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Practice Profile

Wraparound Process for Children with Serious Emotional and Behavioral Disorders

Evidence Ratings for Outcomes:

Promising - One Meta-Analysis Mental Health & Behavioral Health - Multiple mental health/behavioral health outcomes
No Effects - One Meta-Analysis Family Functioning - Living Situation
No Effects - One Meta-Analysis Education - Multiple education outcomes
No Effects - One Meta-Analysis Crime & Delinquency - Multiple crime/offense types

Practice Description

Practice Goals
Wraparound for children with serious emotional and behavioral disorders (SEBD) is a team-based collaborative process designed to provide coordinated and individualized services to youths with SEBD and their families across a variety of settings. As these youths are often involved in more than one child-serving agency and do not receive the individualized care that they need, they are at increased risk for institutionalization (Suter and Bruns 2009). To respond to this risk and overcome the uncoordinated services that youths with SEBD typically receive, the versatile wraparound process “wraps” a variety of services and support networks “around” the individual and their families. The overall goal of these processes is to improve mental health, improve school achievement and attendance, reduce recidivism, and achieve more successful permanency outcomes (Bruns et al. 2008a; Suter and Bruns 2008; Development Services Group 2014).

Practice Components
Given that the wraparound process is designed to provide youths with better access to treatment, it is closely tied to the system-of-care (SOC) framework (Suter and Bruns 2009; Development Services Group 2014). According to Winters and Metz (2009), the SOC framework is a “comprehensive spectrum of mental health and other services and supports organized into a coordinated network to meet the diverse and changing needs of children and adolescents with severe emotional disorders and their families” (p. 136). Wraparound processes work within an SOC by selecting and implementing treatments and other services for youths and their families.

Wraparound provides a flexible process through which any number of traditional and nontraditional services and supports can be identified, implemented, and coordinated. The active ingredients of the wraparound process are defined by a set of 10 philosophical principles: 1) family voice and choice, 2) being team-based, 3) natural supports, 4) collaboration, 5) being community-based, 6) being culturally competent, 7) being individualized, 8) being strengths-based, 9) being unconditional, and 10) being outcome-based. These 10 principles are then applied across a four-phase process: 1) engagement and team preparation, 2) plan development, 3) plan implementation, and 4) transition from the wraparound process (Walker et al. 2008; Suter and Bruns 2009).

Moreover, the team-based approach encourages coordination among providers and families that can help identify gaps in treatment and barriers to follow-through while avoiding redundancies. Further, the emphasis on community-based and natural supports provides a mechanism for the generalization of skills learned in treatment.

Meta-Analysis Outcomes

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Promising - One Meta-Analysis Mental Health & Behavioral Health - Multiple mental health/behavioral health outcomes
Aggregating the results from four studies, Suter and Bruns (2009) found that wraparound programs had a statistically significant impact on mental health outcomes. Specifically, the overall mean effect size was 0.31, showing that youths who participated in wraparound programs experienced a reduction in their emotional and behavioral symptoms, problems, and/or disorders.
No Effects - One Meta-Analysis Family Functioning - Living Situation
Examining the results from three studies, Suter and Bruns (2009) found that wraparound programs did not have a statistically significant effect on living situation (i.e., whether youths were living in more stable and a less restrictive environment following the wraparound intervention).
No Effects - One Meta-Analysis Education - Multiple education outcomes
Aggregating the effect sizes from four studies, Suter and Bruns (2009) found that wraparound programs did not have a statistically significant impact on school functioning.
No Effects - One Meta-Analysis Crime & Delinquency - Multiple crime/offense types
Examining the results from five studies, Suter and Bruns (2009) found that wraparound programs did not have a statistically significant effect on reducing recidivism.
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Meta-Analysis Methodology

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Meta-Analysis Snapshot
 Literature Coverage DatesNumber of StudiesNumber of Study Participants
Meta-Analysis 11998 - 20087802

Meta-Analysis 1
Suter and Bruns (2009) analyzed the impact of wraparound programs on youths, aged 3–21, with serious emotional and behavioral disorders (SEBD) and/or significant functional impairment. Those considered to have significant functional impairment included youths who were at risk of out-of-home placements, or were returning from out-of-home placements. To be eligible for inclusion in the meta-analysis, studies had to provide direct comparisons of youths receiving wraparound services with youths in a control group. To be considered a wraparound intervention, the study authors had to specify that the intervention was a wraparound intervention, or had to indicate that the intervention shared the 10 principles of wraparound programs. Community-based interventions that provided services for youths with emotional and behavioral disorders, but did not incorporate the 10 principles of wraparound, were not eligible for inclusion. Similarly, systems-of-care that used related principles of wraparound, but did not include the wraparound process at the family level, were also excluded.

Eligible studies had to use random assignment or quasi-random assignment to the wraparound program. Control conditions could include no intervention, wait-list control, or a treatment as usual (i.e., services that youths would receive if not in the wraparound program). Moreover, studies had to include at least one of the primary outcomes of interest: 1) living situation, 2) mental health, 3) functioning, and 4) assets and resiliency. Living situation focused on the stability of a youth’s residence and whether the youth was living in a less restrictive environment following the intervention. Mental health was measured by a reduction in emotional and behavioral problems, a reduction in emotional and behavioral systems, and a reduction in emotional and behavioral disorders as a result of the intervention. Functioning measured whether the youth had improved functioning in home, school, and community as a result of the intervention. It is important to note that although family functioning is important to the wraparound process, the outcomes had to be youth-specific to be eligible for inclusion in the meta-analysis. Finally, the study had to have been conducted between January 1, 1986, and December 31, 2008, and written in the English language.

A comprehensive literature search yielded seven studies that were eligible for inclusion in the meta-analysis. These seven studies provided 66 outcomes (i.e., 66 effect sizes), which were coded into one of the four outcome domains of interest. This coding strategy resulted in 8 outcomes that were related to living situation, 12 outcomes that were related to mental health, 41 outcomes that were related to functioning (which included both school functioning outcomes and juvenile justice-related outcomes), and 4 outcomes that were related to assets and resiliency. It is important to note that 1 of the 66 outcomes was not coded to a specific category because the outcome was related to all four of the outcome domains. Moreover, the authors noted that the two studies related to the assets and resiliency outcomes did not include enough information to compute effect sizes, which excluded these outcomes from the review.

The included studies were published between 1998 and 2008, with three of the seven studies using a randomized control design. Of the four studies that used quasi-experimental design, three used nonequivalent comparison groups that were not matched, and one used a nonequivalent matched comparison group. Three of the seven studies targeted mental health populations, two targeted child welfare populations, one targeted juvenile justice populations, and one targeted juvenile justice and mental health populations. The included studies had a total sample size of 802 youths, of which 33.57 percent were female. The average age of the sample was approximately 13, and, in studies where it could be determined, 56.95 percent of study participants identified as white, and 23.10 percent identified as African American. In terms of intervention format, all included studies noted that youths and their families were paired with a wraparound facilitator who coordinated and developed the youth’s wraparound plan.

Given the level of diversity in programs included in the meta-analysis, a random effects model was used to account for the heterogeneity across studies. The standardized mean difference, typically referred to as Cohen’s d, was used to calculate the effect and all effects were adjusted using Hedges’ small sample size correction to create unbiased estimates.
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Cost

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There is no cost information available for this practice.
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Evidence-Base (Meta-Analyses Reviewed)

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These sources were used in the development of the practice profile:

Meta-Analysis 1
Suter, Jesse C., and Eric J. Bruns. 2009. “Effectiveness of the Wraparound Process for Children with Emotional and Behavioral Disorders: A Meta-Analysis.” Clinical Child and Family Psychology Review 12:336–51.
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Additional References

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These sources were used in the development of the practice profile:

Bruns, Eric J. 2008. “The Evidence Base and Wraparound.” In Eric J. Bruns and Janet S. Walker (eds.). The Resource Guide to Wraparound. Portland, Ore.: National Wraparound Initiative.

Development Services Group, Inc. 2014. “Wraparound Process.” Literature review. Washington, D.C.: Office of Juvenile Justice and Delinquency Prevention.
https://www.ojjdp.gov/mpg/litreviews/Wraparound_Process.pdf

Suter, Jesse C., and Eric J. Bruns. 2008. “A Narrative Review of Wraparound Outcome Studies.” In Eric J. Bruns and Janet S. Walker (eds.). The Resource Guide to Wraparound. Portland, Ore.: National Wraparound Initiative.


Walker, J. S., Eric J. Bruns, and National Wraparound Initiative Advisory Group. 2008. “Phases and Activities of the Wraparound Process: Building Agreement Around a Practice Model.” In Eric J. Bruns and Janet S. Walker (eds.). The Resource Guide to Wraparound. Portland, Ore.: National Wraparound Initiative.

Wilson, Kate J. 2008. Literature Review: Wraparound Services for Juvenile and Adult Offender Populations. A Report Prepared for the California Department of Corrections and Rehabilitation. Davis, Calif.: University of California, Davis, Center for Public Policy Research.
. http://www.cdcr.ca.gov/Adult_Research_Branch/Research_Documents/Wraparound_Services_UCDAVIS_Jan_2008.pdf

Winters, Nancy C., and W. Peter Metz. 2009. “The Wraparound Approach in Systems of Care.” Psychiatric Clinics of North America 32:135–51.
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Related Programs

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Following are CrimeSolutions.gov-rated programs that are related to this practice:

Connections Promising - One study
A juvenile court-based program designed to address the needs of offenders on probation who have emotional and behavioral disorders and the needs of their families. The approach is meant to be an integrated, seamless, coordinated system of care for children with mental health problems. The program is rated Promising. The intervention youth were significantly less likely to recidivate, commit a felony offense or serve time in detention.
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Practice Snapshot

Age: 3 - 21

Gender: Both

Race/Ethnicity: Black, Other, White

Targeted Population: Families, Mentally Ill Offenders

Settings: Other Community Setting

Practice Type: Diversion, Family Therapy, Violence Prevention, Wraparound/Case Management

Unit of Analysis: Persons

Researcher:
Jesse C. Suter
Executive Director, Research Associate Professor
Center on Disability and Community Inclusion, University of Vermont
208 Colchester Avenue, Mann Hall 3rd Floor
Burlington VT 05405
Phone: 802.656.4031
Website
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