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Influences of Inner and Outer Settings on Wraparound Implementation Outcomes

April 28, 2021

~ Press release for “Influences of Inner and Outer Settings on Wraparound Implementation Outcomes” – Article published in Global Implementation Research and Applications ~

Wraparound care coordination has been implemented throughout the United States to help support youth with serious emotional and behavioral needs and their families. A recent meta-analysis of 17 controlled studies found that young people who participate in Wraparound are more likely to stay in their homes and communities, and they experience better outcomes in the areas of mental health symptoms, mental health functioning, and school functioning when compared to youth receiving traditional mental health services.

With Wraparound now clearly recognized as a research-based strategy, states and jurisdictions need guidance on how to optimally support high-quality implementation via policy and funding strategies. A new study by a team of researchers at the University of Washington Department of Psychiatry and Behavioral Sciences has identified several conditions that can help promote high quality implementation of Wraparound. Using data drawn from a sample of more than 1000 Wraparound providers from 9 states, a team led by Jonathan Olson, Ph.D., a Research Scientist at the University of Washington Department of Psychiatry, examined the influence of specific policies, administrative structures, and characteristics of provider organizations on the quality of Wraparound implementation.

The study, published in Global Implementation Research and Applications, found that implementation was consistently better when Wraparound was administered through Care Management Entities (CMEs) as compared to more traditional Community Mental Health Centers (CMHCs). Not only do CMEs employ practitioners that specialize in care coordination, states that invest in CMEs typically provide them with more flexible financing arrangements (such as case rates) and allow them to contract with a wide array of providers to allow for a more diverse array of services for the youth and families enrolled in Wraparound.

The study found that care coordinators employed by CMEs demonstrated better implementation outcomes, such as higher levels of skill in the Wraparound model and more Wraparound-related professional development trainings, compared to CMHC-employed care coordinators. States using CMEs also were able to get to full implementation of Wraparound faster than states using CMHCs to provide Wraparound.

“These findings are not entirely surprising given that CME structures allow for greater flexibility and coordination of care,” said Olson. “They are specifically designed to engage multiple systems to support youth by offering a more flexible case rate, employing providers who specialize in care coordination, and creating processes that promote individualized care for young people and their families.”

The findings of this study have important implications for organizations interested in implementing Wraparound. “One obvious implication of this research is that those interested in implementing Wraparound would be well-served by employing CME structures,” said Eric Bruns, Ph.D., Professor of Psychiatry and senior author on the research team. “However, since state policy can be very difficult to change, states could also seek to emulate characteristics of CMEs. For example, more traditional mental health provider organizations could establish dedicated care coordination units with specialized supervision, be reimbursed via case rates to allow flexibility, and work with other agencies to diversify the service array available to these families, rather than just refer to services provided by their organization.”

Download the Journal Article

In the coming months, the research team plans to examine additional data related to the characteristics of CME and CMHC structures with the goal of clarifying the exact processes that either promote or inhibit successful implementation of Wraparound processes. According to Olson, “The current findings really underscore the importance of both policy-level and organization-level influences on Wraparound implementation. Our next step is to better define these influences and study how they interact to promote high quality care for these high-needs youth and families.”

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