Outcomes for Youth with Severe Emotional Disturbance: A Repeated Measures Longitudinal Study of a Wraparound Approach of Service Delivery in Systems of Care
- 836 Downloads
Systems of care is a family centered, strengths-based service delivery model for treating youth experiencing a serious emotional disturbance. Wraparound is the most common method of service delivery adopted by states and communities as a way to adhere to systems of care philosophy.
The purpose of this study was to evaluate outcomes for children ages 5–18 experiencing serious emotional disturbances who received wraparound in a systems of care community funded through a 6-year federal grant from the Substance Abuse and Mental Health Services Administration, Grant # SM54497-06. This study evaluated the following hypotheses. (1) Youths diagnosed with a SED participating in wraparound services will experience improved mental health symptoms, improved functioning, and improved behavioral and emotional strengths. (2) Caregivers of youths diagnosed with a serious emotional disturbance participating in wraparound services will experience decreased levels of caregiver strain.
Youths were evaluated at intake (baseline) and every 6 months up to 24 months.
All of the caregiver completed measurement instruments showed statistical and clinical levels of improvement in youth behavioral and emotional strengths, mental health symptoms, and caregiver stress by the 6-month data collection point that was sustained through 24-month. Youths rated themselves as having fewer problems than the ratings given by caregivers at intake. Changes across the youth rated instruments did not show significant improvement until the 12 or 18-month data points. The findings of this study are overall favorable for using a wraparound service delivery model in systems of care for youth experiencing a SED.
KeywordsChildren’s mental health Wraparound Systems of care
- Achenbach, T. M. (1991a). Manual for youth self-report and 1991 profile. Burlington, VT: University of Vermont, Department of Psychiatry.Google Scholar
- Achenbach, T. M. (1991b). Manual for the child behavior checklist/4–18 and 1991 profile. Burlington, VT: University of Vermont, Department of Psychiatry.Google Scholar
- American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.Google Scholar
- Bird, H. R., Shaffer D., Fisher P., Gould M. S., Staghezza, B., Chen, J. Y., et al. (1993). The Columbia impairment scale (CIS): Pilot findings on a measure of global impairment for children and adolescents. International Journal of Methods in Psychiatric Research, 3(3), 167–176.Google Scholar
- Brannan, A. M., Heflinger, C. A., & Bickman, L. (1997). The caregiver strain questionnaire: Measuring the impact on the family of living with a child with serious emotional disturbance. Journal of Emotional and Behavioral Disorders, 5(4), 212–222. doi: 10.1177/106342669700500404.CrossRefGoogle Scholar
- Bruns, E. J., Rast, J., Peterson, C., Walker, J., & Bosworth, J. (2006a). Spreadsheets, service providers, and the statehouse: Using data and the wraparound process to reform systems for children and families. American Journal of Community Psychology, 38, 201–212. doi: 10.1007/s10464-006-9074-z.PubMedCrossRefGoogle Scholar
- Bruns, E. J., & Suter, J. C. (2010). Summary of the wraparound evidence-base. In E. J. Bruns & J. S. Walker (Eds.), The resource guide to wraparound. Portland, OR: National Wraparound Initiative. www.nwi.pdx.edu/…/Chapters/Bruns-3.5-(evidence-base).pdf.
- Bruns, E. J., Suter, J. S., Rast, J., Walker, J. S. & Zabel M. (2006c). Wraparound fidelity index, version 4. Results of an initial pilot test. National Wraparound Initiative & Systems of Care. Presentation, retrieved from the web August 3, 2010 from: http://depts.washington.edu/wrapeval/docs/FINAL_WFI4poster.ppt.
- Burns, B. J., Goldman, S. K., Faw, L., & Burchard, J. D. (1999). The wraparound evidence base. In B. J. Burns & S. K. Goldman (Eds.), Promising practices in wraparound for children with severe emotional disorders and their families (pp. 77–95). Rockville, MD: Center for Mental Health Services. Child, Adolescent, and Family Branch.Google Scholar
- Bureau of Mental Health & Substance Abuse Services. (2011). Bureau of Mental Health & Substance Abuse Services Definition of severe emotional disturbance (SED) as cited by the cooperative educational Service Agency 6. Retrieved August 20, 2011 from http://www.cesa6.k12.wi.us/products_services/individyouthservices/seddefinition.cfm.
- Clark, H. B., Prange, M. E., Lee, B., Steinhardt, S. E., Barrett McDonald, B., & Boyd, L. A. (1998). An individualized wraparound process for children in Foster Care with emotional/behavioral disturbances: Follow-up findings and implications from a controlled study. In M. H. Epstein, K. Kutash, & A. Duchnowski (Eds.), Outcomes for children and youth with behavioral and emotional disorders and their families: Programs and evaluations best practices (pp. 513–542). Austin, TX: Pro-Ed.Google Scholar
- Cohen, J. (1988). Statistical power analysis for the social sciences. Hillsdale, NJ: Erlbauum.Google Scholar
- Copp, H. L., Bordnick, P. S., Traylor, A. C., & Thyer, B. A. (2007). Evaluating wraparound services for seriously emotionally disturbed youth: Pilot study outcomes in Georgia. Adolescence, 42, 2007.Google Scholar
- Crusto, C. A., Lowell, D. I., Paulicin, B., Reynolds, J., Feinn, R., Friedman, S. R., et al. (2008). Evaluation of a wraparound process for children exposed to family violence. Best Practices in Mental Health, 4, 1–18.Google Scholar
- Department of Health and Human Services. (1999). Mental health: A report of the surgeon general—Executive summary. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health,.http://www.surgeongeneral.gov/library/mentalhealth/summary.html.
- Department of Health and Human Services. (2009). Substance abuse and mental health services administration: Justification of estimates for appropriations committees. Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health, http://www.samhsa.gov/Budget/FY2009/SAMHSA_CJ2009.pdf.
- Eber, L., Breen, K., Rose, J., Unizycki, R. M., & London, T. H. (2008). Wraparound as a tertiary level intervention for students with complex emotional/behavioral needs and their families and teachers. Teaching Exceptional Children, 40(6), 16–22.Google Scholar
- Epstein, M. H. (2004). Behavioral and emotional rating scale second edition (BERS-2). Austin, TX: PRO-ED.inc.Google Scholar
- Epstein, M. H., Nordess, P. D., & Hertzog, M. (2002). Wraparound observation form-second version.Google Scholar
- Evans, M., Armstrong, M. I., Kuppinger, A. D., Huz, S., & Johnson, S. (1998). A randomized trial of family-centered intensive case management and family-based treatment: Outcomes of two community-based programs for children with serious emotional disturbance. Research report. Tampa, FL: College of Nursing.Google Scholar
- Heflinger, C. A., Northrup, D. A., Sonnichsen, S. E., & Brannan, A. M. (1998). Including a family focus in research on community-based services for children with serious emotional disturbance: Experience from the Fort Bragg Evaluation Project. In M. H. Epstein, K. Kutash, & A. Duchnowski (Eds.), Outcomes for children with and youth with behavioral and emotional disorders: Programs and evaluation best practices (pp. 261–293). Austin, TX: Pro-Ed.Google Scholar
- Henggeler, S. W., Schoenwald, S. K., Borduin, C. M., Rowland, M. D., & Cunningham, P. B. (1998). Multisystemic treatment of antisocial behavior in children and adolescents. New York: Guilford.Google Scholar
- Hyde, K. L., Woodworth, K., Jordan, K., & Burchard, J. D. (1995). Wrapping services in an urban setting: Outcomes of service reform in Baltimore. In C. J. Liberton, K. Kutash & R. M. Friedman (Eds.), The 7th Annual Research Conference Proceedings, A System of Care for Children’s Mental Health: Expanding the Research Base (pp. 255–260). Tampa, FL: University of South Florida, Florida Mental Health Institute, Research and Training Center for Children’s Mental Health.Google Scholar
- Institute of Medicine. (2009). In M. E. O’Connell, T. Boat, & K. E. Warner (Eds.), Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities. Washington, DC: The National Academies Press.Google Scholar
- Knitzer, J. (1982). Unclaimed children. Washington, DC: Children’s Defense Fund.Google Scholar
- McConaughy, S. H., Mattison, R. E., & Peterson, R. L. (1994). Behavioral/emotional problems of children with serious emotional disturbances and learning disabilities. School Psychology Review, 23, 77–94.Google Scholar
- New Freedom Commission on Mental Health. (2003). Achieving the promise: Transforming mental health care in America. Final report. DHHS Publication No. SMA-03-3832. Rockville, MD.Google Scholar
- Nordness, P. D., & Epstein, M. H. (2003). Reliability of the wraparound observation form second version: An instrument designed to assess the fidelity of the wraparound approach. Mental Health Services Research, 5(2), 89–96. Available from www.ncbi.nlm.nih.gov.
- Painter, K. P., Ghoraishi, M., Patterson, C., Perry, B., & Brown, K. (2009). Final report. SAMHSA/CMHS Grant # SM54497-06. Unpublished report.Google Scholar
- Rauso, M., Ly, T. M., Lee, M. H., & Jarosz, C. J. (2009). Improving outcomes for foster care youth with complex emotional and behavioral needs: A comparison of outcomes for wraparound vs. residential care in Los Angeles County. Emotional & Behavioral Disorders in Youth, 9, 63–68.Google Scholar
- Reynolds, C. R. (2002). Reynolds adolescent depression scale-second edition (RADS- 2) professional manual. Los Angeles, CA: Psychological Assessment Resources.Google Scholar
- Reynolds, C. R., & Richmand, B. O. (2008). Revised children’s manifest anxiety scale: 2nd edition (RCMAS-2) manual. Los Angeles, CA: Western Psychological Services.Google Scholar
- Stambaugh, L. F., Mustillo, S. A., Burns, B. J., Stephens, R. L., Baxter, B., Edwards, D., et al. (2007). Outcomes from wraparound and multisystemic therapy in a center for mental health services system-of-care demonstration site. Journal of Emotional and Behavioral Disorders, 15, 143–155.CrossRefGoogle Scholar
- Stroul, B., & Friedman, R. (1996). The system of care concept and philosophy. In B. Stroul (Ed.) Children’s mental health: Creating systems of care in a changing society (pp. 1–22). Baltimore, MD: Paul H. Brookes Publishing Company.Google Scholar
- Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics (4th ed.). Boston, MA: Allyn and Bacon.Google Scholar