Health information technology (HIT) and care coordination for individuals with complex needs are high priorities for quality improvement in health care. However, there is little empirical guidance about how best to design electronic health record systems and related technologies to facilitate implementation of care coordination models in behavioral health, or how best to apply user input to the design and testing process. In this paper, we describe an iterative development process that incorporated user/stakeholder perspectives at multiple points and resulted in an electronic behavioral health information system (EBHIS) specific to the wraparound care coordination model for youth with serious emotional and behavioral disorders. First, we review foundational HIT research on how EBHIS can enhance efficiency and outcomes of wraparound that was used to inform development. After describing the rationale for and functions of a prototype EBHIS for wraparound, we describe methods and results for a series of six small studies that informed system development across four phases of effort -predevelopment, development, initial user testing, and commercialization -and discuss how these results informed system design and refinement. Finally, we present next steps, challenges to dissemination, and guidance for others aiming to develop specialized behavioral health HIT. The research team's experiences reinforce the opportunity presented by EBHIS to improve care coordination for populations with complex needs, while also pointing to a litany of barriers and challenges to be overcome to implement such technologies.Among the approximately 15 million young people with mental health conditions, children and adolescents with serious emotional and behavioral disorders (SEBD) are at the greatest risk for negative health and functioning outcomes, including school dropout, drug and alcohol abuse, incarceration, and unemployment (Perou et al., 2013). These youth also consume a disproportionate share of the nation's overall children's mental health care resource. Of $10 billion expended annually by Medicaid on mental health services for Correspondence regarding this submission should be addressed to Eric J. Bruns, University of Washington, Department of Psychiatry and Behavioral Sciences, 2815 Eastlake Ave E, Suite 200, Seattle, WA, 98102; ebruns@uw.edu.. HHS Public Access Author Manuscript Author Manuscript Author ManuscriptAuthor Manuscript children and adolescents, $6 billion goes to treating the 10% of youth with the most serious and complex needs (Pires, Grimes, Allen, Gilmer, & Mahadevan, 2013). A large proportion of these expenses are accounted for by inpatient, residential, and other out-of-home treatment options that may be unnecessary when effective and intensive service options are available in the community (Cooper et al., 2008;Stroul & Friedman, 1996) Tolan & Dodge, 2005) As early as 2003, the Institute of Medicine formally recognized care coordination as a priority area for quality improvement in health care (Institu...
The wraparound process has been promoted in the children's services field as a mechanism to achieve collaborative service planning and delivery for families of young people with complex emotional and behavioral needs that span multiple agencies. We compared results of two surveys of state children's mental health directors, completed in 1998 and 2008, to
In this study, we compared service experiences and outcomes for youths with serious emotional disorder (SED) randomly assigned to care coordination via a defined wraparound process (n = 47) versus more traditional intensive case management (ICM; n = 46) 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 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.
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