Wraparound

About This Program

Target Population: Designed for children and youth with severe emotional, behavioral, or mental health difficulties and their families where the child/youth is in, or at risk for, out-of-home, institutional, or restrictive placements, and involved in multiple child and family-serving systems (e.g., child welfare, mental health, juvenile justice, special education, etc.)

For children/adolescents ages: 4 – 17

For parents/caregivers of children ages: 4 – 17

Program Overview

Wraparound is a team-based planning process intended to provide individualized and coordinated family-driven care. Wraparound is designed to meet the complex needs of children who are involved with several child and family-serving systems (e.g., mental health, child welfare, juvenile justice, special education, etc.), who are at risk of placement in institutional settings, and who experience emotional, behavioral, or mental health difficulties. The Wraparound process requires that families, providers, and key members of the family's social support network collaborate to build a creative plan that responds to the particular needs of the child and family. Team members then implement the plan and continue to meet regularly to monitor progress and make adjustments to the plan as necessary. The team continues its work until members reach a consensus that a formal Wraparound process is no longer needed.

The values associated with Wraparound require that the planning process itself, as well as the services and supports provided, should be individualized, family driven, culturally competent and community-based. Additionally, the Wraparound process should increase the "natural support" available to a family by strengthening interpersonal relationships and utilizing other resources that are available in the family's network of social and community relationships. Finally, Wraparound should be "strengths-based," helping the child and family recognize, utilize, and build talents, assets, and positive capacities.

Program Goals

The goals of Wraparound are:

  • Maintain children with highest levels of mental health and related needs successfully and safely in their homes and communities
  • Improve functioning across life domains
  • Decrease out-of-home placements

Logic Model

The program representative did not provide information about a Logic Model for Wraparound.

Essential Components

The essential components of Wraparound include:

  • Practice that confirms to the Ten Principles of the Wraparound Process (see document citation in References section) which specify that care should be family-driven and youth-guided, community- and strengths-based, individualized, outcome oriented, culturally competent, collaborative, and so on. The document provides information about what these principles "look like" when applied to the Wraparound process.
  • Practice must also include the activities outlined in the Phases and Activities of the Wraparound Process (see document citation in References section). The phases and activities are listed below. A more detailed description of each phase and activity is provided in the document.
    • PHASE 1: Engagement and team preparation
      • Orient the family and youth to wraparound and address legal and ethical issues
      • Stabilize crises: Elicit information from family members, agency representatives and potential team members about immediate crises or potential crises, and prepare a response
      • Explore strengths, needs, culture, and vision during conversations with child/youth and family, and prepare summary document
      • Engage and orient other team members
      • Make necessary meeting arrangements
    • PHASE 2: Initial plan development
      • Develop an initial plan of care: Determine ground rules, describe and document strengths, create team mission, describe and prioritize needs/goals, determine outcomes and indicators for each goal, select strategies, and assign action steps
      • Create a safety/crisis plan to ameliorate risk and respond to potential emergencies
      • Complete necessary documentation and logistics
    • PHASE 3: Implementation
      • Implement action steps for each strategy of the wraparound plan, track progress on action steps, evaluate success of strategies, and celebrate successes
      • Revisit and update the plan, considering new strategies as necessary
      • Maintain/build team cohesiveness and trust by maintaining awareness of team members' satisfaction and "buy-in" and addressing disagreements or conflict
      • Complete necessary documentation and logistics
    • PHASE 4: Transition
      • Plan for cessation of formal wraparound: Create a transition plan and a post-transition crisis management plan, and modify the wraparound process to reflect transition
      • Create a "commencement" by documenting the team's work and celebrating success
      • Follow up with the family

Program Delivery

Child/Adolescent Services

Wraparound directly provides services to children/adolescents and addresses the following:

  • Severe emotional, behavioral, or mental health difficulties and their families where the young people are often in, or at risk for, out of home, institutional, or restrictive placements, and are involved in multiple child and family-serving systems (e.g., child welfare, mental health, juvenile justice, special education, etc.)

Parent/Caregiver Services

Wraparound directly provides services to parents/caregivers and addresses the following:

  • Child in foster or residential care, child in child welfare system, child in juvenile justice system, child with significant emotional and behavioral problems, and/or child at-risk for out-of-home placement

Recommended Intensity:

This can vary. Usually there is an intensive engagement and initial planning process that may require two 60-90 minute sessions with the family and two team sessions during the first three weeks to a month. The team continues to meet thereafter, usually with increased intensity in the early phases (often once per month or even more) and decreasing thereafter. The care coordinator, facilitator, and parent partner could have other contacts with the youth and family as necessary. Services and supports called for in the plan are provided by other team members or by people not included on the team.

Recommended Duration:

Well-established programs provide services for an average of 14 months or so

Delivery Settings

This program is typically conducted in a(n):

  • Adoptive Home
  • Birth Family Home
  • Foster / Kinship Care
  • Community-based Agency / Organization / Provider
  • Group or Residential Care

Homework

Wraparound includes a homework component:

Youth and family can have homework if the team determines it will facilitate carrying out their roles in implementing the overall plan.

Languages

Wraparound has materials available in a language other than English:

Spanish

For information on which materials are available in this language, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

Most of the cost is in personnel. Programs typically hire care coordinators with caseloads of 10-15 families. Additionally, most programs hire parent advocates/parent partners to work with teams. Because this program is typically a collaborative effort, implementation usually (but not always) requires some sort of interagency oversight or governance body with representation from participating child- and family-serving agencies and organizations.

Manuals and Training

Prerequisite/Minimum Provider Qualifications

Most programs require staff to be at least at the Bachelor's level for care coordinator and supervisory positions. Requirements for family partners are flexible. The most important qualification is expertise in multiagency collaboration and the program itself.

Manual Information

There is a manual that describes how to deliver this program.

Training Information

There is training available for this program.

Training Contact:
  • Janet Walker
    National Wraparound Initiative

    phone: (503) 725-8236
Training Type/Location:

The National Wraparound Implementation Center (NWIC) provides innovative approaches that are grounded in implementation science and designed to provide the most cutting-edge strategies to support Wraparound implementation. NWIC is a partnership between the three leading universities in Wraparound implementation: The University of Washington, School of Medicine, Department of Psychiatry and Behavioral Sciences; Portland State University, School of Social Work, Regional Research Institute; and the University of Maryland, Baltimore School of Social Work. Our goal is to ensure that sites have concentrated support to implement high fidelity, high quality Wraparound for children with behavioral health needs and their families. Please visit www.nwic.org for more details about Wraparound implementation and training.

Number of days/hours:

Varies

Implementation Information

Pre-Implementation Materials

There are pre-implementation materials to measure organizational or provider readiness for Wraparound as listed below:

Pre-implementation materials are available and are tailored to the agency requesting them, please contact the National Wraparound Implementation Center at www.nwic.org or through Janet Walker at janetw@pdx.edu for more details about pre-implementation materials.

Formal Support for Implementation

There is formal support available for implementation of Wraparound as listed below:

The National Wraparound Implementation Center (NWIC, www.nwic.org) provides innovative approaches that are grounded in implementation science and designed to provide the most cutting-edge strategies to support Wraparound implementation. The center's goal is to ensure that sites have concentrated support to implement high fidelity, high quality Wraparound for children with behavioral health needs and their families. NWIC works with sites at any stage of implementation—from initial planning to established initiative—using a tailored and intensive approach for implementation support. This process begins with a rigorous assessment of current implementation. Based on assessment results, NWIC will work with the site to design a comprehensive implementation support plan to address identified needs. The comprehensive plan will integrate efforts across the three main areas of implementation:

  • Organization and system development, which focuses on policy, financing, and systems structure
  • Workforce development, which focuses on processes for training, coaching and supervision
  • Accountability, which focuses on the measurement of key quality assurance indicators and outcomes

Implementation support from NWIC is provided using a strategic combination of in-person and technology- enabled strategies. NWIC's expanding array of technology- enabled communication options includes telephone and video conferencing, the Wraparound Virtual Learning Collaborative (WVLC), a virtual training center, and the Virtual Coaching Platform (VCP). Implementation support is also provided through the use of a variety of online tools including automated tracking and feedback systems, web-based clinical support, and a wraparound-specific electronic behavioral health record.

Fidelity Measures

There are fidelity measures for Wraparound as listed below:

A brief overview of different Wraparound fidelity measures can be found at https://nwi.pdx.edu/assessment-fidelity/. For additional details, please see http://www.nwi.pdx.edu/NWI-book/Chapters/Bruns-5e.1-(measuring-fidelity).pdf.

Implementation Guides or Manuals

There are implementation guides or manuals for Wraparound as listed below:

The Wraparound Implementation Guide: A Handbook for Administrators and Managers is available at http://nwi.pdx.edu/order-print-publications/ and http://www.nwi.pdx.edu/pdf/ImplementationGuide-Complete.pdf.

Research on How to Implement the Program

Research has been conducted on how to implement Wraparound as listed below:

The Wraparound Evaluation and Research Team (WERT) is the "accountability wing" of the National Wraparound Initiative (http://depts.washington.edu/wrapeval/). Using a collaborative process that involves NWI advisors, WERT develops, pilot tests, refines, and disseminates evaluation measures that support Wraparound implementation such as those of the Wraparound Fidelity Assessment System.

Citations:

Bruns, E. J., Weathers, E. S., Suter, J. C., Hensley, S., Pullman, M. D., & Sather, A. (2014). Psychometrics, reliability, and validity of a Wraparound team observation measure. Journal of Child and Family Studies, 24, 979–991. https://doi.org/10.1007/s10826-014-9908-5

Bruns, E. (2008). Measuring Wraparound fidelity. In E. J. Bruns & J. S. Walker (Eds.), The resource guide to Wraparound. National Wraparound Initiative, Research and Training Center for Family Support and Children's Mental Health. http://www.nwi.pdx.edu/NWI-book/Chapters/Bruns-5e.1-(measuring-fidelity).pdf

Bruns, E. J., Burchard, J. D., Suter, J. C., Leverentz-Brady, K., & Force, M. M. (2004). Assessing fidelity to a community-based treatment for youth: The Wraparound Fidelity Index. Journal of Emotional and Behavioral Disorders, 12(2), 79–89. https://doi.org/10.1177/10634266040120020201

Relevant Published, Peer-Reviewed Research

Child Welfare Outcomes: Permanency and Child/Family Well-Being

When more than 10 research articles have been published in peer-reviewed journals, the CEBC reviews all of the articles as part of the rating process and identifies the most relevant articles, with a focus on randomized controlled trials (RCTs) and controlled studies that have an impact on the rating. The articles chosen for Wraparound are summarized below:

Clark, H. B., Lee, B., Prange, M. E., & McDonald, B. A. (1996). Children lost within the foster care system: Can wraparound service strategies improve placement outcomes? Journal of Child and Family Studies, 5(1), 39–54. https://doi.org/10.1007/BF02234677

Type of Study: Randomized controlled trial
Number of Participants: 132

Population:

  • Age — 7–15 years
  • Race/Ethnicity — Not specified
  • Gender — Not specified
  • Status — Participants were children living in foster care or emergency shelter placement.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the feasibility of applying a wraparound strategy to children with emotional and behavioral disturbances within the foster care system and their foster, biological, and/or adoptive families. Participants were randomly assigned to Wraparound services or to usual foster care services. Measures utilized include placement settings and changes, runaway status, and incarceration. Results indicate the Wraparound group had significantly fewer changes after the beginning of the intervention than did those receiving standard services. Groups did not differ on number of runaway incidents per year: both groups decreased in incidents after receiving services. However, Wraparound children with runaway incidents showed a decrease in the number of days away, while the comparison group showed an increase. Both groups increased in the number of days spent incarcerated for the subset of children with any incarceration, but the increase was significantly greater for the standard services group. Finally, the Wraparound group children were significantly more likely to have received a permanent placement than were the comparison children. Limitations include lack of postintervention follow-up.

Length of controlled postintervention follow-up: None.

Evans, M. E., Armstrong, M. I., & Kuppinger, A. D. (1996). Family-centered intensive case management: A step toward understanding individualized care. Journal of Child and Family Studies, 5(1), 55–65. https://doi.org/10.1007/BF02234678

Type of Study: Randomized controlled trial
Number of Participants: 42

Population:

  • Age — 5–12 years
  • Race/Ethnicity — 92% Non-Hispanic White
  • Gender — 93% Male
  • Status — Participants were children referred to services for serious emotional disorders.

Location/Institution: New York State

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the outcomes of individualized care for foster families. Participants were randomly assigned to Family Based Treatment (FBT) or to Family-Centered Intensive Case Management (FCICM) [now called Wraparound]. Assessments were conducted at baseline and every six months up through 6 months after discharge. Measures utilized include the Client Description Report (CDR), the Child Behavior Checklist (CBCL), the Child and Adolescent Functional Assessment Scales (CAFAS), and the Family Adaption and Cohesion Scales (FACES III). Results indicate children in FCICM showed a significant decrease in symptoms and problem behaviors based on the CDR after receiving one year of services. CBCL scores, which were assessed by parents, did not change for either group. The children in FCICM also improved significantly on behavior, moods, emotions, and role performance as measured by the CAFAS. Family outcomes did not differ across groups on the FACES III, although caseworkers did note greater improvement for FCICM families on ability to understand children's problems, willingness to access services, provide structure, making children feel loved and wanted, identifying appropriate discipline and knowing when to call the treatment team. Limitations include small sample size; differences between the two groups at baseline; lack of generalizability due to ethnicity and gender; and at the one-year timepoint, data was only available on 17 families and the differences between the groups were no longer statically significant.

Length of controlled postintervention follow-up: Estimated 2.5–8.5 months.

Hyde, K. L., Burchard, J. D., & Woodworth, K. (1996). Wrapping services in an urban setting. Journal of Child and Family Studies, 5(1), 67–82. https://doi.org/10.1007/BF02234679

Type of Study: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants: 121

Population:

  • Age — Mean=15.6–20.1 years
  • Race/Ethnicity — 67–100% African American
  • Gender — 58–91% Male
  • Status — Participants were youth at risk for out-of-home placements and youth diverted from out-of-state residential treatment centers.

Location/Institution: Baltimore, MD

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to obtain information that would begin to answer questions about Wraparound services. Participants were part of one of four groups: The Wraparound Return (WR) group, the Wraparound Diversion (WD) group, the Pre-Wraparound (PW) group, and the Non-Wraparound (NW) group. Measures utilized include the Community Adjustment Rating Scale, including measures of restrictiveness of living, school attendance, job training attendance, and harmful behaviors. Involvement in community activities and evaluation of services provided were also measured. Results indicate a higher percentage of youth in both Wraparound groups were rated as Good or Fair in adjustment than in the other two groups. Those in the NW group had the poorest ratings, with none achieving a rating of Good and 60% being rated as Poor. The same patterns held for ratings of the number of youth with more than 10 days of community involvement. Limitations include small sample sizes, lack of follow-up, and lack of normative data for the measures used.

Length of controlled postintervention follow-up: None.

Carney, M. M., & Butell, F. (2003). Reducing juvenile recidivism: Evaluating the wraparound services model. Research on Social Work Practice, 13(5), 551–568. https://doi.org/10.1177/1049731503253364

Type of Study: Randomized controlled trial
Number of Participants: 141

Population:

  • Age — Mean=15 years
  • Race/Ethnicity — Wraparound: 45% Caucasian, 53% African American, and 1% Biracial; Conventional Services: 56% Caucasian, 43% African American, and 2% Biracial
  • Gender — Wraparound Services: 60% Male and 40% Female, Conventional Services: 63% Male and 37% Female
  • Status — Participants were delinquent youth entering the juvenile justice system.

Location/Institution: Columbus, OH

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to (a) evaluate the relative effectiveness of wraparound services versus conventional services for juvenile delinquent youth and (b) create a predictive model that would assist the juvenile court system in correctly identifying youth at greatest risk of reoffending. Participants were randomly assigned to Wraparound services or conventional services conditions. Measures utilized include interviews with parents or guardians and juvenile court re-arrest data. Parent/Guardian interviews included questions about school attendance, unruly or delinquent behavior, team functioning (Wraparound only), and service receipt. Results indicate youth in the Wraparound group had fewer absences and suspensions from school and fewer incidents of running away from home. They were also less assaultive and less likely to be picked up by police. No significant differences were found in arrests or incarceration during the course of the evaluation at 6, 12, and 18 months. Limitations include limited generalizability due to the small sample, overrepresentation of youth already enrolled in case management services, and lack of follow-up.

Length of controlled postintervention follow-up: None.

Bickman, L., Smith, C., Lambert, E. W., & Andrade, A. R. (2003). Evaluation of a congressionally mandated Wraparound demonstration. Journal of Child and Family Studies, 12(2), 135–156. https://doi.org/10.1023/A:1022854614689

Type of Study: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants: 111

Population:

  • Age — 4-16 years (Mean=12.2 years)
  • Race/Ethnicity — 72% White
  • Gender — 58% Male
  • Status — Participants were dependents of members of the military referred for services.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare a sample of families who had been referred to a Department of Defense mandated Wraparound demonstration implementation and to a sample who were referred to the demonstration and refused or were ineligible on some criteria. Measures utilized include the Child Behavior Checklist (CBCL), the Youth Self Report (YSR); the Caregiver Strain Questionnaire (CSQ); the Family Environment Scale–Cohesion and Conflicts Subscales; the Vanderbilt Functioning Index–Parent/Primary Caregiver Version (VFI-P) and Adolescent Version (VFI-A); the Vanderbilt Positive Function Index Parent/Primary Caregiver Version (VPFI-P) and Adolescent Version (VPFI-A); the Ohio Scales–Parent Version (OS-P) and Adolescent Version (OS-A); the Mental Health Attitude (MHA); the Mental Health Efficacy (MHE); the Student Life Satisfaction Scale (SLSS); the Helping Alliance Scale–Adolescent Version (HAS-A) and Helper Version (HAS-H); the Helping Behaviors Checklist–Adolescent Version (HBC-A), Clinician Version (HBC-C), and Non-clinician Version (HBC-NC); the Parent-Helper Relationship Questionnaire–Primary Caregiver Version and Clinician Version; the Perceived Social Support from Family (PSS-FA); the Vanderbilt Satisfaction Scales; the Service Process Inventory for Families and Youth (SPIFY); the Service Utilization and Medication Usage; the Family Background Form; and the Adherence Measure. Results indicate children in the Wraparound group received more wraparound services than those in the treatment as usual (TAU) Comparison group. These services included case management, in-home treatment, and other nontraditional services. The Demonstration also provided better continuity of care. Both groups showed some improvement on some measures but there were no differences between the groups in functioning, symptoms, life satisfaction, positive functioning, or sentinel events. Regardless of which statistical model was used to estimate costs, the Demonstration was also more expensive. The higher level of expenditures for the Wraparound group was a result of some expensive traditional care and the addition of nontraditional services. Limitations of this study include the Wraparound cost and service utilization analysis is based solely on Health Care Services Record (HCSR) data, generalizability due to ethnicity, and lack of follow up.

Length of controlled postintervention follow-up: None.

Pullman, M. D., Kerbs, J., Koroloff, N., Veach-White, E., Gaylor, R., & Sieler, D. (2006). Juvenile offenders with mental health needs: Reducing recidivism using wraparound. Crime and Delinquency, 52(3), 375–397. https://doi.org/10.1177/0011128705278632

Type of Study: Pretest-posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants: 204

Population:

  • Age — Youth: Mean=15.0–15.4 years; Adults: Not specified
  • Race/Ethnicity — Youth: 88–89% White; Adults: Not specified
  • Gender — Youth: 66–72% Male; Adults: Not specified
  • Status — Participants were youth involved with the juvenile justice system and mental health system.

Location/Institution: Clark County, WA

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare youth receiving Wraparound services to youth who had been in the same system prior to implementation of Wraparound. Measures utilized include the juvenile justice management information system looking at recidivism and number and length of detentions. Results indicate youth in the comparison group were significantly more likely to commit an offense and to commit an offense sooner after entering services than the Wraparound group. This pattern was repeated when the analysis looked at felony offenses alone. All of the comparison group youth served detention at some point in the follow-up time, compared to 72% of youth receiving Wraparound services. Limitations include lack of randomization of participants, generalizability due to gender, and lack of postintervention follow-up.

Length of controlled postintervention follow-up: None.

Stambaugh, L. F., Mustillo, S. A., Burns, B. J., Stephens, R. L., Baxter, B., Edwards, D., & DeKraai, M. (2007). Outcomes from Wraparound and Multisystemic Therapy in a center for mental health services system-of-care demonstration site. Journal of Emotional and Behavioral Disorders, 15(3), 143–155. https://doi.org/10.1177/10634266070150030201

Type of Study: Pretest-posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants: 320

Population:

  • Age — Children: Mean=11.5–14.4 years; Adults: Not specified
  • Race/Ethnicity — Children: 90% White, 6% Other, and 4% American Indian; Adults: Not specified
  • Gender — Children: 57–78% Male; Adults: Not specified
  • Status — Participants were families enrolled in a Center for Mental Health Services system-of-care site after being referred by child-serving agencies.

Location/Institution: Nebraska

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare families receiving Wraparound (Wrap) services, families receiving Multisystemic Therapy (MST) and those receiving both treatments (Wrap + MST). Measures utilized include the Child Behavior Checklist (CBCL), the Child and Adolescent Functional Assessment Scale (CAFAS), and the Multisector Service Contact Questionnaire (MSCC). Results indicate all three groups improved over the study period. The MST-only group demonstrated more clinical improvement than the other groups. Functional outcomes did not differ significantly across groups. Youth in Wrap + MST had higher baseline severity and experienced less clinical and functional change than the other two groups, despite more mental health service use. Limitations include a high level of attrition (although this did not differ across groups), generalizability due to gender and ethnicity, and differences across groups at baseline.

Length of controlled postintervention follow-up: Unknown since the durations of the different interventions vary.

Mears, S. L., Yaffe, J., & Harris, N. J. (2009). Evaluation of Wraparound services for severely emotionally disturbed youths. Research on Social Work Practice, 19(6), 678–685. https://doi.org/10.1177/1049731508329385

Type of Study: Pretest-posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants: 126

Population:

  • Age — Children: 5-18 years (Mean=12.3 years); Adults: Not specified
  • Race/Ethnicity — Children: 61% White, 17% Black or African American, 16% Hispanic, 13% Other, 6% American Indian/Alaskan Native, 2% Asian, and 1% Native Hawaiian/other Pacific Islander; Adults: Not specified
  • Gender — Children: 63% Male; Adults: Not specified
  • Status — Participants were youth in foster care with severe emotional disturbance (SED) referred by clinical resource coordinators.

Location/Institution: Nevada

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare the outcomes of youth in two groups, one in state custody foster care and one in parental custody, who received Wraparound process intervention, with youth receiving traditional child welfare case management. Measures utilized include the Child and Adolescent Functional Assessment Scale (CAFAS), the Child Behavior Checklist for Ages 6-18 (CBCL/6-18), and the Restrictiveness of Living Environment Scale (ROLES), and school and community behavioral indicators. Results indicate that youth receiving the Wraparound approach showed significant improvement on the CAFAS when compared with youth receiving traditional child welfare services and youth receiving traditional child welfare services experienced significantly fewer placements. However, neither group showed significant differences on other clinical or functional outcomes. Limitations include lack of randomization, lack of a postintervention follow-up, and missing data on the CBCL measure.

Length of controlled postintervention follow-up: None.

Yohannan, J., Carlson, J. S., Shepherd, M., & Batsche-McKenzie, K. (2017). Exploring attrition, fidelity, and effectiveness of Wraparound services among low-income youth of different racial backgrounds. Families, Systems, & Health, 35(4), 430–438. https://doi.org/10.1037/fsh0000313

Type of Study: Pretest-posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants: 1,006

Population:

  • Age — Children: 6–18 years (Mean=12.77 years); Adults: Not specified
  • Race/Ethnicity — Children: 557 Caucasian and 449 African American; Adults: Not specified
  • Gender — Children: 610 Male and 392 Female; Adults: Not specified
  • Status — Participants were low-income youth identified as having a serious emotional disturbance.

Location/Institution: Michigan

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to explore potential racial disparities in response to Wraparound services. Measures utilized include the Child and Adolescent Functional Assessment Scale (CAFAS) and an assessment of fidelity was created for the measurement of Wraparound process reliability and adherence to Wraparound principles by the Michigan Department of Health and Human Services. Results indicate African American youth receiving free/reduced lunch failed to complete Wraparound services at significantly higher rates when compared to Caucasian youth. For those who met treatment goals (i.e., completed services), mean intervention fidelity scores showed services to be implemented similarly across youth. Furthermore, Wraparound services resulted in improvements in mental health functioning, though racial background and attrition status impacted exit scores. Limitations include nonrandomization of subjects, may not be generalizable to other ethnic populations, fidelity forms available for analysis was fairly small (which limits generalizations of the fidelity data), and lack of follow-up.

Length of controlled postintervention follow-up: None.

Coldiron, J. S., Hensley, S. W., Parigoris, R. M., & Bruns, E. J. (2019). Randomized control trial findings of a wraparound program for dually involved youth. Journal of Emotional and Behavioral Disorders, 27(4), 195–208. https://doi.org/10.1177/1063426619861074

Type of Study: Randomized controlled trial
Number of Participants: 47

Population:

  • Age — 14–19 years; Wraparound: Mean=15.9 years; Treatment As Usual (TAU): Mean=16.0 years
  • Race/Ethnicity — Wraparound: 58 Black, Non-Hispanic, 29% White, Non-Hispanic, and 13% Hispanic; TAU: 70% Black, Non-Hispanic, 22% White, Non-Hispanic, and 9% Hispanic
  • Gender — Wraparound: 63% Male and 38% Female; TAU: 70% Male and 30% Female
  • Status — Participants were youth who were dually involved in both the Department of Child and Families and the Department of Juvenile Justice.

Location/Institution: A large urban county in southeastern Florida

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine a Wraparound program for youth in foster care and involved in the juvenile justice system. Participants were randomized to either Wraparound (n=24) or community "treatment as usual" (TAU; n=23). Measures utilized include the Restrictivenessof Living Environment Scale (ROLES) and administrative data on criminal behavior and recidivism, child welfare placement and restrictiveness, and academic achievement. Results indicate youth in both groups experienced significantly improved outcomes, including fewer arrests and greater residential stability. Wraparound youth were less likely to be rearrested, and survival analysis found they went longer before doing so than TAU youth. Wraparound youth were also more likely to be educationally on track than TAU youth by the end of the study. Although these findings were nonsignificant due to small sample sizes, effect sizes were medium to large, and no such trends were found for the TAU group. Limitations include small sample size; the evaluationwindow began at the inception of the program; findings were limited to a handful of outcomes able to be assessed using administrative data; and instead of comparing two starkly different services, the two treatment groups received services more of a continuum of Wraparound.

Length of controlled postintervention follow-up: None.

Additional References

Bruns, E. J., Burchard, J. D., Suter, J. C., Leverentz-Brady, K., & Force, M. M. (2004). Assessing fidelity to a community-based treatment for youth: The Wraparound Fidelity Index. Journal of Emotional and Behavioral Disorders 12, 79-89.

Bruns, E. J., Walker, J. S., Adams, J., Miles, P., Osher, T. W., Rast, J.,...National Wraparound Initiative Advisory Group (2004). Ten principles of the wraparound process. Portland, OR: National Wraparound Initiative, Research and Training Center on Family Support and Children's Mental Health, Portland State University. Retrieved from http://nwi.pdx.edu/NWI-book/Chapters/Bruns-2.1-(10-principles-of-wrap).pdf

Walker, J. S., Bruns, E. J., VanDenBerg, J. D., Rast, J., Osher, T. W., Miles, P.,...National Wraparound Initiative Advisory Group (2004). Phases and activities of the wraparound process. Portland, OR: National Wraparound Initiative, Research and Training Center on Family Support and Children's Mental Health, Portland State University. Presented as pages 5-16. Retrieved from http://www.nwi.pdx.edu/NWI-book/Chapters/Walker-4a.1-(phases-and-activities).pdf

Contact Information

Janet S. Walker, PhD
Title: Co-Director of the National Wraparound Initiative, Research Associate Professor in the School of Social Work and the Regional Research Institute at Portland State University and Director of the Research and Training Center on Pathways to Positive Futures
Website: www.nwic.org
Email:
Phone: (503) 725-8236
Fax: (503) 725-4180

Date Research Evidence Last Reviewed by CEBC: April 2021

Date Program Content Last Reviewed by Program Staff: July 2020

Date Program Originally Loaded onto CEBC: August 2007