Since the term was first coined in the 1980s, "Wraparound" has been defined in different ways. It has been described as a philosophy, an approach, and a service. In recent years, Wraparound has been most commonly conceived of as an intensive, individualized care planning and management process. Wraparound is not a treatment perse. The Wraparound process aims to achieve positive outcomes by providing a structured, creative and individualized team planning process that, compared to traditional treatment planning, results in plans that are more effective and more relevant to the child and family. Additionally, Wraparound plans are more holistic than traditional care plans in that they are designed to meet the identified needs of caregivers and siblings and to address a range of life areas. Through the team-based planning and implementation process – as well as availability of research-based interventions that can address priority needs of youth and caregivers; Wraparound also aims to develop the problem-solving skills, coping skills, and self-efficacy of the young people and family members. Finally, there is an emphasis on integrating the youth into the community and building the family’s social support network.
The values of Wraparound, as expressed in its core principles, are fully consistent with the system of care framework. Wraparound’s philosophy of care begins from the principle of "voice and choice," which stipulates that the perspectives of the family – including the child or youth – must be given primary importance during all phases and activities of Wraparound. The values associated with Wraparound further require that the planning process itself, as well as the services and supports provided, should be individualized, family driven, culturally competent, and community based. Additionally, the Wraparound process should increase the "natural support" available to a family by strengthening interpersonal relationships and utilizing other resources that are available in the family’s network of social and community relationships. Finally, the Wraparound process should be "strengths based," including activities that purposefully help the child and family to recognize, utilize, and build talents, assets, and positive capacities.
WHAT TAKES PLACE DURING THE WRAPAROUND PROCESS?
Wraparound is commonly described as taking place across four phases of effort: Engagement and team preparation, Initial plan development, Implementation, and Transition. During the Wraparound process, a team of people who are relevant to the life of the child or youth (e.g., family members, members of the family’s social support network, service providers, and agency representatives) collaboratively develop an individualized plan of care, implement this plan, monitor the efficacy of the plan, and work towards success over time. A hallmark of the Wraparound process is that it is driven by the perspectives of the family and the child or youth. The plan should reflect their goals and their ideas about what sorts of service and support strategies are most likely to be helpful to them in reaching their goals. The Wraparound plan typically includes formal services, including research-based interventions as appropriate to build skills and meet youth and family needs, together with community services and interpersonal support and assistance provided by friends, kin, and other people drawn from the family’s social networks. After the initial plan is developed, the team continues to meet often enough to monitor progress, which it does by measuring the plan’s components against the indicators of success selected by the team. Plan components, interventions and strategies are revised when the team determines that they are not working, i.e., when the relevant indicators of success are not being achieved.
WHAT ARE THE IMPLEMENTATION REQUIREMENTS FOR WRAPAROUND?
Providing comprehensive care through the Wraparound process requires a high degree of collaboration and coordination among the child- and family-serving agencies and organizations in a community. These agencies and organizations need to work together to provide access to flexible resources and a well-developed array of services and supports in the community. In addition other community- or system-level supports are necessary for Wraparound to be successfully implemented and sustained. Research on Wraparound implementation has defined these essential community and system supports for Wraparound, and grouped them into six themes:
- Community partnership: Representatives of key stakeholder groups, including families, young people, agencies, providers, and community representatives have joined together in a collaborative effort to plan, implement and oversee Wraparound as a community process.
- Collaborative action: Stakeholders involved in the Wraparound effort work together to take steps to translate the Wraparound philosophy into concrete policies, practices and achievements that work across systems.
- Fiscal policies and sustainability: The community has developed fiscal strategies to support and sustain Wraparound and to better meet the needs of children and youth participating in Wraparound.
- Access to needed supports and services: The community has developed mechanisms for ensuring access to the Wraparound process as well as to the services and supports that Wraparound teams need to fully implement their plans, including evidence-based interventions.
- Human resource development and support: The system supports Wraparound staff and partner agency staff to fully implement the Wraparound model and to provide relevant and transparent information to families and their extended networks about effective participation in Wraparound.
- Accountability. The community implements mechanisms to monitor Wraparound fidelity, service quality, and outcomes, and to oversee the quality and development of the overall Wraparound effort.
WHAT SPECIALIZED STAFF ROLES ARE NEEDED FOR THE WRAPAROUND PROCESS WITH FAMILIES?
Wraparound is intended to be a way of supporting individuals with a range of complex needs in any community. In addition, Wraparound is individualized to meet the needs of each youth and family who participates. Thus, across Wraparound programs, people in a variety of different roles – both professional and non-professional – play important roles in carrying out the Wraparound process with families and their children. Most typically, implementing a Wraparound project requires a cadre of individuals who are trained and supported to effectively lead the process. These individuals are most commonly Wraparound facilitators (or care coordinators), family support partners, and youth support partners. In addition, other types of professionals may play important roles in carrying out the Wraparound process in a community. These professionals include clinicians trained on research-based practices to address psychosocial needs, in-home behavioral support specialists, resource coordinators, and others.
IS WRAPAROUND EVIDENCE-BASED? WHAT IS THE RESEARCH?
The Wraparound process has been implemented widely across the United States and internationally for several reasons, including its documented success in promoting shifts from residential treatment and inpatient options to community-based care (and associated cost savings); its alignment with the value base for systems of care; and its resonance with families and family advocates. Wraparound has been included in Surgeon General’s reports on both Children’s Mental Health and Youth Violence, mandated for use in several federal grant programs, and presented by leading researchers as a mechanism for improving the uptake of evidence-based practices.
Continued expansion of the Wraparound research base has provided additional support for continued investment in Wraparound. To date, results of 10-12 (depending on criteria used) controlled (experimental and quasi-experimental) studies have been published in the peer-reviewed literature. A meta-analysis of seven of these studies was published showing consistent and significant outcomes in favor of the Wraparound group compared to control groups across a wide range of outcomes domains, including residential placement, mental health outcomes, school success, and juvenile justice recidivism.1 The overall effect size found in this meta-analysis was found to be between .33 – .40, about the same as was found in a recent meta-analysis of children’s mental health evidence-based treatments.
Thus, though Wraparound has typically been described as a "promising" intervention, there has been consistent documentation of the model’s ability to impact residential placement and other outcomes for youth with complex needs. As a result, Wraparound is now listed as "research-based" on several major inventories of child and family interventions and strategies, including that of the influential Washington State Institute for Public Policy. The research base for Wraparound continues to expand and, as a result, Wraparound is likely to be more consistently referenced as an "evidence-based" model in the years to come.
A cautionary note from the research is warranted, however, While most studies have found Wraparound to be associated with positive residential, functioning, and cost outcomes, two recent studies found Wraparound to result in positive outcomes for families, but outcomes that were no better than "services as usual" in their systems. These two studies shared one major thing in common – both found Wraparound fidelity to be far below recommended norms and implementation quality overall to be poor. Rather than be ignored as outliers, such research underscores the importance of attending to system and program factors, and maintaining a focus on fidelity of implementation, as is described by the materials on the NWI website and promoted by the training and TA of NWIC. (For more on this recent research, see the new chapter in the Resource Guide to Wraparound.)
The information on this page has been peer reviewed through the NWI. http://nwi.pdx.edu/
Suter, J.C. & Bruns, E.J. (2009). Effects of Wraparound from a meta-analysis of controlled studies. Clinical Child and Family Psychology Review, 12, 336-351.