Wraparound - Detailed Report

In order to provide Wraparound with high fidelity—as measured by the Wraparound Fidelity Index, below—the following elements are required:

• Practice that confirms to the "Ten Principles of the Wraparound Process"—citation below—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” document—citation below. 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.

Please refer to these documents:

Walker, J.S., Bruns, E.J., Rast, J., VanDenBerg, J.D., Osher, T.W., Koroloff, N., Miles, P., Adams, J., & the 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. Retrieved on September 4, 2007, at http://www.rtc.pdx.edu/nwi/PhaseActivWAProcess.pdf.

Bruns, E.J., Walker, J.S., Adams, J., Miles, P., Osher, T.W., Rast, J., VanDenBerg, J.D., & the 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 on September 4, 2007, at
http://www.rtc.pdx.edu/PDF/TenPrincWAProcess.pdf.

Wraparound 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) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. For more information on the rating of a "3 - Promising Research Evidence," please see the Scientific Rating Scale.

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 Range: At least 7 years
Race/Ethnicity: Not given
Status (e.g., foster care, CW): Children living in foster care or emergency shelter placement

Location/Institution: Not given
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.

Length of post-intervention follow-up: None. Children were followed for 2.5 years but continued to receive some services.
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 Range: not given
Race/Ethnicity: Not given
Status (e.g., foster care, CW): 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 motive 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.
Length of post-intervention 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 Range: Average about 15 years
Race/Ethnicity: Wraparound: 45.2% Caucasian, 53.4% African American, 1.4% biracial. Conventional Services: 55.9% Caucasian, 42.6% African American, 1.5% biracial.
Status (e.g., foster care, CW): 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 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.
Length of post-intervention 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: Historical comparison group
Number of participants: 106 Wraparound, 98 comparison group

Population:

Age Range: 15 at the start of the intervention
Race/Ethnicity: Wraparound: 88% Caucasian, Comparison: 89% Caucasian
Status (e.g., foster care, CW) 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.
Length of post-intervention 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 Range: 5-12
Race/Ethnicity: 92% White, non-Hispanic
Status (e.g., foster care, CW): 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 Wraparound services, here called Family-Centered Intensive Case Management (FCICM). 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 one year only 17 families provided complete data. They attribute this to a structured approach that pressured families to use too many services, some of which they might not have needed or wanted.
Length of post-intervention follow-up: 6 months after discharge from the programs.

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: Non-randomized comparison group
Number of participants: 71 Wraparound, 40 Comparison
Population:

Age Range: 4 to 16 years
Race/Ethnicity: 72% White
Status (e.g., foster care, CW): Dependents of members of the military referred for services.

Location/Institution: Unknown

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 post-intervention follow-up: None

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: Non-equivalent comparison groups
Number of participants: 121 youth
Population:

Age Range: (See below for group descriptions.) Average ages were WD:15.6, WR: 17.5, NW: 16.9, PW: 20.1
Race/Ethnicity: Percentages of African-Americans were WD: 71%, WR:67%, NW: 100%, PW: 79%
Status (e.g., foster care, CW): 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 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 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/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 NR 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 post-intervention follow-up: None

Myaard, M.J., Crawford, C., Jackson, M, and Alessi, G. (2000). Journal of Emotional and Behavioral Disorders, 8(4), 216-229.

Type of Study: Case study, multiple baseline design
Number of participants: 4
Population:

Age Range: 14-16.
Race/Ethnicity: Caucasian
Status (e.g., foster care, CW): Youth at risk of long-term residential placement.

Location/Institution: Rural St. Joseph County, MI
Summary: (To include comparison groups, outcomes, measures, notable limitations) Youth with severe emotional and behavioral problems from families referred into wraparound services were followed for 1 year. Measures of progress included the Daily Adjustment Indicator Checklist (DAIC), which measures positive and negative behaviors; and the Child and Adolescent Functional Assessment (CAFAS), which measures level of functioning for the child and the family as a whole. All 4 youths demonstrated improvement in compliance, peer interaction, reduction of physical aggression, and reduction of alcohol and drug use. (Note that 1 of the participants had no aggressive incidents or alcohol/drug use prior to introduction of wraparound.) Limitations of the study included subjectivity of measures and small sample size.

Length of post-intervention 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.

Type of Study: Non-equivalent comparison groups
Number of participants: 320 children
Population:

Age Range: 4 to 17.5 years
Race/Ethnicity: 90% White, 4% American Indian, 6% other.
Status (e.g., foster care, CW) 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 (wrap), 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 wrap-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 wrap-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 wrap-only group. The wrap-only and wrap+MST group’s scores did not differ significantly. On the CAFAS, wrap-only and MST did not differ, but the wrap+MST groups scores were significantly worse than the wrap-only group. Limitations include a high level of attrition, although this did not differ across groups, and differences across groups at baseline.
Length of post-intervention follow-up: Unknown. The durations of the different interventions vary.

Crusto, C.A., Lowell, D.I., Paulicin, B., Reynolds, J., Feinn, R., Friedman, S.R., & Kaufman, J.S. (2008). Evaluation of a wraparound process for children exposed to family violence. Best Practices in Mental Health, 4(1), 1-18.

Type of Study: Pretest/Posttest
Number of participants: 82
Population:

Age Range: 5 or younger
Race/Ethnicity: 55% Latino/Hispanic, 27% black, 9% white, 1% other, 9% unknown.
Status (e.g., foster care, CW) Children enrolled in the Child FIRST program who had been shown to have been exposed to violence and/or received services for family violence.

Location/Institution: Bridgeport, CT
Summary: (To include comparison groups, outcomes, measures, notable limitations) Families who received wraparound services to address problems associated with family violence were assessed at the beginning of services and at program discharge. Evaluation staff assessed service needs, use, and barrier to service with the Resource and Outcome Data Form and a form developed for this study. Family violence and traumatic events were assessed with the Traumatic Events Screening Inventory-Parent Report Revised (TESI-PRR). Trauma-related symptoms were measured with the Trauma Symptom Checklist for Young Children (TSCYC). Finally, parenting stress was measured with the Parenting Stress Index-Short Form (PSI-SF). Analyses showed a significant decrease in both family and non-family violence events, as well as overall traumatic events from baseline to post-test. Children showed significant reductions in post-traumatic stress-intrusive thoughts and avoidance, as well as other stress symptoms which did not reach statistical significance. Parent also reported reductions in total stress, parental distress, parent-child dysfunctional interaction and rating their child as difficult. Many of these outcomes were positively correlated with number of service hours and/or length of time in the program. Limitations include lack of randomization or control groups.
Length of post-intervention follow-up: None

Walker, J.S., Bruns, E.J., Rast, J., VanDenBerg, J. D., Osher, T.W., Koroloff, N., Miles, P., Adams, J., & the 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. Retrieved online on September 4, 2007 at http://www.rtc.pdx.edu/nwi/PhaseActivWAProcess.pdf

Bruns, E.J., Walker, J.S., Adams, J., Miles, P., Osher, T.W., Rast, J., VanDenBerg J.D., & the 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 online on September 4, 2007 at http://www.rtc.pdx.edu/PDF/TenPrincWAProcess.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.

Clark, H. B., Prange, M. E., Lee, B., Stewart, E. S., McDonald, B. B., & Boyd, L. A. (1998). An individualized wraparound process for children in foster care with emotional/behavioral disturbances: Follow-up findings and implications from a controlled study. In M. H. Epstein, K. Kutash & A. Duchnowski (Eds.), Outcomes for children and youth with emotional and behavioral disorders and their families: Programs and evaluation best practices (pp. 513-542). Austin, TX: Pro-ED, Inc.