English
Adjective
wraparoundNoun
- A garment that is wrapped around the body and tied
- A label or advertising display that wraps around a container
- A word processing feature that moves text on to the next line if it will not fit on the current one
In the context of "date=January 2008": The
Wraparound Process is an intensive, individualized care management
process for youths with serious or complex needs. Wraparound was
initially developed in the 1980s as a means for maintaining youth
with the most serious emotional and behavioral problems in their
home and community. In recent years, however, it has been applied
within many child-serving settings as a way to improve outcomes for
children and adolescents with serious emotional disturbance. For
example, it has been used as a means to facilitate permanency
outcomes for youth involved in the child
welfare system, to reduce recidivism for youths
involved in the juvenile
justice system, and to improve academic success for youths in
the special
educational system.
During the wraparound process, a team of
individuals who are relevant to the well-being of the child or
youth (e.g., family members and other natural supports, service
providers, and agency representatives) collaboratively develop an
individualized plan of care, implement this plan, and evaluate
success over time. The wraparound plan typically includes formal
services and interventions, together with community services and
interpersonal support and assistance provided by friends, kin, and
other people drawn from the family’s social networks. The team
convenes frequently to measure the plan’s components against
relevant indictors of success. Plan components and strategies are
revised when outcomes are not being achieved.
The process of engaging the family, convening the
team, developing the plan, implementing the plan, and transitioning
the youth out of formal wraparound is typically facilitated by a
trained care manager or “wraparound facilitator,” sometimes with
the assistance of a family support worker. The wraparound process,
and the plan itself, is designed to be culturally competent,
strengths based, and organized around family members’ own
perceptions of needs, goals, and likelihood of success of specific
strategies.
Wraparound has been implemented nationally for
over 20 years and presented as a promising practice in many
publications. However, specification and consistent implementation
of the model has occurred only in the past few years. As recently
specified, wraparound is conceived of a four phase process:
Engagement and team preparation, Initial plan development, plan
implementation, and transition. The full description of the
activities that typically take place in each of these phases can be
found in “Phases and Activities of the Wraparound Process,” a
document available on the website of the National Wraparound
Initiative .
Implementation Essentials
Wraparound is intended to ensure that youth with complex needs (and multiple agency involvement) benefit from a coordinated care planning process that produces a single plan of care that cuts across all agencies and providers. Wraparound plans and wraparound teams require access to flexible resources and a well-developed array of services and supports in the community. As a result, wraparound implementation requires that the child-serving system is supportive of wraparound. Some of the key types of community and system supports include:- Community partnership: Key stakeholder groups, including agencies, providers, and representatives of youths and families have joined together in a collaborative effort to plan and implement wraparound.
- Collaborative action: Stakeholders involved in the wraparound effort take concrete steps to translate the wraparound philosophy into concrete policies, practices and achievements.
- Fiscal Policies: The community has developed fiscal strategies to support the wraparound effort and to better meet the needs of children and youth participating in the wraparound effort
- Access to needed supports and services: The community has developed mechanisms for ensuring access to the services and supports that wraparound teams need to fully implement their plans.
- Human Resource Development and Support: The system supports wraparound staff and partner agency staff to work in a manner that allows full implementation of the wraparound model.
- Accountability. The community has implemented mechanisms to monitor wraparound fidelity, service quality, and outcomes, and to oversee the quality and development of the overall wraparound effort.
In addition to system supports, the wraparound
process requires skilled facilitators and family support partners
who have the right working conditions to do their jobs. As a
result, the lead agency responsible for implementing the wraparound
process for families must support implementation in several key
ways, including maintaining adequately low caseload sizes; ensuring
that primary staff receive comprehensive training and skill
development; supporting wraparound team efforts to get necessary
members to attend meetings and participate collaboratively; and
making timely decisions regarding funding for strategies developed
by teams to meet families’ unique needs.
Program Evaluation and Evidence for Effectiveness
The wraparound process has been implemented widely across the United States and internationally because of the documentation of its successful use in several communities, its alignment with the value base for systems of care, and its resonance with families and family advocates. However, the formal wraparound research base has been slow to develop because of several reasons: (1) its status as a care management process rather than a focal treatment for a specific disorder; (2) its grassroots development rather than development by a single research team; and (3) its individualized nature, in that the identified needs and specific strategies for each family participating in wraparound should be unique. Thus, at the current juncture, there is some consensus that the research base on wraparound is largely positive but that more rigorous evaluation is needed (Farmer, Dorsey, & Mustillo, (2004)).At the same time, the research base on wraparound
continues to expand and evolve:
- To date, positive results have been found from three published experimental studies, six published quasi-experimental studies, and numerous pre- post longitudinal studies.
- The wraparound process has been cited as a promising practice in Surgeon General’s reports on both youth violence and mental health.
- Since the wraparound practice model has been more fully specified, four random assignment control studies have been begun in four different locations, all with a consistent practice model and training and coaching model. Fidelity measures aligned with the wraparound model described above are also now available and in use in all the above studies.
Resources
The wraparound process is not proprietary. The website of the National Wraparound Initiative includes a description of the practice model, as well as many implementation resources compiled from trainers, technical assistance providers, and program sites nationally. The NWI website also includes a list of consultants and trainers that communities and organizations may wish to access. More comprehensive examples of how wraparound has been implemented in schools can be found at the Illinois Positive Behavioral Support network website, and in Eber (2003). Information about implementation and fidelity measures for wraparound can be found at the Wraparound Evaluation and Research Team’s website at .Training and Technical Assistance
Many communities and programs have been trained and coached by experts on the wraparound process to successfully implement the wraparound process. Typical curricula include initial 4 day training sessions for staff (e.g., facilitators and parent partners) followed by shadowing of experienced staff, and in-vivo coaching. Supervisors also receive a series of human resource development activities so they can collect data about staff performance and support staff over the long term via intensive group and individual supervision, as well as ongoing coaching.Summary of Published Controlled Studies of the Wraparound Process
STUDY 1: Randomized control study (18 months) of
youth in child welfare custody in Florida: 54 in wraparound vs. 78
in standard practice foster care.
RESULTS: Significantly fewer placement changes
for youths in the wraparound program, fewer days on runaway,
fewer days incarcerated (for subset of
incarcerated youths), and older youths were significantly more
likely to be in a permanency plan at follow-up. No group
differences were found on rate of placement changes, days absent,
or days suspended. No differences on internalizing problems, but
boys in wraparound showed significantly greater improvement on
externalizing problems than the comparison group. Taken together,
the findings provided moderate evidence for better outcomes for the
wraparound program; however, differences appear somewhat limited to
boys and externalizing problems.
STUDY 2: Matched comparison study (18 months) of
youth in child welfare custody in Nevada: 33 in
wraparound vs. 32 receiving MH services as usual
References: Bruns, Rast,
Walker, Bosworth, & Peterson, 2006; Rast, Bruns,
Brown, Peterson, & Mears (in submission).
RESULTS: After 18 months, 27 of the 33 youth
(approximately 82%) who received wraparound moved to less
restrictive environments, compared to only 12 of the 32 comparison
group youth (approximately 38%), and family members were identified
to provide care for 11 of the 33 youth in the wraparound group
compared to only six in the comparison group. Mean CAFAS scores for
youth in wraparound decreased significantly across all waves of
data collection (6, 12, 18 months) in comparison to the traditional
services group. More positive outcomes were also found for the
wraparound cohort on school attendance, school disciplinary actions,
and grade point
averages. No significant differences were found in favor of the
comparison group.
STUDY 3: Randomized control study (18 months) of
“at risk” and juvenile justice involved (adjudicated) youth in
Ohio: 73 in
wraparound vs. 68 in conventional services
Reference: Carney &
Buttell, 2003.
RESULTS: Study supported the hypothesis that
youth who received wraparound services were less likely to engage
in subsequent at-risk and delinquent behavior. The
youth who received wraparound services did not miss school
unexcused, get expelled or suspended from school, run away from
home, or get picked up by the police as frequently as the youth who
received the juvenile
court conventional services. There were, however, no
significant differences, in formal criminal offenses.
STUDY 4: Matched comparison study (>2 years)
of youth involved in juvenile justice and receiving MH services:
110 youth in wraparound vs. 98 in conventional MH services
RESULTS: Youths in the comparison group were
three times more likely to commit a felony offense than youths in the
wraparound group. Among youth in the wraparound program, 72% served
detention “at some
point in the 790 day post identification window” (p. 388), while
all youth in the comparison group served detention. And of youth in
the Connections program who did serve detention, they did so
significantly less often than their peers. Connections youth also
took three times longer to recidivate than those in the comparison
group. According to the authors, a previous study by Pullman and
colleagues showed “significant improvement on standardized measures
of behavioral and emotional problems, increases in behavioral and
emotional strengths, and improved functioning at home at school,
and in the community” (p. 388) among Connections youth.
STUDY 5: Randomized control study (12 months) of
youths referred to out-of-home placements for serious mental health
problems in New York State: 27 to family centered intensive case
management (wraparound) vs. 15 to treatment foster care.
References: Evans, Armstrong, & Kuppinger,
1996; Evans, Armstrong, Kuppinger, Huz, & McNulty,1998
RESULTS: Significant group differences were found
in favor of the case management/ wraparound program for behavioral
and mood functioning. No differences were found, however, with
respect to behavior problems (internalizing and externalizing),
family cohesiveness, or self-esteem. No differences found in favor
of the TFC group. Overall, small sample size plus loss of data on
many of the outcome measures resulted in the study having very low
power to detect differences between groups.
STUDY 6: Quasi-experimental (6 months) study in
Department of Defense demonstration site of youths with serious
mental health issues: 71 in wraparound group vs. 40 in comparison
group (study refusers/ineligible youths).
Reference: Bickman,
Smith, Lambert, & Andrade, 2003
RESULTS: Findings included higher utilization of
“wraparound services” (e.g., case management, in-home supports, and
nontraditional services) for the demonstration group, higher costs
for the demonstration group (primarily due to this group remaining
in treatment longer), and no consistent differences between the
groups on outcome measures (e.g., behavior, functioning, caregiver
strain, perceived social support, family environment). 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)
STUDY 7: Quasi-experimental (24 months) study of
youths with serious mental health issues in urban Baltimore: 45
returned or diverted from residential care to wraparound vs. 24
comparison.
Reference: Hyde, Burchard,
& Woodworth, 1996.
RESULTS: Primary outcome was a single rating that
combined several indicators: restrictiveness of youth living
situation, school attendance, job/job training attendance, and
serious problem behaviors. Youths received ratings of “good” if
they were living in regular community placements, attending school
and/or working for the majority of the week, and had fewer than
three days of serious behavior problems during the course of
previous month. At 2-year follow-up, 47% of the wraparound groups
received a rating of good, compared to 8% of youths in traditional
MH services. Limitations of the study include study attrition and
group non-equivalence at baseline.
STUDY 8: Quasi-experimental (multiple-baseline
case study) of four youths referred to wraparound because of
serious mental health issues in rural Michigan.
Reference: Myaard,
Crawford, Jackson, & Alessi (2000).
RESULTS: The multiple baseline case study design
was used to evaluate the impact of wraparound by assessing whether
outcome change occurred with (and only with) the introduction of
wraparound at different points in time. The authors tracked
occurrence of five behaviors (compliance, peer interactions,
physical aggression, alcohol and drug use, and extreme verbal
abuse) for each of the youths. Participants began receiving
wraparound after 12, 15, 19, and 22 weeks. For all four
participants, on all five behaviors, dramatic improvements occurred
immediately following the introduction of wraparound.
References
- 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.
- Burchard JD, Bruns EJ, & Burchard SN (2002). The wraparound approach. In Community treatment for youth: Evidence-based interventions for severe emotional and behavioral disorders. Edited by Burns BJ, Hoagwood K. New York, Oxford University Press.
- Burns BJ & Goldman SK (Eds) (1999). Promising practices in wraparound for children with severe emotional disorders and their families. Systems of care: Promising practices in children's mental health, 1998 series: Volume IV. Washington, DC, Center for Effective Collaboration and Practice, American Institutes for Research.
- Eber, L. (2003). The Art and Science of Wraparound. Bloomington, IN: Forum on Education at Indiana University.
- Eber, L. (2005). Wraparound: Description and Case Example. In Sugai, G. & Horner, R. (2005) Ed., Encyclopedia of Behavior Modification and Cognitive Behavior Therapy: Educational Applications. 1601-1605. Thousand Oaks: Sage.
- Eber, L., Nelson, C.M., & Miles, P. (1997). School-based wraparound for students with emotional and behavioral challenges. Exceptional Children, 63(4), 539-555.
- Kamradt, B. (2000). Wraparound Milwaukee: Aiding youth with mental health needs. Juvenile Justice 7,14-23.
- Kendziora K, Bruns E, Osher D, et al (Eds) (2001). Wraparound: Stories from the field. Systems of care: Promising practices in children's mental health, 2001 series: Volume I. Washington, DC, Center for Effective Collaboration and Practice, American Institutes for Research.
- Walker, J.S. & Bruns, E.J. (2006). Building on practice-based evidence: Using expert perspectives to define the wraparound process. Psychiatric Services, 57(11), 1579-1585.
- Walker JS, Koroloff N, & Schutte K (2003). Implementing high-quality collaborative Individualized Service/Support Planning: Necessary conditions, Portland OR: Research and Training Center on Family Support and Children's Mental Health.
Extra References for Review of Outcomes
Studies
- Bickman, L., Smith, C., Lambert, E. W., & Andrade, A. R. (2003). Evaluation of a congressionally mandated wraparound demonstration. Journal of Child & Family Studies, 12, 135-156.
- Carney, M. M., & Buttell, F. (2003). Reducing juvenile recidivism: Evaluating the wraparound services model. Research on Social Work Practice, 13, 551-568.
- 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, 39-54.
- 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.
- 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, 55-65.
- Evans, M. E., Armstrong, M. I., Kuppinger, A. D., Huz, S., & McNulty, T. L. (1998). Preliminary outcomes of an experimental study comparing treatment foster care and family-centered intensive case management. In Epstein, M.H. (Ed); Kutash, K (Ed); et al. (1998). Outcomes for children and youth with emotional and behavioral disorders and their families: Programs and evaluation best practices. (pp. 543-580). Xviii, 738 pp.
- Hyde, K. L., Burchard, J. D., & Woodworth, K. (1996). Wrapping services in an urban setting. Journal of Child & Family Studies, 5(1), 67-82.
- Myaard, M. J., Crawford, C., Jackson, M., & Alessi, G. (2000). Applying behavior analysis within the wraparound process: A multiple baseline study. Journal of Emotional & Behavioral Disorders, 8, 216-229.
- Pullmann, 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, 375-397.
- Rast, J., Bruns, E.J., Brown, E.C., Peterson, C.R., & Mears, S.L. (submitted May 2007). Impact of the wraparound process in a child welfare system: Results of a matched comparison study. Social Work Research.