A Comprehensive Review of Wraparound Care Coordination Research, 1986€“2014
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J Child Fam Stud DOI 10.1007/s10826-016-0639-7 ORIGINAL PAPER A Comprehensive Review of Wraparound Care Coordination Research, 1986–2014 1 1 1 Jennifer Schurer Coldiron ● Eric Jerome Bruns ● Henrietta Quick © Springer Science+Business Media New York 2017 Abstract Wraparound is a team-based care coordination intervention and implementation components, as well as strategy for children and youth with complex behavioral more rigorous effectiveness studies. health needs and their families. Despite widespread adop- tion, a review of the literature pertaining to Wraparound has Keywords Wraparound ● Care coordination ● Literature not previously been conducted. To address this gap, we review ● Children’s mental health ● Systems of care conducted a comprehensive review, ultimately identifying 206 unique Wraparound-related publications in peer- reviewed outlets. We then coded and analyzed the pub- lications’ methods, main foci, measures, and findings. Eighty-three publications (40%) were non-empirical, most Introduction of which focused on defining Wraparound and advocating for its use, largely based on its alignment with the System of Research suggests that approximately 20% of all children Care philosophy. Among empirical studies (n = 123; 60%), and adolescents in the United States have a diagnosable 22 controlled studies were found, most finding positive or mental health disorder, at an annual cost of $247 billion mixed evidence for Wraparound’s effectiveness. Other (Institute of Medicine & National Research Council 2009). empirical studies examined implementation issues such as At the same time, however, research also shows that necessary system conditions and measurement and influ- 75–80% of young people who need behavioral health ser- ence of fidelity. Major gaps include rigorous tests of vices do not receive them (Kataoka et al. 2002). Wraparound’s change mechanisms, workforce development A primary driver of this gap between need and help is models, peer support, and the use of specific treatments. We that public child-serving systems disproportionately allocate conclude that literature produced to date has provided useful their scarce resources to youth with the most serious and information about Wraparound’s core components, complex problems, reducing opportunities to invest in program-level and system-level implementation supports, prevention and early identification and treatment. and applicability across systems and populations, as well as Approximately 10% of youth with the most serious and preliminary information about effectiveness and cost- complex behavioral health needs consume 40–70% of all effectiveness. The Wraparound research base would, how- child-serving resources (Bruns et al. 2010; Center for ever, benefit from additional studies of the model’s Health Care Strategies 2011; Pires et al. 2013). Much of this imbalance in expenditure is accounted for by use of con- gregate and institutional care settings for youth with serious emotional and behavioral disorders (SEBD), despite per- * Jennifer Schurer Coldiron sistent concerns about the capacity of such care strategies to [email protected] promote generalizable improvements in youth symptoms or functioning (Barth 2002; Burns et al. 1999; Curtis et al. 1 Division of Public Behavioral Health and Justice Policy, University of Washington, 2815 Eastlake Ave. East, Suite 200, 2001; Epstein 2004; U.S. Department of Health and Human Seattle, WA 98102, USA Services 2003; United States Public Health Service 1999). J Child Fam Stud To address the imbalance in resource allocation and their families. The model has been used in states improve outcomes for youth with SEBD, states, jurisdic- and communities across the U.S. for at least 30 years tions, and provider organizations have invested in intensive, (VanDenBerg et al. 2003), and is now implemented in multi-modal interventions that include manualized nearly every state and in several other countries (Bruns et al. evidence-based treatments (EBT) such as Functional Family 2011). In addition to Wraparound’s practical appeal, its Therapy (FFT; Alexander and Sexton 2002), Multisystemic growth has been encouraged by the federal government’s Therapy (MST; Henggeler et al. 1998), and Multi- endorsement—and widespread adoption—of the System of dimensional Treatment Foster Care (MFTC; Chamberlain Care philosophy which promotes use of community-based 2003). These types of approaches have been shown to be care management for youth with multi-system involvement capable of addressing the complex needs of these youth and and/or complex needs (Stroul and Blau 2010). Moreover, their families (Bruns and Hoagwood 2008; Tolan and core values of the System of Care philosophy, such as being Dodge 2005; U. S. Surgeon General 2001), as well as family-driven, youth-guided, community-based, and cultu- reduce overall costs of care due to prevention of out-of- rally and linguistically competent, align well with Wrap- community placement in settings such as psychiatric hos- around’s principles (Stroul 2002). pitals and residential treatment centers (Aos et al. 2004). Further indicators of Wraparound’s increasing advance- Despite their proven research base, however, uptake of ment include it being listed on several evidence-based these EBTs into public behavioral health systems has been practice inventories, including both the Oregon and slow and penetration rates low (Bruns et al. 2015). Several Washington State registries (e.g., Washington State Institute barriers to adoption have been consistently cited. First, for Public Policy 2012) and California Evidence-Based research suggests that manualized EBTs may have limited Clearinghouse for Child Welfare. Several class-action generalizability to the full range of youth with intensive, lawsuit settlements focused on Medicaid beneficiary youth multi-system needs (Daleiden and Chorpita 2005; Southam- with SEBD also encourage or mandate use of Wraparound- Gerow et al. 2008; Weersing and Weisz 2002), a concern adherent care management (Bruns et al. 2014), as did the increasingly cited as something that must be addressed by federal government’s nine-state Community Alternatives to service systems (Chorpita et al. 2011). Research has also Psychiatric Residential Treatment Facilities (PRTF) found challenges to building multiple EBTs into an acces- Demonstration Grant Program that allowed states to divert sible service array (Chorpita et al. 2011), unfavorable inpatient treatment dollars to install community-based pro- provider attitudes toward EBTs (Borntrager et al. 2009), grams (Urdapilleta et al. 2012). Moreover, a joint bulletin and high organizational costs (Chorpita et al. 2007; Weisz from the Center for Medicaid Services (CMS) and Sub- et al. 2012). stance Abuse and Mental Health Services Administration As an alternative to manualized interventions for specific (SAMHSA 2013) was recently issued encouraging states to problem areas (e.g., MST for juvenile offending), public use federal funding mechanisms to implement Wraparound systems have tended to be more likely to invest in care and other community-based services for youth with SEBD. management strategies and integrated service models for As more and more communities have adopted the model, youth with multiple and complex needs, such as intensive and more federal funding mechanisms have supported its case management (Burns et al. 1996) and the Wraparound implementation (Center for Health Care Strategies 2011), process (Walker and Bruns 2006b). These models have Wraparound implementation nationally has become better fewer exclusionary criteria than most EBTs, are more operationalized and supported. In the past decade, readily reimbursed by Medicaid, and hold the potential to researchers, practitioners, and funding agencies have coa- be deployed as an “operating system” for providing indivi- lesced around a set of definitional documents and resources dualized care across child-serving agencies, enabling their formally articulating the model’s principles, tasks, and use as a broad system strategy with greater applicability activities (Walker et al. 2011), providing guidance about than one—or even multiple—EBTs (Bruns et al. 2013). practice, implementation, and evaluation (Bruns et al. Such models are also non-proprietary and locally adaptable, 2008). Wraparound’s increasing model specification has enhancing flexibility and appeal among system adminis- allowed for the development of fidelity measures with trators and providers. In addition, such strategies can co- national norms and quality indicators (Bruns et al. 2008; exist with, if not enhance, EBTs by coordinating EBTs and Walker et al. 2011; see www.nwi.pdx.edu) and the pursuit other services and providing follow-on support after such of more rigorous research studies (e.g., Bruns et al. 2014). time-limited interventions have ended (Bruns et al. 2013; Definitional work has also facilitated standardized work- Friedman and Drews 2005). force development approaches, including training and Wraparound, specifically, is a defined, team-based pro- coaching, and has supported increasingly formalized cess for developing and implementing individualized care implementation and performance monitoring infrastructure plans to meet the complex needs of youth with SEBD and on the ground (Walker and Matarese 2011). J Child Fam Stud The evidence base for Wraparound has grown com- conference presentations were excluded as they are not mensurately with its adoption in the field. In 2009, Suter systematically available through online search