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 setting records and foster care payment records. Results indicate the Wraparound group had significantly fewer changes in placement settings 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 — 83% White, Non-Hispanic
• Gender — 91% Male
• Status — Participants were children in out of home care 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]. 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 that 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: Approximately 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 that 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.

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 evaluate the cost-effectiveness of the Wraparound demonstration. Participants were grouped into Wraparound or to treatment as usual (TAU). 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 that children in the Wraparound group received more wraparound services than those in the TAU comparison group. These services included case management, in-home treatment, and other nontraditional services. Wraparound 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, Wraparound 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 include the Wraparound cost and service utilization analysis is based solely on Health Care Services Record (HCSR) data, concerns about generalizability due to ethnicity, and lack of follow up.

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=14.8 years
• Race/Ethnicity — Wraparound: 53% African American, 45% Caucasian, 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 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 unclear length of controlled postintervention follow-up for both groups.

Length of controlled postintervention follow-up: Unknown.

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 — Mean=15.0–15.4 years
• Race/Ethnicity — 88–89% White
• Gender — 66–72% Male
• 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 data from two groups of juvenile offenders with mental health problems: youth in a juvenile justice wraparound program called Connections [now called Wraparound] and a historical comparison group of youth in traditional mental health services. Participants were either a part of the Connections program or a comparison group. Measures utilized include the juvenile justice management information system looking at recidivism and number and length of detentions. Results indicate that youth in the comparison group were significantly more likely to commit an offense and to commit an offense sooner after entering services than the Connections 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 Connections services. Limitations include lack of randomization of participants, lack of generalizability due to gender, and lack of controlled 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 — Mean=11.5–14.4 years
• Race/Ethnicity — 90% White, 6% Other, and 4% American Indian
• Gender — 57– 78% Male
• 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 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). Participants were assigned to either Wraparound, MST or Wrap + MST. Results indicate that 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), lack of generalizability due to gender and ethnicity, and differences across groups at baseline.

Length of controlled postintervention follow-up: Unknown due to varying intervention duration.

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 — 5–18 years (Mean=12.3 years)
• Race/Ethnicity — 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
• Gender — 63% Male
• 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. Participants were assigned to either Wraparound or 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), 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.

Bruns, E. J., Pullmann, M. D., Sather, A., Denby Brinson, R., & Ramey, M. (2014). Effectiveness of Wraparound versus case management for children and adolescents: Results of a randomized study. Administration and Policy in Mental Health, 42(3), 309–322. https://doi.org/10.1007/s10488-014-0571-3

Type of Study: Randomized controlled trial
Number of Participants: 93

Population:

• Age — Mean Age=11.9 years
• Race/Ethnicity — 41% African American, 39% White, 12% Mixed Race, 8% Other, and 1% Native American
• Gender — 57% Male
• Status — Participants were youth with serious emotional disorder (SED) and referred for intensive mental health services to the Division of Child and Family Services (DCFS).

Location/Institution: Large County in a western state

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare service experiences and outcomes for youth with serious emotional disorder (SED). Participants were randomly assigned to Wraparound services or to a control group that received traditional intensive case management (ICM). Measures utilized include the CAFAS, structured interviews measuring youth functioning in eight areas (home, school/work, community, behavior towards others, moods, thinking, self-harm, substance abuse), the Service Assessment for Children and Adolescents— Parent Form (SACA), the Working Alliance Inventory (WAI), the Strength and Difficulties Questionnaire (SDQ), Youth Satisfaction Questionnaire (YSQ), Working Alliance Inventory (WAI), Wraparound Fidelity Index, Organizational Social Context Questionnaire (OSC), Team Observation Measure (TOM), Community Supports for Wraparound Inventory (CSWI), and DCFS administrative data. Results indicate that the Wraparound group received more mean hours of care management and services; however, there ultimately were no group differences in restrictiveness of residential placement, emotional and behavioral symptoms, or functioning. Wraparound implementation fidelity was found to be poor. Organizational culture and climate, and worker morale, were poorer for the Wraparound providers than the ICM group. Results also suggest that, for less-impaired youths with SED, less intensive options such as ICM may be equally effective to poor-quality Wraparound delivered in the absence of Wraparound implementation supports and favorable system conditions. Limitations include threats to internal validity due to difficulty separating treatment effects from social and organizational context, concerns over contagion as the ICM group may have received some services that had features of Wraparound, unclear length of follow-up, and small sample size.

Length of controlled postintervention follow-up: Unknown.

Browne, D. T., Puente-Duran, S., Shlonsky, A., Thabane, L., & Verticchio, D. (2016). A randomized trial of Wraparound facilitation versus usual child protection services. Research on Social Work Practice, 26(2), 168–179. https://doi.org/10.1177%2F1049731514549630

Type of Study: Randomized controlled trial
Number of Participants: 135

Population:

• Age — Caregivers: Average= 32.22 years; Children: Not specified
• Race/Ethnicity — Not specified
• Gender — Caregivers: 91% Female; Children: Not specified
• Status — Participants were families involved with child protective services.

Location/Institution: Southern Ontario

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate whether the addition of a Wraparound facilitator to regular child protection services (CPS) improved child and family functioning over 20 months. Participants were randomized to either the Wraparound intervention group or to a control group that received CPS care as usual. Measures utilized include the Kessler 10, the Behavioral and Emotional Rating Scale 2nd Edition (BERS-2), the Ages and Stages Questionnaire (ASQ), the Parental Stress Scale, Family Resource Scale, the Child and Adolescent Functional Assessment Scale, and the Wraparound Fidelity Index. Results indicate that both groups improved in child impairments, caregiver psychological stress, and family resources. No measurable benefit was associated with the intervention. However, treatment fidelity analysis revealed that many components of Wraparound were either missing or present in both groups. Limitations include small sample size, unclear length of follow up, and concerns over self-report bias.

Length of controlled postintervention follow-up: Unknown.

McCarter, S. A. (2016). Holistic representation: A randomized pilot study of Wraparound services for first-time juvenile offenders to improve functioning, decrease motions for review, and lower recidivism. Family Court Review, 54(2), 250–260. https://doi.org/10.1111/fcre.12216

Type of Study: Randomized controlled trial
Number of Participants: 51

Population:

• Age — Treatment Group: Mean= 14.59 years; Control Group: Mean=14.22 years
• Race/Ethnicity — Treatment Group: 68% African American, 23% Caucasian, and 5% Other; Control Group: 71% African American and 14% Caucasian
• Gender — Treatment Group: 82% Male and 18% Female; Control Group: 86% Male and 14% Female
• Status — Participants were juvenile offenders who sought legal representation.

Location/Institution: Participants were juvenile offenders who sought legal representation.

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate whether providing a randomized trial of Wraparound forensic social work services in addition to court-appointed legal services would improve functioning, decrease motions for review (MFR), and lower recidivism for first-time juvenile offenders. Participants were randomly assigned to legal defense services + Wraparound social work services or to a control group that received legal defense services only. Measures utilized include the Achenbach System of Empirically Based Assessment (ASEBA), Youth Self-Report (YSR), MFRs, and court records. Results indicate that there were statistically significant improvements for youth receiving wraparound services on six out of eight measures. Limitations include small sample size, length of study, and lack of controlled postintervention 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 or community "treatment as usual" (TAU). Measures utilized include the Restrictiveness of Living Environment Scale (ROLES), and administrative data on criminal behavior and recidivism, child welfare placement and restrictiveness, and academic achievement. Results indicate that 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 evaluation window 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 on more of a continuum of Wraparound.

Length of controlled postintervention follow-up: None.

The following studies were not included in rating Wraparound on the Scientific Rating Scale...

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

The purpose of the study was to explore potential racial disparities in response to Wraparound services. Participants all received Wraparound services, but were grouped and compared based on race: African American and Caucasian. Measures utilized include the Child and Adolescent Functional Assessment Scale (CAFAS) and an assessment of fidelity for the measurement of Wraparound process reliability and adherence to Wraparound principles created by the Michigan Department of Health and Human Services. Results indicate that 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 lack of randomization 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; lack of a non-treatment control group, and lack of follow-up. Note: This article was not used in the rating process due to the lack of a control group.