Wraparound care coordination associated with many positive outcomes amongst youth with behavioral health needs

A study in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) finds that Wraparound Care Coordination (Wraparound), which has been adopted in states and jurisdictions across the country to help meet the needs of children and adolescents with serious emotional and behavioral disorders, produces more positive outcomes for youth when compared to more common service approaches.

Moreover, Wraparound may hold the potential for reducing disparities in outcomes for youth of color, which has long been found in mental health services.

A team of researchers, led by Jonathan Olson, Ph.D., at the University of Washington Department of Psychiatry and Behavioral Sciences, Seattle, WA, USA, conducted a meta-analysis of 17 controlled studies, and their results, published between 1996 and 2019 in order to compare the effects of Wraparound to regular services in youth with SED (serious emotional disorders).

"For many years, public systems have used Wraparound because it makes sense and provides families with the kind of compassionate approach, something that all families say they want and need," said Dr. Eric Bruns, Professor of Psychiatry and senior author on the research team. "Now we have clear results that support what many have seen in their own local systems of care: that Wraparound is more effective and cost-effective than traditional services."

Significant effects in favor of Wraparound across a range of important youth outcomes were found—including reduced out-of-home placements and improved mental health functioning and school outcomes. The study also found significantly lower overall care costs for youth in Wraparound care, due to less spending on costly out-of-home placements. Across the 17 studies, Wraparound effects were more positive for samples with higher proportions of youth of color.

"Wraparound lives up to principles we want to uphold—for example, being youth- and family-driven, strengths-based and using a team of people with a blank checkbook to 'do whatever it takes' to meet the needs of the youth and family," added Dr. Bruns. "While many states have taken Wraparound to scale, others have been more hesitant, saying it wasn't 'evidence-based.' This study should help address those concerns."

Wraparound was established in the 1980s as an alternative to service delivery strategies that kept youth and family services in fragmented siloes, driven by professionals and often relying on costly institution-based care rather than investing in community supports. Instead, Wraparound invests in a care coordinator with a low caseload who convenes a team that includes the family, friends and members of the wider community, as well as service and support providers.

Dr. Olson also points out, however, that the study additionally reinforced how important it is to implement high-quality Wraparound services that are true to the model: "Unfortunately, many studies were conducted before there were measures of fidelity, or measures of 'doing Wraparound right,'" he said. "However, for studies that did measure fidelity, we saw more positive outcomes for youth and families who received care that was of high-quality and closely adhered to Wraparound principles."

The potential for Wraparound to better meet the needs of youth of color was an unexpected finding, concluded Dr. Bruns, but perhaps not surprising: "We need to remember that in all these studies, Wraparound was compared to more traditional services delivered in mental health, child welfare and juvenile justice.

"There is a long history of research showing disparities in access and outcomes for youth of color and their families. It may be that by allowing for more youth and family voice and choice, and teams that include family, friends, and community members, Wraparound helps reduce those disparities. However, such questions were not the explicit focus of these studies. We need to investigate the issue of what may address disparities with greater rigor."