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A Narrative Review of Wraparound Outcome Studies

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A Narrative Review of Wraparound Outcome Studies This document was peer reviewed through the NWI. Theory and Research: Chapter 3.3 A Narrative Review of Wraparound Outcome Studies Jesse Suter, Faculty University of Vermont Eric Bruns, Co-Director, National Wraparound Initiative, and Associate Professor, University of Washington School of Medicine he wraparound process has been described as having a T promising body of evidence (Burns, Goldman, Faw, & Burchard, 1999; National Advisory Mental Health Council, 2001; New Freedom Commission on Mental Health, 2003), to the point it has been included in two Surgeon General re- ports (U. S. Department of Health and Human Services, 1999, 2000), recommended for use in federal grant programs (U. S. Department of Health and Human Services, 2005), and presented as a mechanism for improving the delivery of evi- dence-based practices for children and adolescents with se- rious emotional and behavioral disorders ([SEBD] Friedman & Drews, 2005; Tolan & Dodge, 2005; Weisz, Sandler, Durlak, & Anton, 2006). Not everyone, however, is convinced. Bick- man and colleagues (Bickman, Smith, Lambert, & Andrade, 2003) have stated that “the existing literature does not pro- vide strong support for the effectiveness of wraparound” (p. 138). Farmer, Dorsey, and Mustillo (2004) recently char- acterized the wraparound evidence base as being “on the weak side of ‘promising’” (p. 869). There are several significant concerns about the state of the wraparound evidence base. As presented in Figure 1, though the number of publications about wraparound has grown steadily over time, the number of outcome studies remains relatively small. Many outcome studies that have been published used less rigorous designs and included rel- atively small samples. Finally, the wraparound model has developed in a “grassroots” fashion and has been driven largely by local priorities. This means that there has his- The Resource Guide to Wraparound Section 3: Theory and Research torically been a wide range of populations of chil- erts, 2006, p.90). This does not make them less dren and families for which wraparound has been important for a review (Lipsey & Wilson, 2001), implemented and studied, as well as wide varia- just more difficult to find. Therefore, the authors tion in adherence to the core principles of wrap- acknowledge that the present review may not around (Bruns et al., 2004). With many target capture all empirical studies on wraparound. With populations, no real consensus on what exactly this recognition, this review is conceptualized as constitutes “wraparound,” and no single research a resource as well as a working document that group invested in documenting wraparound out- will most likely need to be revised and amended comes, the outcomes research base has been slow as more studies on wraparound are conducted and to emerge, and results are less consistent than identified. for more strictly defined models. In addition, re- views of outcomes studies of children’s services Method have tended to mischaracterize some evaluation studies as pertaining to the wraparound process. For example, one widely cited review (Aos, Lieb, Selection Criteria Mayfield, Miller, & Pennucci, 2004) cited evalua- Studies chosen for this review evaluated inter- tion studies of “systems of care” (e.g., Bickman, ventions following the wraparound process at the Sumerfeldt & Noser, 1997) as speaking to the child and family level. Because the goal was to evidence base on the wraparound process, even provide a comprehensive resource to the field, se- though the two models are quite distinct in prac- lection criteria were chosen that were much more tice (Stroul, 2002). inclusive than most reviews. More specifically, the Taken together, these concerns have made it following selection criteria were chosen. difficult to draw clear conclusions about wrap- Intervention. The team-based planning pro- around’s evidence base. Therefore, it is important cess used in the study must have been identified to take stock of the full range of existing outcome as wraparound or sufficiently described by the au- studies on wraparound. To date, three wraparound thors as sharing the primary components of wrap- narrative reviews have been published (Burchard, around (see related descriptions elsewhere in Bruns, & Burchard, 2002; Burns et al., 1999; Farm- this Resource Guide). Interventions that included er et al., 2004). However, they did not capture all community-based planning for children with emo- available outcome studies, and additional studies tional and behavioral disorders (e.g., case man- have been published since those reviews. Given agement), but did not explicitly incorporate other that published research on wraparound seems to wraparound principles were excluded. Similarly, be growing at an increasing rate, it is important systems of care evaluation studies that followed to conduct regular reviews of the literature to similar principles as wraparound but were evalu- characterize the status of wraparound’s evidence ated primarily at the system rather than the indi- base. vidual family level were also excluded. The primary goal of the present narrative re- Participants. The target population of the view was to identify and summarize the full scope study was children or adolescents (5 to 22 years) of wraparound outcome studies, to serve as a re- with SEBD and significant functional impairment. source for researchers and practitioners. While Evidence of significant functional impairment traditional reviews of outcome studies may use included those at-risk of (or returning from) an inclusion criteria to analyze only studies with the out-of-home placement (e.g., psychiatric hospi- most rigorous designs, the current review was in- tal, residential treatment center, juvenile justice tended to be more inclusive of the full breadth facility, foster care), as this is a common target of outcome studies on wraparound. Because much population for wraparound. of the outcome literature on wraparound is com- Design. Study design selection criteria were es- posed of program evaluations, the studies are pecially liberal to allow a full breadth of outcome often not published in traditional outlets (e.g., studies on wraparound. As such, experimental peer-reviewed journals). Such studies are often (e.g., randomized controlled trials), quasi-experi- referred to as “gray literature” (Petticrew & Rob- mental (e.g., non-randomized group compari- 2 Chapter 3.3: Suter & Bruns sons), and non-experimental designs (e.g., single Family Studies, Journal of Emotional and Behav- group pretest-posttest) were permitted. Qualita- ioral Disorders, and the annual research confer- tive and quantitative single subject designs were ence proceedings of A System of Care for Chil- also permitted. dren’s Mental Health: Expanding the Research Outcomes. Study outcomes must have includ- Base hosted by the University of South Florida, ed measures of child functioning in their homes, Louis de la Parte Florida Mental Health Institute, schools, or communities. This could include emo- Research and Training Center for Children’s Men- tional or behavioral functioning, academic or job tal Health. These three sources were chosen for performance, violence or delinquency, changes in a manual search because traditionally they have living situation, or substance use. been the primary outlets for research on wrap- Timeframe and Language. The study must around. have been made available between January 1, 1986 and February 29, 2008. This timeframe was Findings Study Characteristics The literature search yielded 36 studies (20 more than the latest review, Farmer et al., 2004), presented in 56 separate reports. When multiple reports were available for the same study, all ci- tations were included in this review. Additional reports for the same studies seemed to reflect either updates (earlier reports represented pre- liminary findings; Vernberg, Jacobs, Nyre, Puddy, & Roberts, 2004; Vernberg et al., in press), moves from unpublished to published sources (e.g., con- ference proceedings to journal article; Anderson, Kooreman, Mohr, Wright, & Russell, 2002; Ander- son, Wright, Kooreman, Mohr, & Russell, 2003), chosen because the wraparound process, as it is or presentation of findings in evaluation reports currently conceptualized, was reported to have and publications (Evans, Armstrong, Kuppinger, begun in 1986 (VanDenBerg, 1999). To be acces- 1996; Evans, Armstrong, Kuppinger, Huz, & John- sible to the researchers, the study had to be in son, 1998). Of these 56 separate reports, the most English. common outlet (45%) were peer-reviewed journals (n = 25), followed by conference proceedings (n = Literature Search 19), book chapters (n = 4), doctoral dissertations Eligible studies for this review were identified (n = 3), federal reports (n = 2), paper presenta- through electronic and manually based searches tions (n = 2), a manuscript submitted for publica- of the literature. First, 16 studies identified in tion, and a published monograph. previous reviews were included.1 Second, elec- Focusing on the 36 unique studies, over 60% tronic databases (Web of Science, PsycINFO and (n = 22) resulted in at least one publication in ERIC) were used to search for the keywords: wrap- a peer-reviewed journal. The remaining studies around, wrap-around, individualized services, were presented in conference proceedings (n = 9) and individualized service plans. Third, a manual dissertations (n = 3), 1 published monograph, and search was conducted of the Journal of Child and 1 paper presentation.
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