THE EVIDENCE BASE FOR WRAPAROUND
Wraparound is now used as a strategy to coordinate care for youth with complex needs and their families by child serving systems in almost every U.S. state. Thus, it is imperative that the field has access to rigorous research to inform funding and policy decisions and support implementation of Wraparound and other service models for this population. Since 2005, UW WERT and its partners have been at the forefront of this research agenda. Below is a summary of selected peer-reviewed publications and what these research studies tell the field. You can also access a full bibliography of WERT’s published papers, or search for more resources at the website of the National Wraparound Initiative (NWI).
Wraparound’s Evidence Base is Strong and Growing…
Results of a meta-analysis of 16 controlled studies show significant, positive effects across multiple outcome domains.
A subsequent editorial by the Journal of the American Academy of Child and Adolescent Psychiatry concludes that Wraparound is “evidence-based.”
A narrative review of Wraparound research from 2017 details what has been learned from over 200 published studies of Wraparound. The review found that approximately half these publications were research studies, and 22 compared outcomes for Wraparound to some other condition. 15 of these found more positive outcomes for Wraparound and none found more positive outcomes for the comparison group(s).
UW WERT also has documented the extensiveness and nature of Wraparound implementation across the United States via several published studies. The most recent was in 2013, indicating we badly need to conduct a new census!
Outcomes of Wraparound are dependent on state approaches to financing and organizing its implementation. This article is one of several studies by UW WERT finding that using Care Management Entities (CMEs) as the locus of Wraparound implementation produces more positive results:
In these widely-cited papers, research by UW WERT revealed state factors that influence implementation of evidence-based treatments (EBT) for youth and families. A previous paper documented that investment in EBT by states is declining.
UW WERT strives to support high-quality implementation of Wraparound care coordination by providing the field with an array of measures and tools to help states and systems stay on track. Thus, we continuously evaluate reliability, validity, and usefulness of our measures. For example:
Analysis of thousands of surveys show the Wraparound Fidelity Index, Short form (WFI-EZ) is reliable and valid, and sheds light of Wraparound’s mechanisms of action.
Research also shows the Team Observation Measure (TOM) is reliable and valid:
Research on a prior version of the WFI shows we can establish benchmarks for fidelity scores that indicate Wraparound is “good enough.”
A randomized study found that an Electronic Health Record (EHR) for Wraparound is feasible and acceptable to its users and can promote better use of fidelity and outcomes data.
Because youth and families enrolled in Wraparound must have access to a robust array of effective community-based services, we also are invested in improving these practice models. One example is our project to define program and practice standards for Intensive In-Home Treatment.
UW WERT is part of the National Wraparound Implementation Center (NWIC), Innovations Institute at UConn, and the UW SMART Center. All provide training, coaching and technical assistance (TA) for Wraparound and behavioral health systems of care. In our quest to be research-based, we have conducted several studies of the impacts of training and TA, so we can apply those findings to our work: