Practice Profile: Wraparound Process for Children with Serious Emotional and Behavioral Disorders

Suter and Bruns (2009) analyzed the impact of wraparound programs on youths, aged 3–21, with serious emotional and behavioral disorders (SEBD) and/or significant functional impairment. Those considered to have significant functional impairment included youths who were at risk of out-of-home placements, or were returning from out-of-home placements. To be eligible for inclusion in the meta-analysis, studies had to provide direct comparisons of youths receiving wraparound services with youths in a control group. To be considered a wraparound intervention, the study authors had to specify that the intervention was a wraparound intervention, or had to indicate that the intervention shared the 10 principles of wraparound programs. Community-based interventions that provided services for youths with emotional and behavioral disorders, but did not incorporate the 10 principles of wraparound, were not eligible for inclusion. Similarly, systems-of-care that used related principles of wraparound, but did not include the wraparound process at the family level, were also excluded.

Eligible studies had to use random assignment or quasi-random assignment to the wraparound program. Control conditions could include no intervention, wait-list control, or a treatment as usual (i.e., services that youths would receive if not in the wraparound program). Moreover, studies had to include at least one of the primary outcomes of interest: 1) living situation, 2) mental health, 3) functioning, and 4) assets and resiliency. Living situation focused on the stability of a youth’s residence and whether the youth was living in a less restrictive environment following the intervention. Mental health was measured by a reduction in emotional and behavioral problems, a reduction in emotional and behavioral systems, and a reduction in emotional and behavioral disorders as a result of the intervention. Functioning measured whether the youth had improved functioning in home, school, and community as a result of the intervention. It is important to note that although family functioning is important to the wraparound process, the outcomes had to be youth-specific to be eligible for inclusion in the meta-analysis. Finally, the study had to have been conducted between January 1, 1986, and December 31, 2008, and written in the English language.

A comprehensive literature search yielded seven studies that were eligible for inclusion in the meta-analysis. These seven studies provided 66 outcomes (i.e., 66 effect sizes), which were coded into one of the four outcome domains of interest. This coding strategy resulted in 8 outcomes that were related to living situation, 12 outcomes that were related to mental health, 41 outcomes that were related to functioning (which included both school functioning outcomes and juvenile justice-related outcomes), and 4 outcomes that were related to assets and resiliency. It is important to note that 1 of the 66 outcomes was not coded to a specific category because the outcome was related to all four of the outcome domains. Moreover, the authors noted that the two studies related to the assets and resiliency outcomes did not include enough information to compute effect sizes, which excluded these outcomes from the review.

The included studies were published between 1998 and 2008, with three of the seven studies using a randomized control design. Of the four studies that used quasi-experimental design, three used nonequivalent comparison groups that were not matched, and one used a nonequivalent matched comparison group. Three of the seven studies targeted mental health populations, two targeted child welfare populations, one targeted juvenile justice populations, and one targeted juvenile justice and mental health populations. The included studies had a total sample size of 802 youths, of which 33.57 percent were female. The average age of the sample was approximately 13, and, in studies where it could be determined, 56.95 percent of study participants identified as white, and 23.10 percent identified as African American. In terms of intervention format, all included studies noted that youths and their families were paired with a wraparound facilitator who coordinated and developed the youth’s wraparound plan.

Given the level of diversity in programs included in the meta-analysis, a random effects model was used to account for the heterogeneity across studies. The standardized mean difference, typically referred to as Cohen’s d, was used to calculate the effect and all effects were adjusted using Hedges’ small sample size correction to create unbiased estimates.