Wraparound Programs Research Articles

Strengths, Barriers, and Recommendations for a Wraparound Gang Intervention Program Targeting High Risk Youth

ABSTRACT The Wraparound approach aims to prevent and interrupt gang activity by “wrapping” youth with individualized supports to increase prosocial connections and reduce the risks for gang involvement. The current study examines 38 interviews with program staff and external stakeholders to assess implementation strengths and challenges of a Wraparound program in British Columbia, Canada. Thematic analysis resulted in seven strengths-related themes concerning program structure, team, and youth engagement strategies, and seven challenge-related themes regarding youth interactions, resources, and communication. Findings highlight the benefits of an individualized approach, with consideration of enhanced communication and outreach strategies, resource allocation, and case manager training.

Population perinatal substance use and an environmental scan of health services in British Columbia, Canada

BackgroundSubstance use during pregnancy is underreported globally and there is limited data on its prevalence and the availability of supportive services. This study determined population perinatal substance use in British Columbia (BC) by region and examined the availability of clinical and community-based programs. MethodsUsing linked provincial health administrative data, we conducted a population-based retrospective cohort study including all BC residents accessing care for substance use (alcohol, opioids, stimulants, sedatives, and cannabis) within 12 months of first perinatal care record to delivery during 2016–2021. We also conducted an environmental scan to identify all programs offering perinatal care and substance use treatment/support in BC as of December 2022 and described program components by region. ResultsThe population included 12,439 people with perinatal substance use with 13,814 linked livebirths during the study period. The incidence rate of perinatal substance use was nearly eight times higher in rural/remote Northern BC compared to the metropolitan Vancouver Coastal region (1044.2 vs. 131.3 per 100,000 population, respectively). We identified 29 related services (19 wrap-around programs, 8 supportive housing, and only 2 acute care programs). Residents outside of Metro Vancouver accounted for 60 % (N=1745) of people with perinatal substance use; however, these regions represented only 35 % of BC’s specialized acute care and supportive housing beds (N=140). ConclusionsExpanding supports for perinatal substance use - particularly acute care and supportive housing within more rural/remote regions in BC - will be critical to address geographic inequities in access to perinatal care and improve health outcomes for pregnant people who use substances and their infants.

The role of social procurement policies and cross‐sector partnerships in addressing youth unemployment: A construction industry case study from Australia

AbstractIn Australia, 9.4% of young people aged 15–24 are unemployed, more than double the national rate. The national employment services system in Australia has, however, not successfully tackled this issue. While some wraparound programs have been implemented to better address young people's needs, most are designed to find young people any job rather than being tailored towards a specific career. Despite governments encouraging solutions that involve cross‐sector collaboration with private businesses, the potential of industry‐specific solutions has been less well‐explored. Addressing this gap, this paper presents an in‐depth case study of how one major Australian construction company has implemented an industry‐specific collaborative wraparound program to address youth unemployment, called the Connectivity Centre model (CCM). The paper discusses the features of this model that make it distinctive compared to other programs supporting young people's employment. It also discusses how the policy context of social procurement (policies generating social value through procurement processes) and cross‐sector collaboration incentivise the model. The policy implications are explored, highlighting how models like the CCM offer a complementary alternative to other unemployment supports available to young jobseekers in Australia.Points for practitioners Social procurement policies incentivise private companies’ involvement in youth unemployment programs, including utilising their cross‐sector networks. Private companies’ involvement enables youth unemployment programs that reflect the same benefits as wraparound programs in intensive/personalised support while providing more industry specificity. This set of characteristics is unique and complementary within Australia's youth unemployment support landscape.

Predicting Response to Services for Homeless Adolescents and Transition Age Youth (TAY) with Substance Use And/Or Mental Health Disorders: Implications for Youth Treatment and Recovery

ABSTRACT Purpose This paper examines patterns of response to a multi-disciplinary wrap-around program for homeless adolescents and transition-aged youth with substance use and/or mental health disorders. Method A cluster analysis of outcome data from 148 youth was conducted. Results Cluster 1 (n = 67) demonstrated significant decreases in risky behavior (e.g., engaging in unprotected sex, crime, and substance use) and poor interpersonal relationships (e.g. more interaction with family and friends and lower rates of violence) but experienced relatively fewer interactions with family and friends. Cluster 2 (n = 57) demonstrated a significant decrease in poor life functioning (e.g., lower rates of employment/education, better quality of life, and less symptoms of internalizing disorders). Cluster 3 (n = 24) experienced significant increases in risky behavior, poor life functioning, and poor interpersonal relationships. Discussion Clusters 1 and 2 improved over six months of care. Cluster 3 deteriorated despite receiving similar services and used more opioids and stimulants. Conclusions Peer engagement in programs for this population are important. Recommendations for cluster 3 include targeted outreach, medication assisted treatment, and additional research-supported treatments. Further research is needed to test these interventions over longer periods of time.

Food Hubs as a Means to Promote Food Security in Post-Secondary Institutions: A Scoping Review.

An estimated 20 to 50% of post-secondary students experience food insecurity. Students who are food insecure are more likely to have poor health and lower academic performance relative to food secure peers. Food hubs are physical or digital spaces that provide access to food initiatives and wraparound programs such as employment placement or income support are increasingly of interest as a means to respond to food insecurity. We conducted a scoping review to identify best practices and effective approaches to food hubs that promote food security in post-secondary institutions in North America. The Medline, Embase, CAB Direct and Web of Science databases were searched. A total of 4637 articles were identified and screened by two reviewers. Four articles were included. They encompassed a mix of interventions: a campus pantry and garden, a food rescue program, food literacy-based curriculum and a toolkit to support implementation of interventions on campus. The heterogeneity of studies precluded identification of best practices, but positive impacts of all interventions were noted on metrics such as self-efficacy and greater awareness of food insecurity. The gap in evidence on effective approaches that promote campus food security is a critical barrier to development and implementation of interventions, and should be addressed in future studies.

Education-Centred Formal Wraparound Services in Support of School-Aged Students With Complex Support Needs: A Systematic Review

AbstractThe aim of this systematic review was to map the peer-reviewed literature (2009–2019) relating to school involvement with wraparound models in the support of students with complex needs. Specific research questions addressed explored the evidence base of the efficacy of wraparound with these students and barriers and enablers in the provision of wraparound services. Database searches were conducted and a total of 50 articles were identified. The analysis revealed eight different aspects of wraparound efficacy, with mixed results. Nine factors were identified as having a positive enabling, or disabling, effect on the provision of effective wraparound services. The wraparound programs were varied in their nature and in their successful implementation, with time to allow the program to mature and adherence to the 10 principles of the wraparound process emerging as enabling factors for wraparound success.

Cost and Utilization Impacts of a Medicaid Managed Care Organization's Behavioral Health Wraparound Program.

Wraparound programs that provide comprehensive evidence-based outpatient treatment, transportation, social services, and housing supports have shown promise for improving clinical behavioral health-related outcomes to reduce the need for institutionalized care; however, the majority of evidence is based on wraparound programs for children. This study examined the impact of a wraparound program for adult Medicaid managed care organization members with serious mental health or substance use disorders on health care costs and utilization. This retrospective observational study used 2013-2018 claims data collected from a large Medicaid managed care organization operating in multiple states. We used an intention-to-treat difference-in-difference study design to examine the association of the wraparound with costs and utilization. Adult Medicaid members with an emergency department (ED) or inpatient visit for a behavioral health condition (index visit) were eligible for the study. Outcomes included all-cause and behavioral health-related costs and utilization during follow-up after the index visit's admission date. Outcomes were calculated overall, as well as separately by inpatient, ED, and outpatient/wraparound settings. We found that during the first post-admission month, the wraparound program was associated with 27.6 percentage points (PP) and 27.2 PP reductions in the number of behavioral health-related inpatient nights and costs, respectively. However, during subsequent months (median follow-up ranging from 7 to 10months) there were no associations with per-member-per-month total all-cause or behavioral health-related costs. Nonetheless, the wraparound program was associated with 12.3 PP reduction in all-cause cost during the entire study period among a subset of members who were high cost at the baseline. Reduced hospital utilization and costs during the first month of wraparound services were fully counteracted by outpatient, housing, and other wraparound services costs during the following months. This indicates the importance of proper payment arrangements with value-based contracting or performance targets with wraparound services providers to align the objective of reducing inpatient use. Future wraparound programs may consider a more focused recruitment from high-cost members with complex care needs. However, our estimates were conservative given that it's from a single Medicaid managed care organization's perspective and some benefit from investing in addressing social needs may be realized in longer term (beyond our study period). States' Medicaid programs may consider the longer-term cost and broader, societal benefit of wraparound investment.

552-P: Impact of Stakeholder Engagement in Pediatric Type 1 Diabetes (T1D): Experience from the T1D High-Fidelity Wraparound Program (HFWP)

Despite recent advances, management of pediatric T1D remains extremely challenging, in part due to psychological distress and poor adherence to recommendations. The HFWP aims to adapt and test an innovative strategy, used in behavioral health, to improve self-management and self-efficacy in high-risk youth with T1D. Stakeholder engagement, with the integration of patient, family and community/system partners into the research team, is increasingly recognized as a critical component of patient-centered research. We describe the process and outcomes of stakeholder engagement to inform T1D HFWP research activities and resources. A total of 21 stakeholders, representing family, youth and community/systems partners (e.g., ADA, JDRF, Health Plan), were selected through a rigorous application process and participated in monthly meetings for 13 months. Measures of satisfaction with processes and experience were obtained via an anonymous survey completed after every meeting. On average, 70% consistently answered the survey over 13 months. Stakeholders strongly agreed that the meetings met their expectations (4.75/5), objectives were identified and followed (4.5/5), their voices were heard (4.64/5) and the Advisory Board was effectively molding the T1D HFWP (4.75/5). The majority (~70%) were satisfied with meeting frequency and duration. The Advisory Board proposed important outcome measures which were adopted, including evaluation of anxiety and distress in youth and caregivers. Concrete areas of need were identified, leading to systematic development of tools, including a guide for families to vet online T1D resources and design of a practical, patient-centered form outlining a medical summary for families (e.g., insurance, type of devices used, phone numbers, etc.). This experience illustrates the willingness and importance of partnering with stakeholders to help shape resources and programs in pediatric T1D intervention research. Disclosure A. G. Nevin: None. C. March: None. L. Jones: None. J. Schreiber: None. I. Libman: Advisory Panel; Self; Novo Nordisk. Funding Children’s Hospital of Pittsburgh Foundation

The Enhanced Critical Incident Technique Investigation of Girls’ Perceptions of Prosocial Connectedness in a Wraparound Program

Women and girls are being implicated in gang-related operations at alarming rates. Anti-social gang behaviours such as drug trafficking, sexual exploitation, gun violence, and street entrenchment are of particular concern. British Columbia has seen a rise in gang-associated violence and homicide directed at or involving women over the last decade. Positive youth development initiatives such as the one in this study aim to support youth currently involved in or at risk of being involved in gangs. School personnel identify students who are exposed to anti-social gang behaviours and refer them to a wraparound program where they are matched with an adult mentor who works with them and their families to facilitate prosocial connections to five life domains: (a) school, (b) community, (c) home, (d) prosocial peers, and (e) the self. A 2012 evaluation report determined the program to be effective in reaching its objectives with a predominantly male population (84%). However, between 2015 and 2016, the program dramatically increased its responsiveness to girls, with a nearly 50% increase in female referrals. Using the enhanced critical incident technique (ECIT), the purpose of the study was to describe how female-identifying students articulate “prosocial connectedness” within the context of their experiences in a school-based wraparound gang prevention program. Critical incidents were collected by the first author, who interviewed eight girls and asked them the following: “What has helped/hindered/would have better helped facilitate your prosocial connectedness?” Findings were organized into 34 categories. ECIT analyses point to the effectiveness of using a relational/attachment model to inform strategies for gang prevention and school-based intervention in female youth.

Wraparound: A Key Component of School-Wide Culture Competence to Support Academics and Socio-Emotional Well-Being

ABSTRACTThis article reviews research on “wraparound” or “community schools” models by discussing the benefits, current educational needs, and measures of success for the models. It examines research on learner outcomes related to the program models in areas of students’ academic achievement and finds generally positive outcomes on a variety of variables associated with wraparound programs. The application of wraparound strategies is described via examples of local, statewide, and national initiatives. These programs suggest wraparound services can improve the school’s effectiveness in serving students with, or at risk of, academic, emotional, and behavioral challenges. The conclusions propose the need for government officials, schools, and systems to consider programs that offer wraparound services.

Randomized Control Trial Findings of a Wraparound Program for Dually Involved Youth

Wraparound care coordination for youth with serious emotional and behavioral challenges has been implemented in every state and in many child-serving contexts, but evidence from rigorous effectiveness studies is scarce. We conducted a 20-month longitudinal randomized control trial of a pilot Wraparound program for youth in foster care and involved in the juvenile justice system ( n = 24), comparing outcomes with youth receiving community “treatment as usual” (TAU; n = 23). Youth in both groups experienced significantly improved outcomes, including fewer arrests and greater residential stability. Wraparound youth were less likely to be rearrested (odds ratio [OR] = 0.59, 95% confidence interval [CI] = [0.17, 2.04]), and survival analysis found they went longer before doing so than TAU youth. Wraparound youth were also more likely to be educationally on track than TAU youth by the end of the study (OR = 4.09, 95% CI = [1.89, 18.72]). Although these findings were nonsignificant at p < .05 due to small sample sizes, effect sizes were medium to large, and no such trends were found for the TAU group. Implications for Wraparound’s implementation and effectiveness, as well as the strengths and limitations of conducting a randomized control trial in “real-world” systems, are discussed.

Spotlight on Caroline Families First Wraparound Program: Lessons for Advancing Collaborative Family-Centred Care for Complex Child and Youth Mental Health

The Caroline Families First Wraparound Program operationalizes cross-sectoral collaboration and planning, family peer support, and family-directed care consistent with strategic directions within the Mental Health Strategy for Canada. In this spotlight article, we present findings from a case study that describes what makes the program work, the barriers and facilitators to its success, and draw conclusions about the lessons learned. For example, while family-directed care is a core and essential value of the program, unless well understood, it can create tensions within teams. Similarly, structural factors such as provider reimbursement can inhibit physician involvement. Suggestions about these and other contextual factors can inform other efforts to mobilize the Mental Health Strategy.

Impacts of a Medicaid Wraparound Model Demonstration Program on Youth Specialty Mental Health Services Use.

Effective coordination of mental health care is critical in Medicaid wraparound model programs for youth. This study examined participation over time in mental health services for youth diverted or transitioned from residential care to a Medicaid wraparound demonstration program. Youth in wraparound had more sustained use of mental health outpatient clinic services than did propensity score matched youth who were not in wraparound. However, the rate of outpatient clinic follow-up after inpatient discharge was no greater in wraparound. Routine assessment of wraparound programs' impacts on receipt of mental health care may inform the development of Medicaid wraparound program performance standards.

Expenditures and use of wraparound health insurance for employed people with disabilities

BackgroundThe Affordable Care Act (ACA) provides health insurance to many working-age adults with disabilities, but we do not expect the new coverage or existing insurance options to fully meet their employment-related health care needs. Wraparound services have the potential to foster employment among people with disabilities. ObjectiveWe use Massachusetts, which implemented health care reform in 2006, as a case study to estimate the wraparound health care expenditures and use for workers with disabilities. MethodsWe identified a group of employed, working-age people with disabilities whose primary health insurance is Medicare or private insurance and who use the Medicaid Buy-In Program for wraparound coverage. We analyzed claims to estimate expenditures and use. ResultsWraparound expenditures averaged $427 per member per month. Community-based services for both mental and non-mental health, which are generally not covered by Medicare or private insurance, accounted for 63% of all expenditures. The number who used community-based services was low, but the expenditures were high. The majority of the remaining expenditures were for services usually covered by primary insurance including: inpatient and outpatient, pharmacy and professional services. Expenditures were higher for people with Medicare compared to private insurance. ConclusionsThis case study suggests that, from a total program cost perspective, wraparound demand is greatest for community-based services. From a member utilization perspective, the demand is greatest for coverage that alleviates out-of-pocket costs for services provided by primary insurance. Additional analysis is needed to further assess the design options for wraparound programs and their feasibility.

Employment-Related Health Insurance and Service Delivery Needs of Persons With Disabilities

The health care reforms underway in the United States will benefit persons with disabilities; however, the reforms may not fully support the employment-related needs of persons with disabilities. Secondary health insurance to wrap around primary coverage may be a viable policy solution to meet the needs. This article identifies and examines the employment-related health insurance, health care, and service delivery needs of employed and potentially employed persons with disabilities. We conducted six focus groups with 54 working-age, insured, employed, and potentially employed persons with disabilities in Massachusetts. Participants reported unmet needs, high out-of-pocket costs, or a burden to manage their health care, disability, and employment. The needs included services currently limited by insurance plans, long-term services and supports, other disability services, care coordination, and cost protections. The data suggest that the combined needs are highest for persons working full-time or near full-time, and the unmet needs are lower for persons with Medicaid secondary coverage. The results suggest that full-time or near full-time workers are an important subgroup for wrap-around coverage; such coverage could potentially alleviate costs and increase work incentives among this subgroup. Additional research is needed to quantify the needs and to assess the design options for a wrap-around program.

Effect of Demographic Variables on Children and Adolescent Functional Assessment Scale (CAFAS) Scores

The Michigan Wraparound Evaluat ion Program provides children/yout h wit h comprehensive prevent ion, direct services, indirect services, and access t o community -based services and support s. A t wo -level Hierarchical Linear Model was conduct ed over 11 count ies and 335 children/youth bet ween ages 6 and 18 to underst and the relat ionship bet ween Child and Adolescent Funct ional Assessment Scale (CAFA S) score at the init ial t ime of enrollment in t he Wraparound Program and t he demographic variables such as a ge, gen der, race, geographic locat ion of children/yout h. There was no significant relat ionship bet ween t he CAFAS score and demographic variables, suggest ing t hat a unified programming model may be possible across all count ies.

Development and Validation of a Wraparound Parent Partner Fidelity Tool

Parent partners are parents or caregivers such as foster parents who have had success in dealing with a difficult child in a child welfare, mental health, or probation system and who become key players on Wraparound teams for families with youths with emotional or behavioral disabilities who are in out-of-home care. Although many studies have been conducted on the Wraparound model, none of them have described the parent partner's role and fidelity to the model. The Parent Partner Fidelity Tool (PPFT) was developed to address this gap in Wraparound research; it is the first tool designed to measure parent partner adherence to the Wraparound model and identify parent partner training and support needs. The 28-item PPFT captures parent partner activities related to the four Wraparound phases designated by the National Wraparound Initiative: engagement, planning, implementation, and transition. Similar PPFT versions are completed by Wraparound facilitators, parent partners, and parents/caregivers to provide multiple perspectives on the parent partner's work. The PPFT pilot testing project was conducted with 14 California Wraparound programs. Analyses of the 585 responses showed good reliability and validity for the PPFT, indicating that it is a psychometrically sound tool.

Behavioral Health and Social Correlates of Reincarceration Among Hispanic, Native American, and White Rural Women

To identify community reentry needs, this study examined mental illness, substance dependence, and other correlates of reincarceration in an ethnically diverse, rural population of women prisoners. A purposive, cross-sectional sample of 98 women in a New Mexico state prison completed structured interviews. Analyses examined associations of substance dependence, mental illness, lifetime trauma, and sociodemographic variables with previous incarceration. Eighty-five percent screened positive for substance dependence, 50% for current mental disorders, and 46% for both. Exposure to trauma was pervasive (100%), especially physical or sexual trauma (83%). In adjusted analyses, previous incarceration was associated with precarious housing before imprisonment (odds ratio [OR]=2.19, p=.038) and with having co-occurring mental illness and substance dependence (OR=2.68, p=.019). Findings support those of similar studies in urban areas and with other ethnic groups. Wraparound programs focusing on harm reduction, housing, and treatment and support services are needed for successful reentry of these underserved women.

Does team-based planning "work" for adolescents? Findings from studies of wraparound.

This article focuses on wraparound as an example of a team planning process, and uses data from several sources to reflect on questions about whether-and under what conditions-collaborative teams are successful in engaging young people-and their caregivers-in planning. We used data collected in three studies to address our research questions. The first data set comes from a study on wraparound service planning in Nevada. We examined data collected from 23 matched pairs of caregivers and youth at 6 months after wraparound planning began. Our second data set came from a national study of 41 local wraparound programs throughout the United States. Our analyses use data from 366 matched pairs of caregivers/youth. The third dataset comes from the pilot test of the Achieve My Plan! intervention. Data was gathered from eight teams before and after the intervention was implemented. Taken together, the findings suggest that teams' success in managing caregiver and adolescent perspectives simultaneously during care and treatment planning is more strongly related to the quality of the team process than to youth age. Through attention to youth engagement, preparation, and tem process, it appears possible to increase meaningful youth participation in planning without sacrificing caregiver satisfaction with the team experience.

Using a Theory of Change to Drive Human Resource Development for Wraparound

Achieving coherence and integration across staff professional development activities is facilitated when training, coaching and staff evaluation are guided by a clearly articulated program theory or “theory of change” that describes how skillful practice promotes desired outcomes. We focus on a theory of change for wraparound, a widely implemented approach to providing community-based care for children with high levels of mental health and related needs. Training, coaching and staff evaluation efforts within wraparound programs have typically been linked only very loosely to theory. We argue that wraparound’s unique history allowed it to evolve with limited theoretical grounding, and we then describe a theory of change for wraparound, focusing on the major causal routes that are hypothesized to lead to outcomes. Finally, we provide an extended illustration of how the theory can provide the basis for a coherent and integrated approach to developing the skills and capacities of staff members playing key roles in wraparound implementation.