National Wraparound Initiative's Wraparound Blog

“Can We Finally Call Wraparound Evidence-Based?”

November 04, 2021 | Eric Bruns

On November 1, 2021, the recently completed meta-analysis of effects of Wraparound care coordination was included as a “spotlighted” article in the print edition of the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP). Authored by Jonathan Olson, Eric Bruns, and others with the University of Washington Wraparound Evaluation and Research Team, this research study found that Wraparound consistently produces more positive outcomes than services as usual for youths with serious and complex needs, particularly for youth of color. The article is available for free and downloadable in full from the Journal’s website.

The November print edition of JAACAP also included a companion editorial by Dr Justine Larson, MD, MPH, entitled “Can We Finally Call Wraparound Evidence-Based for Youths with Serious Emotional Disorders?” Dr. Larson argues that “No greater obligation exists for child and adolescent psychiatrists than understanding how to take care of the most complex youths—those with serious emotional disorders (SEDs), co-occurring conditions, and multi-system involvement.”

Dr. Larson goes on to conclude that the results of the meta-analysis reinforce what many in the field have long known, that the heterogeneity and complexity of youths with serious emotional and behavioral challenges requires use of a comprehensive approach to service coordination and delivery that is “best suited to the population,” specifically, “a structure or process for planning intervention(s), as opposed to one specific intervention.” She goes on to write that “the review by Olson et al. provides further support for Wraparound as an evidence-based intervention,” and that “children and adolescents with SEDs are complex, with multiple diagnoses and psychosocial challenges requiring complex, multi-component intervention; Wraparound is the process that can organize the treatment.”

Given the findings that studies with higher rates of youth of color showed significantly greater effects, Dr. Larson concludes by stating “It is a matter not only of science but of equity to further study such interventions that seem particularly effective for youths of color.”

At the same time, Dr. Larson notes that “the quality and approach of Wraparound programs can vary significantly by community,” and that “measures of fidelity and implementation standards do exist, but the use of such measures in research and community practice is inconsistent.”

We could not agree more with all the above points made by Dr. Larson. Investment in community-based models such as Wraparound (as well as mobile crisis services, parent and youth peer support, respite, and intensive in-home treatment) should all be viewed as “obligations” of public systems. But these models must be implemented with quality and fidelity, and supported by coaching, technical assistance, and data at multiple levels. As noted in another recent empirical study by the research team, the conditions present in states, systems, and provider organizations must be hospitable to achieve fidelity to research-based standards as well as positive youth and family outcomes.

We also wholeheartedly agree that continued examination of Wraparound effects for youth and families from different backgrounds holds promise to not just inform Wraparound development and implementation, but the field of child, youth, and family behavioral health as a whole.

In her editorial, Dr. Larson muses, “What is the ‘special sauce’ that makes Wraparound effective? To use a pharmacological analogy, Wraparound can be thought of as acting on multiple receptors affecting the youths and family—engagement challenges, psychosocial issues, as well as specific treatment targets with specific interventions… the mechanisms of action resulting in wraparound’s effectiveness involve both family engagement and appropriate tailoring of interventions.”

For public systems to actualize this theory requires unwavering attention to quality of implementation. With Wraparound’s potential for positive effects now known, the field can turn fully to the true challenge, which is assuring that Wraparound lives up to that potential in every state and service system in which it is deployed.