Wraparound

Scientific Rating:
3
Promising Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
High
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Wraparound has been rated by the CEBC in the area of: Placement Stabilization Programs.

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: 0 – 17

For parents/caregivers of children ages: 0 – 17

Brief Description

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

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

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

Delivery Settings

This program is typically conducted in a(n):

  • Adoptive Home
  • Birth Family Home
  • Community Agency
  • Foster/Kinship Care
  • Residential Care Facility

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.

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.

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
  • John Ossowski, National Wraparound Initiative

    phone: (503) 725-9619
Training is obtained:

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

Since Wraparound is rated on the Scientific Rating Scale, information was requested from the program representative on available pre-implementation assessments, implementation tools, and/or fidelity measures.

Show 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 John Ossowski at jdo@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 http://nwi.pdx.edu/fidelity.shtml. 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. Advance online publication. doi: 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. Portland, OR: National Wraparound Initiative, Research and Training Center for Family Support and Children's Mental Health. Retrieved from 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, 79 - 89.

Relevant Published, Peer-Reviewed Research

This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

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

Show relevant research...

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 10 most relevant articles, with a focus on randomized controlled trials (RCTs) and controlled studies that have an impact on the rating. The 10 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.

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

Population:

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

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Children determined by caseworkers to be at-risk, due to behavioral indicators such as harm to self or substance use, or to situational indicators such as failed placement or more restrictive placement in the past 6 months, were randomly assigned to receive Wraparound services or to standard practice conditions. The study measured placement settings and changes, runaway status, and incarceration. The rate of placement changes per year was assessed for both groups prior to entering the study and after the Wraparound intervention. 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 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.

Type of Study: Randomized controlled trial
Number of Participants: 42 Children and Families

Population:

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

Location/Institution: New York State

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Families 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. The measures included 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). 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. The authors note that at the one-year timepoint, data was only available on 17 families and the differences between the groups were no longer statically significant. Limitations include the small sample size, differences between the two groups at baseline, and the large amounts of missing data.

Length of 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.

Type of Study: Nonequivalent control group design
Number of Participants: 121 youth

Population:

  • Age — Wraparound Diversion (WD): Mean=15.6 years, Wraparound Return (WR): Mean=17.5 years, Non-Wraparound (NW): Mean=16.9 years, Pre-Wraparound (PW): Mean=20.1 years
  • Race/Ethnicity — WD: 71% African-American, WR: 67% African-American, NW: 100% African-American, PW: 79% African-American
  • Gender — WD: 81% Males, WR: 58% Males, NW: 91% Males, PW: 79% Males
  • 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 comparison groups, outcomes, measures, notable limitations)
Four groups of youth were compared. Two groups received Wraparound services. Both groups were diverted from out-of-state residential treatment centers. The Wraparound Return (WR) group included youth returning from residential treatment. The Wraparound Diversion (WD) group included those who were at-risk of residential treatment. Two other groups received traditional services. The Pre-Wraparound (PW) group had been returned from out-of-state residential programs in the year before the implementation of Wraparound services. The Non-Wraparound (NW) group returned from residential treatment at the same time as the WR group, but did not receive Wraparound services. The authors developed the Community Adjustment Rating Scale, which includes measures of restrictiveness of living, school attendance, job training attendance, and harmful behaviors rated by the youth, parent, and case manager. Based on scores, adjustment could be categorized as Good, Fair, or Poor. Involvement in community activities and evaluation of services provided were also measured. 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 levels of statistical significance for these differences were not reported. The same patterns held for ratings of the number of youth with more than 10 days of community involvement. Limitations noted were the small sample sizes and the lack of normative data for the measures used.

Length of 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.

Type of Study: Nonequivalent control group design
Number of Participants: Wraparound: 71, Comparison: 40

Population:

  • Age — 4-16 years
  • Race/Ethnicity — 72% White
  • Gender — Wraparound Group: 58% Male
  • Status — Participants were dependents of members of the military referred for services.

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study compared a sample of families who had been referred to a Department of Defense mandated Wraparound demonstration implementation and agreed to participate to a sample who were referred to the demonstration and refused or were ineligible on some criteria. Criteria for ineligibility for Wraparound services included long-term residential treatment, persistent substance abuse, persistent, untreatable antisocial behavior, and conviction of sexual perpetration or predatory behavior. This article provides a list of the 17 measures used to assess youth and family outcomes, but does not provide specific data, which is available from the authors. The assessments cover mental health status, behavior problems, treatment and medication, school performance, family socioeconomic data and contact with services. They report that both groups showed some improvement, but there were no differences between groups on functioning, symptoms, life satisfaction, or serious events. Wraparound costs were greater, due to the use of expensive traditional services and addition of nontraditional services. Limitations of this study include the short time span (6 months) and whether the demonstration project truly followed the Wraparound process. Authors stated the “wrap” condition had access to informal services and flexible funding, but authors did not assess “wrapness” and stated that, “there is no evidence that the content or the quality of the services were different for the Wraparound children.” (p.151)

Length of 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.

Type of Study: Randomized controlled trial
Number of Participants: Wraparound: 73, Conventional Services: 68

Population:

  • Age — Mean=15 years
  • Race/Ethnicity — Wraparound: 45.2% Caucasian, 53.4% African American, and 1.4% biracial. Conventional Services: 55.9% Caucasian, 42.6% African American, and 1.5% biracial
  • Gender — Wraparound services: 60.3% (44) Male and 39.7% (29) Female. Conventional services: 63.2% (43) Male and 36.8% (58) Female
  • Status — Participants were delinquent youth entering the juvenile justice system.

Location/Institution: Columbus, OH

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Youth were randomly assigned to the Wraparound services or conventional services conditions. Effects of conditions were assessed using 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. Analyses indicated that 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 non-random assignment.

Length of postintervention follow-up: None.

Bruns, E. J., Rast, J., Peterson, C., Walker, J., & Bosworth, J. (2006). Spreadsheets, service providers, and the statehouse: Using data and the wraparound process to reform systems for children and families. American Journal of Community Psychology, 38, 201-212.

Type of Study: Matched comparison group
Number of Participants: 97

Population:

  • Age — Not specified
  • Race/Ethnicity — Not specified
  • Gender — Not specified
  • Status — Participants were children with severe emotional disorders who were involved with child welfare services.

Location/Institution: Nevada

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Children who were placed into a Wraparound process were matched with a comparison group receiving traditional casework on age, sex, race, current residential placement, and severity of mental health problems. Researchers found that youth receiving Wraparound services moved to less restrictive placements more often than those in the comparison groups after 18 months (82% versus 38%) and more comparison group youth moved to more restrictive placements than Wraparound group youth (22% versus 6%). Using the Child and Adolescent Functional Assessment Scale (CAFAS), researchers found that scores indicating the seriousness and impact of mental illness were lower for the Wraparound group after 6 months. Limitations include nonrandomization of participants, small sample size, and lack of postintervention follow-up.

Length of 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.

Type of Study: Nonequivalent control group design, using a historical comparison group
Number of Participants: Wraparound: 106, Comparison group: 98

Population:

  • Age — 15 years
  • Race/Ethnicity — Wraparound: 88% Caucasian, Comparison: 89% Caucasian
  • Gender — Wraparound: 72% Male, Comparison: 66% Male
  • Status — Participants were youth involved with the juvenile justice system and mental health system.

Location/Institution: Clark County, WA

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Youth receiving Wraparound services were compared to youth who had been in the same system prior to implementation of Wraparound. The researchers measured recidivism for both groups as number of days between the time they entered services and any substantiated probation violations, misdemeanors and felonies. They also measured number and length of detentions. 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 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.

Type of Study: Nonequivalent control group design
Number of Participants: 320 Children

Population:

  • Age — 4-17.5 years
  • Race/Ethnicity — 90% White, 4% American Indian, and 6% Other
  • Gender — Wrap-only: 78% Male, MST-only: 57% Male, Wrap+MST: 70%
  • 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 comparison groups, outcomes, measures, notable limitations)
The study compared families receiving Wraparound services, families receiving Multisystemic Therapy (MST) and those receiving both treatments (Wrap + MST). This report documents outcomes from enrollment through 18 months of follow-up. Children’s outcomes were assessed with the Child Behavior Checklist (CBCL) and the Child and Adolescent Functional Assessment Scale (CAFAS) completed by caregivers. Type and frequency of service access was measured with the Multisector Service Contact Questionnaire (MSCQ). Several differences were found across groups at baseline: Youth in the Wrap + MST group had more severe problems, as measured by the CBCL and the CAFAS. They also experienced more placements. The Wraparound-only group was younger, more likely to be referred from school rather than court and had higher internalizing scores. The study found that the percentage of children moving from severe to minimal/moderate impairment by the end of the study was 36% for the Wraparound-only group, 66% for the MST group and 26% for the Wrap + MST group. On the CBCL, the MST group’s scores improved significantly more than the Wraparound-only group. The Wraparound-only and Wrap + MST group’s scores did not differ significantly. On the CAFAS, Wraparound-only and MST did not differ, but the Wrap + MST group’s scores were significantly worse than the Wraparound-only group. Limitations include a high level of attrition (although this did not differ across groups) and differences across groups at baseline.

Length of 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, 678-685.

Type of Study: Nonequivalent control group design
Number of Participants: 126

Population:

  • Age — 5-18 years
  • Race/Ethnicity — 61% Caucasian, 17% African American, 13% Hispanic, 6% American Indian/Alaska Native, 2% Asian, and 1% Native Hawaiian/Pacific Islander
  • Gender — 63% Male and 37% Female
  • Status — Participants were youth in foster care with severe emotional disturbance (SED) referred by clinical resource coordinators.

Location/Institution: Nevada

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The study evaluated the implementation of Wraparound services for youth in foster care with severe emotional disturbance (SED).  Two intervention groups (state custody foster care and parental custody) receiving Wraparound services were compared to traditional foster care case management.  Participants were assessed for SED using the Child and Adolescent Functional Assessment Scale (CAFAS) at intake and 6 months into treatment. Measures used included the Child Behavior Checklist for Ages 6-18 (CBCL/6-18) and the Restrictiveness of Living Environment Scale (ROLES). Results indicated that youth receiving the Wraparound approach showed significant improvement on the CAFAS when compared with youth receiving traditional child welfare services. Results also showed that youth receiving traditional child welfare services experienced significantly fewer placements. However, neither group showed significant differences on other clinical or functional outcomes. Major study limitations include lack of randomization, lack of a post-intervention follow-up, and missing data on the CBCL measure.

Length of postintervention follow-up: None.

Painter, K. (2012). Outcomes for youth with severe emotional disturbance: A repeated measures longitudinal study of a Wraparound approach of service delivery in systems of care. Child & Youth Care Forum, 41(4), 407-425.

Type of Study: One group longitudinal study with repeated measures
Number of Participants: 160

Population:

  • Age — 5-18 years
  • Race/Ethnicity — 41% White (non-Hispanic), 33% African American, 24% Hispanic/Latino, and 3% American Indian
  • Gender — 67% Male and 24% Female
  • Status — Participants were youth in foster care with severe emotional disturbance (SED) referred by clinical resource coordinators.

Location/Institution: Nevada

Summary: (To include comparison groups, outcomes, measures, notable limitations)
The purpose of this study was to evaluate outcomes for children ages experiencing serious emotional disturbances who received Wraparound in a systems-of-care community funded by a 6-year grant. Measures utilized include the Behavioral and Emotional Rating Scale (BERS-2), Child Behavior Checklist 6–18 (CBCL 6–18), the Reynolds Adolescent Depression Scale (RADS-2), the Revised Children’s Manifest Anxiety Scale (RCMAS-2), the Columbia Impairment Scale (CIS), and the Caregiver Strain Questionnaire (CGSQ). Results indicate all of the caregiver-completed measurement instruments showed statistical and clinical levels of improvement in youth behavioral and emotional strengths, mental health symptoms, and caregiver stress. Youth rated themselves as having fewer problems than the ratings given by caregivers at intake. Changes across the youth-rated instruments did not show significant improvement until the 12- or 18-month data points. Limitations include nonrandomization of subjects, lack of a comparison group, and lack of examination of possible nesting factors due to the multiple sites and therapists. In addition, some of the youths in this study (35 of 160) were not followed the full 24 months due to the grant ending and were excluded from analysis and nearly half (47%) of the youths who participated in Wraparound were not included in this study due to timing issues with the national evaluation protocol.

Length of postintervention follow-up: Varies – up to 24 months.

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

Name: 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.nwi.pdx.edu
Email:
Phone: (503) 725-8236
Fax: (503) 725-4180

Date Research Evidence Last Reviewed by CEBC: January 2015

Date Program Content Last Reviewed by Program Staff: March 2016

Date Program Originally Loaded onto CEBC: August 2007