Advertisement

Child & Youth Care Forum

, Volume 41, Issue 4, pp 407–425 | Cite as

Outcomes for Youth with Severe Emotional Disturbance: A Repeated Measures Longitudinal Study of a Wraparound Approach of Service Delivery in Systems of Care

  • Kirstin Painter
Original Paper

Abstract

Background

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.

Objective

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.

Methods

Youths were evaluated at intake (baseline) and every 6 months up to 24 months.

Results

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.

Keywords

Children’s mental health Wraparound Systems of care 

References

  1. Achenbach, T. M. (1991a). Manual for youth self-report and 1991 profile. Burlington, VT: University of Vermont, Department of Psychiatry.Google Scholar
  2. 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
  3. Achenbach, T. M., McConaughy, S. H., & Howell, C. T. (1987). Child/adolescent behavioral and emotional problems: Implications of cross-informant correlations for situational specificity. Psychological Bulletin, 101, 213–232.PubMedCrossRefGoogle Scholar
  4. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.Google Scholar
  5. Anderson, J. A., Wright, E. R., Kelley, K., & Koorman, H. (2008). Patterns of clinical functioning over time for young people served in a system of care. Journal of Emotional and Behavioral Disorders, 16(2), 90–104.CrossRefGoogle Scholar
  6. Bickman, L., Smith, C. M., Lambert, E. W., & Andrade, A. R. (2003). Evaluation of a congressionally mandated wraparound demonstration. Journal of Child and Family Studies, 12(2), 135–156.CrossRefGoogle Scholar
  7. 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
  8. 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
  9. 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
  10. 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.
  11. Bruns, E. J., Suter, J. S., Force, M. D., & Burchard, J. D. (2005). Fidelity to the wraparound process and its association with child and family outcomes. Journal of Child and Family Studies, 14, 521–534.CrossRefGoogle Scholar
  12. Bruns, E. J., Suter, J. S., & Levernentz-Brady, K. (2006b). Relations between program and system variables and fidelity to the wraparound process for children and families. Psychiatric Services, 57, 1586–1593.PubMedCrossRefGoogle Scholar
  13. 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.
  14. Bruns, E. J., Walrath, C. M., & Sheehan, A. K. (2007). Who administer wraparound? An examination of the training, beliefs, and implementation supports for wraparound providers. Journal of Emotional and Behavioral Disorders, 15(3), 156–168.CrossRefGoogle Scholar
  15. 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
  16. Burns, B. J., Schoenwald, S. K., Burchard, J. D., Faw, L., & Santos, A. B. (2000). Comprehensive community-based interventions for youth with severe emotional disorders: Multisystemic therapy and the wraparound process. Journal of Child and Family Studies, 9(3), 283–314.CrossRefGoogle Scholar
  17. 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.
  18. Carney, M. M., & Buttell, F. (2003). Reducing juvenile recidivism: Evaluating the wraparound services model. Research on Social Work Practice, 13, 551–568.CrossRefGoogle Scholar
  19. 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
  20. Cohen, J. (1988). Statistical power analysis for the social sciences. Hillsdale, NJ: Erlbauum.Google Scholar
  21. 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
  22. 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
  23. Department of Health and Human Services. (1999). Mental health: A report of the surgeon generalExecutive 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.
  24. 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.
  25. 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
  26. Epstein, M. H. (2004). Behavioral and emotional rating scale second edition (BERS-2). Austin, TX: PRO-ED.inc.Google Scholar
  27. Epstein, M. H., Nordess, P. D., & Hertzog, M. (2002). Wraparound observation form-second version.Google Scholar
  28. Evans, M. E., Armstrong, M. I., & Kuppinger, A. D. (1996). Family-centered intensive case management: A step toward understanding individualized care. Journal of Child and Family Studies, 5, 55–65.CrossRefGoogle Scholar
  29. 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
  30. Furman, R., & Jackson, R. (2002). Wrap-around services: An analysis of community-based mental health services for children. Journal of Child and Adolescent Psychiatric Nursing, 15, 124–131.PubMedCrossRefGoogle Scholar
  31. Graves, K. N., & Shelton, T. L. (2007). Family empowerment as a mediator between family-centered systems of care and changes in child functioning: Identifying an important mechanism of change. Journal of Children and Family Studies, 16, 556–566.CrossRefGoogle Scholar
  32. 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
  33. 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
  34. Hyde, K. L., Burchard, J. D., & Woodworth, K. (1996). Wrapping services in an urban setting. Journal of Child and Family Studies, 5, 67–82.CrossRefGoogle Scholar
  35. 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
  36. 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
  37. Kazdin, A. E., & Weisz, J. R. (1998). Identifying and developing empirically supported child and adolescent treatments. Journal of Consulting and Clinical Psychology, 66(1), 19–36.PubMedCrossRefGoogle Scholar
  38. Knitzer, J. (1982). Unclaimed children. Washington, DC: Children’s Defense Fund.Google Scholar
  39. 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
  40. Mears, S. L., Yaffe, J., & Harris, N. J. (2009). Evaluation of wraparound services for severely emotionally disturbed youths. Research on Social Work Practice, 19, 678–685.CrossRefGoogle Scholar
  41. Myaard, M. J., Crawford, C., Jackson, M., & Ales-si, G. (2000). Applying behavior analysis within the wraparound process: A multiple baseline study. Journal of Emotional & Behavioral Dis-orders, 8, 216–229.CrossRefGoogle Scholar
  42. 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
  43. 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.
  44. Painter, K. P., Allen, J. S., & Perry, B. (2011). Families’ experiences in wraparound: A qualitative study conceived and conducted by families through a professional-family collaboration. Journal of Emotional and Behavioral Disorders, 19, 156–168.CrossRefGoogle Scholar
  45. Painter, K. P., Ghoraishi, M., Patterson, C., Perry, B., & Brown, K. (2009). Final report. SAMHSA/CMHS Grant # SM54497-06. Unpublished report.Google Scholar
  46. Pullmann, M. D., Kerbs, J., Koroloff, N., Veach-White, E., Gaylor, R., & Sieler, D. (2006). Juvenile offenders with mental health needs: Reducing recidivism using wraparound. Crime and Delinquency, 52, 375–397.CrossRefGoogle Scholar
  47. 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
  48. Reynolds, C. R. (2002). Reynolds adolescent depression scale-second edition (RADS- 2) professional manual. Los Angeles, CA: Psychological Assessment Resources.Google Scholar
  49. Reynolds, C. R., & Mazza, J. J. (1998). Reliability and validity of the Reynolds adolescent depression scale with young adolescents. Journal of School Psychology, 36, 295–312.CrossRefGoogle Scholar
  50. 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
  51. Ryngala, D. J., Shields, A. L., & Caruso, J. C. (2005). Reliability generalization of the revised children’s manifest anxiety scale. Educational and Psychological Measurement, 65, 259–271.CrossRefGoogle Scholar
  52. 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
  53. 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
  54. Suter, J. C., & Bruns, E. J. (2009). Effectiveness of the wraparound process for children with emotional and behavioral disorders: A meta-analysis. Clinical Child Family Psychological Review, 12, 336–351. doi: 10.1007/s10567-009-0059-y.CrossRefGoogle Scholar
  55. Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics (4th ed.). Boston, MA: Allyn and Bacon.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.MHMR of Tarrant CountyFort WorthUSA

Personalised recommendations