trouble or not making progress, or when progress and/or positive outcomes should be celebrated.

Given that 90% of text messages are opened within three seconds of their receipt, our hope is that “SMART-Wrap” may serve as a way to reduce the cost, time, and logistical barriers to getting actionable, “real-time” information from caregivers and youth to inform teamwork, plan of care revisions, supervision, and program evaluation.

Over the course of four phases of work, this project will:

  1. Get input on SMART-Wrap system functionality from parents/caregivers, young people, Wraparound providers, mROM researchers, and other experts;
  2. Develop an initial SMART-Wrap prototype;
  3. Test out SMART-Wrap usability and feasibility with a small number of programs and enrolled families;
  4. Prepare for a larger test of the system, incorporation into WrapStat, and dissemination to the field.

As some may remember, a survey of the National Wraparound Initiative community of practice in 2020 informed the original NIMH grant and demonstrated interest among Wraparound initiatives nationally. Now that it has been awarded, we plan to continue to inform and engage Wraparound experts nationally as we use NIMH funds to develop and test SMART-Wrap over the next 18 months.

If your Wraparound Provider Organization or initiative is interested in participating in this project in some way, please do not hesitate to contact UW WERT at wrapeval@uw.edu.

As always, we are grateful to be part of a national movement to provide effective care to youth with the most complex needs and their families. We hope this project will be yet another successful undertaking that advances Wraparound and its positive impact.