Connecting the Dots: Stages of Implementation, Wraparound Fidelity and Youth Outcomes

Abstract

Wraparound is a family-driven, youth guided, team-based process for planning and implementing services and supports (Miles et al. 2006). The National Wraparound Initiative (NWI) has identified ten elements of wraparound (i.e., family voice and choice, team based, natural supports, collaborative, community based, culturally competent, individualized, strengths based, persistence and outcomes based) and four phases through which teams consisting of the identified youth, his/her parents or caregivers, family members, community members, mental health professionals, and others are expected to move as they develop and implement a single plan of care. The plan of care includes the services and supports necessary to build on the strengths of the youth and his/her family and addresses the complex needs of the youth involved in the wraparound process.Emerging evidence supports the effectiveness of wraparound for youth who have needs in multiple life domains (e.g., home, school and community). Nine controlled studies of wraparound (see Bruns and Suter 2010;Suter and Bruns 2009) found improved outcomes for youth in wraparound compared to similar youth in other programs, with effect sizes similar to those found in studies of other evidence based interventions implemented in real world practice (Suter and Bruns 2009). However, only one of the nine studies considered the relationship between wraparound fidelity and outcomes (Bruns et al. 2006). Research on other evidencebased practices has repeatedly found that fidelity to the practice model is vital to outcomes (e.g., Henggeler et al. 1997;McGrew et al. 1994;Walton 2006). Additional research on wraparound that includes a measure of fidelity as well as further research on the factors that predict successful outcomes for youth involved in the wraparound process are needed Cox et al. 2010

Psychometrics, Reliability, and Validity of a Wraparound Team Observation Measure

“…For example, although evidence for concurrent and construct validity has now been produced, association with child and family outcomes has not yet been attempted, as has been done for the WFI (Bruns et al, 2005; Cox et al, 2010; Effland et al, 2011). Given the small sample sizes, replication of the findings showing differences in results for different types of raters will be important to attempt in the near future.…”

“…A multiple regression indicated positive relationships between WFI scores at baseline and child behavioral strengths six months later as measured by the Behavioral and Emotional Rating Scale (Epstein & Sharma, 1998), after controlling for baseline characteristics (Bruns et al, 2005). Another study (Effland et al, 2011) found positive relationships between WFI-4 scores and changes in scores on a standardized measure of functioning – the Child and Adolescent Needs and Strengths tool (Lyons, Weiner, & Lyons, 2004). Intraclass Correlation for all three respondents has been found to be .51, indicating good inter-respondent agreement for a scale of this nature (Bruns et al 2009).…”

“…For example, Bruns and colleagues (2005) found that overall fidelity was associated with improved behavior, functioning, restrictiveness of living, and caregiver satisfaction with services. Studies by Cox, Baker, and Wong (2010); Effland, Walton, and McIntyre (2011); and Vetter and Strech (2012) found positive associations between adherence to wraparound principles as assessed by the WFI and improvements in child functioning.…”

Evaluating fidelity to the wraparound service model for youth: Application of item response theory to the Wraparound Fidelity Index.

“…A multiple regression indicated positive relationships between WFI-2 scores at baseline and child behavioral strengths six months later as measured by the Behavioral and Emotional Rating Scale (Epstein & Sharma, 1998), after controlling for baseline characteristics (Bruns, Suter, Force, & Burchard, 2005). Another study found positive relationships between WFI-4 scores and a decrease in youth needs (Effland, Walton, & McIntyre, in press), as measured by the Child and Adolescent Needs and Strengths measure (Lyons, Weiner, & Lyons, 2004). Studies have also found positive correlations between WFI scores and system factors theorized to be associated with successful wraparound implementation (Bruns, Suter, & Leverentz-Brady, 2006; Effland, et al, in press).…”

Wraparound Team Composition, Youth Self-determination, and Youth Satisfaction in Transition Services

“…Poor implementation of wraparound has been credited for some of the inconsistencies in findings on youth satisfaction with wraparound obtained to the present. 5,6,23 Although evidence bearing directly on challenges to wraparound implementation with transition-age youth is limited to date, two types of concerns can be raised. First, it may be more difficult to involve family and other supports when working with youth transitioning to adulthood than with younger youth, as these relationships among older youth are frequently strained and disengaged.…”