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Attell BK, Singleton AC, McLaren SA, Moses G. Measurement Characteristics of the Wraparound Fidelity Index Short Form: Results from a Statewide Implementation. Eval Health Prof 2023; 46:320-333. [PMID: 37178060 PMCID: PMC10637074 DOI: 10.1177/01632787231175184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Implementation fidelity has been an important issue in the service provision and associated outcomes of Wraparound, an intensive, individualized care planning process that uses a team-based approach to integrate youth into the community to minimize the need for intensive, institutional services. In response to the growing need to monitor fidelity to the Wraparound process, a variety of instruments have been created and tested. In this study, the authors present the results of several analyses designed to better understand the measurement characteristics of the Wraparound Fidelity Index Short Form (WFI-EZ), a multi-informant fidelity instrument. The results from our analysis of 1027 WFI-EZ responses indicate that the internal consistency of the instrument is very good, although the negatively worded items did not appear to function as well as positively worded items. Results from two confirmatory factor analyses were unable to validate the original domains identified by the instrument developers, but for certain outcomes the WFI-EZ demonstrated deseriable predictive validity. Preliminary evidence is also provided that WFI-EZ responses likely differ by respondent type. We conclude by discussing the implications of using the WFI-EZ in programming, policy, and practice considering the findings of our study.
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Affiliation(s)
- Brandon K. Attell
- Georgia Health Policy Center, Georgia State University, Atlanta, GA, USA
| | - Ashley C. Singleton
- National Training and Technical Assistance Center for Child, Youth, and Family Mental Health, Center for Applied Research Solutions Inc, Santa Rosa, CA, USA
| | - Susan A. McLaren
- Georgia Health Policy Center, Georgia State University, Atlanta, GA, USA
| | - Giselle Moses
- Georgia Health Policy Center, Georgia State University, Atlanta, GA, USA
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Stenersen MR, Schreier A, Strambler MJ, Marshall T, Bracey J, Kaufman JS. Needs of Youth Enrolled in a Statewide System of Care: A Latent Class Analysis. Child Youth Serv Rev 2023; 154:107126. [PMID: 37744024 PMCID: PMC10512660 DOI: 10.1016/j.childyouth.2023.107126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Objective Access to wraparound care coordination within systems of care (SOC) is increasing nationwide for youth with emotional and behavioral disorders and their families. Though wraparound care coordination serves a broad population of youth who experience a variety of complex needs, less is known about the impact of wraparound services based on these specified needs. Using latent class analysis, the current study aimed to first identify classes of youth based on their presenting needs and then examine the impact of class membership on treatment experiences and outcomes at baseline and six-month follow-up. Method Caregiver-reported data from 1,243 youth enrolled in wraparound care coordination services within a statewide SOC were used. Latent class analysis was used to determine classes of youth needs and regression results examined whether baseline characteristics, child and family team meeting characteristics, mental health outcomes, and perceptions of care differed based on identified classes. Results Results revealed five distinct classes of youth needs: Behavioral Needs, ADHD-related Behavior Needs, Educational Needs, Mental Health Needs, and Multi-Needs. Overall participants saw improvement in all follow-up outcomes. Significant between-class differences were also found in all outcome categories measured. Conclusion The current results further solidify the benefits of comprehensive wraparound care within a SOC. Additionally, understanding youth's needs and their impact on treatment services allows for more targeted care for youth and their families.
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Affiliation(s)
- Madeline R Stenersen
- Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine
| | - Alayna Schreier
- Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine
| | - Michael J Strambler
- Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine
| | - Tim Marshall
- Office of Community Based Mental Health Services, Connecticut Department of Children and Families
| | - Jeana Bracey
- Child Health and Development Institute of Connecticut, Inc
| | - Joy S Kaufman
- Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine
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Schreier A, Stenersen MR, Strambler MJ, Marshall T, Bracey J, Kaufman JS. Needs of Caregivers of Youth Enrolled in a Statewide System of Care: A Latent Class Analysis. Child Youth Serv Rev 2023; 147:106838. [PMID: 37719138 PMCID: PMC10501261 DOI: 10.1016/j.childyouth.2023.106838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Objective Systems of care (SOC) provide a coordinated array of services to youth with serious emotional and behavioral problems and their families. Little is known about what caregiver-specific needs at presentation to care may contribute to use of and engagement with care coordination and subsequent youth and family outcomes. This study aimed to determine latent classes of youth enrolled in wraparound care coordination within a statewide SOC based on caregiver needs impacting youth functioning and identify the relationship between class membership and characteristics of participation in Child and Family Team meetings (CFTs) and mental health outcomes at six-month follow-up. Method Participants were 703 youth (Mage = 11.21, SD = 3.67) and their caregivers that had information about caregiver needs and received a six-month follow-up assessment. Latent class analysis determined latent classes of families based on caregiver service needs at presentation to care, and differences in participation in care coordination and youth outcomes at 6-month follow up based on class membership was examined. Results Results indicated four classes of caregivers: Physical Health Needs, No Needs, Basic Needs, and Mental Health/Trauma Needs. Class membership was associated with size of the CFT, number of CFTs attended by the youth, percentage of CFTs with a natural support present, and percentage of CFTs that occurred in the family's home. Class membership was associated with caregiver ratings of objective strain at 6-month follow-up. Conclusion Assessing caregiver needs at presentation to care can provide direction for care coordinators to more directly target areas of family need through wraparound and individualize services.
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Affiliation(s)
- Alayna Schreier
- Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine
| | - Madeline R Stenersen
- Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine
| | - Michael J Strambler
- Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine
| | - Tim Marshall
- Office of Community Based Mental Health Services, Connecticut Department of Children and Families
| | - Jeana Bracey
- Child Health and Development Institute of Connecticut, Inc
| | - Joy S Kaufman
- Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine
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Olson JR, Benjamin PH, Azman AA, Kellogg MA, Pullmann MD, Suter JC, Bruns EJ. Systematic Review and Meta-analysis: Effectiveness of Wraparound Care Coordination for Children and Adolescents. J Am Acad Child Adolesc Psychiatry 2021; 60:1353-1366. [PMID: 33785404 DOI: 10.1016/j.jaac.2021.02.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/22/2021] [Accepted: 02/19/2021] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Wraparound is a common method for coordinating care for children and adolescents with serious emotional disorders (SED), with nearly 100,000 youths served annually in the United States. The current systematic review and meta-analysis estimated effects on youth outcomes (symptoms, functioning, school, juvenile justice, and residential placement) and costs. METHOD A literature search identified 17 peer-reviewed and gray literature studies meeting criteria, which were coded on characteristics of sample, design, implementation, and outcomes. Random effects modeling was conducted using Comprehensive Meta-Analysis Version 3.0. Effect sizes were calculated using Hedges g. Homogeneity of effects were assessed using Q statistics. RESULTS Medium-sized effects favored Wraparound-enrolled youths for costs (g = 0.391, CI = 0.282-0.500, p < .001), residential outcomes (g = 0.413, CI = 0.176-0.650, p = .001), and school functioning (g = 0.397, CI = 0.106-0.688, p = .007); small effects were found for mental health symptoms (g = 0.358, CI = 0.030-0.687, p = .033) and functioning (g = 0.315, CI = 0.086-0.545, p = .007). Larger effects were found for peer-reviewed studies, quasi-experimental designs, samples with a larger percentage of youths of color, and Wraparound conditions with higher fidelity. CONCLUSION Results indicate positive effects for Wraparound, especially for maintaining youths with SED in the home and community. However, many studies showed methodological weaknesses, and fidelity measurement was largely absent, suggesting a need for additional research. Nonetheless, the results should aid decisions around resource allocation, referral practices, and system partnerships among child psychiatrists and other behavioral health professionals.
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Affiliation(s)
- Jonathan R Olson
- Drs. Olson, Pullmann, Bruns, Mr. Benjamin, and Mss. Azman and Kellogg are with the University of Washington School of Medicine, Seattle.
| | - Philip H Benjamin
- Drs. Olson, Pullmann, Bruns, Mr. Benjamin, and Mss. Azman and Kellogg are with the University of Washington School of Medicine, Seattle
| | - Alya A Azman
- Drs. Olson, Pullmann, Bruns, Mr. Benjamin, and Mss. Azman and Kellogg are with the University of Washington School of Medicine, Seattle
| | - Marianne A Kellogg
- Drs. Olson, Pullmann, Bruns, Mr. Benjamin, and Mss. Azman and Kellogg are with the University of Washington School of Medicine, Seattle
| | - Michael D Pullmann
- Drs. Olson, Pullmann, Bruns, Mr. Benjamin, and Mss. Azman and Kellogg are with the University of Washington School of Medicine, Seattle
| | - Jesse C Suter
- Dr. Suter is with the Center on Disability and Community Inclusion, University of Vermont, Burlington
| | - Eric J Bruns
- Drs. Olson, Pullmann, Bruns, Mr. Benjamin, and Mss. Azman and Kellogg are with the University of Washington School of Medicine, Seattle
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Schreier A, Horwitz M, Marshall T, Bracey J, Cummins M, Kaufman JS. Trauma Symptoms and Relationship With Child and Family Team Meeting Characteristics and Outcomes in a Statewide System of Care. J Emot Behav Disord 2021; 29:175-186. [PMID: 34712039 PMCID: PMC8547490 DOI: 10.1177/1063426620980695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Systems of care (SOCs) are comprehensive, community-based services for youth with emotional and behavioral disorders. For these youth, little is known about how trauma symptoms influence participation in SOC care coordination through the Child and Family Team (CFT) meeting. The current study assessed the extent to which exposure to potentially traumatic events (PTEs) and trauma symptoms were associated with participation in CFTs and youth and family outcomes. Participants were 464 youth (M age = 11.02, SD = 3.72) and their caregivers. Families completed measures of youth and caregiver functioning, PTEs, and trauma symptoms at enrollment and 6-month follow-up. Care coordinators completed surveys assessing CFT characteristics following each meeting and assessments of youth functioning. Moderated multiple regression analyses tested the conditional effects of youth trauma symptoms on the relationships between CFT characteristics and youth and caregiver outcomes. Trauma symptoms moderated the relationship between the number of days to the first CFT meeting and youth impairment and the relationship between CFT meeting duration and youth impairment. Results suggest the presence of trauma and other contextual factors contributed to difficulty in initiating services and to changes in youth impairment. Implications for the provision of trauma-informed SOC services are discussed.
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Affiliation(s)
| | | | - Tim Marshall
- Connecticut Department of Children and Families, Hartford, USA
| | - Jeana Bracey
- Child Health and Development Institute of Connecticut, Inc., Farmington, USA
| | - Mary Cummins
- Connecticut Department of Children and Families, Hartford, USA
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Furlong M, Stokes A, McGilloway S, Hickey G, Leckey Y, Bywater T, O'Neill C, Cardwell C, Taylor B, Donnelly M. A community-based parent-support programme to prevent child maltreatment: Protocol for a randomised controlled trial. HRB Open Res 2018; 1:13. [PMID: 32002506 PMCID: PMC6973527 DOI: 10.12688/hrbopenres.12812.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2018] [Indexed: 11/20/2022] Open
Abstract
The prevention of child abuse and neglect is a global public health priority due to its serious, long-lasting effects on personal, social, and economic outcomes. The Children At Risk Model (ChARM) is a wraparound-inspired intervention that coordinates evidence-based parenting- and home-visiting programmes, along with community-based supports, in order to address the multiple and complex needs of families at risk of child abuse or neglect. The study comprises a multi-centre, randomised controlled trial, with embedded economic and process evaluations. The study is being conducted in two child-welfare agencies within socially disadvantaged settings in Ireland. Families with children aged 3-11 years who are at risk of maltreatment (n = 50) will be randomised to either the 20-week ChARM programme (n = 25) or to standard care (n = 25) using a 1:1 allocation ratio. The primary outcomes are incidences of child maltreatment and child behaviour and wellbeing. Secondary outcomes include quality of parent-child relationships, parental stress, mental health, substance use, recorded incidences of substantiated abuse, and out-of-home placements. Assessments will take place at pre-intervention, and at 6- and 12-month follow-up periods. The study is the first evaluation of a wraparound-inspired intervention, incorporating evidence-based programmes, designed to prevent child abuse and neglect within intact families. The findings offer a unique contribution to the development, implementation and evaluation of effective interventions in the prevention of child abuse and neglect. The trial is registered with the International Standard Randomised Controlled Trial Number Register (DOI 10.1186/ISRCTN13644600, Date of registration: 3 rd June 2015).
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Affiliation(s)
- Mairead Furlong
- Centre for Mental Health and Community Research, Department of Psychology, John Hume Building, National University of Ireland Maynooth, Maynooth, Co. Kildare, Ireland
| | - Ann Stokes
- Centre for Mental Health and Community Research, Department of Psychology, John Hume Building, National University of Ireland Maynooth, Maynooth, Co. Kildare, Ireland
| | - Sinead McGilloway
- Centre for Mental Health and Community Research, Department of Psychology, John Hume Building, National University of Ireland Maynooth, Maynooth, Co. Kildare, Ireland
| | - Grainne Hickey
- Centre for Mental Health and Community Research, Department of Psychology, John Hume Building, National University of Ireland Maynooth, Maynooth, Co. Kildare, Ireland
| | - Yvonne Leckey
- Centre for Mental Health and Community Research, Department of Psychology, John Hume Building, National University of Ireland Maynooth, Maynooth, Co. Kildare, Ireland
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Van Dongen T, Sabbe B, Glazemakers I. A protocol for interagency collaboration and family participation: Practitioners' perspectives on the Client Network Consultation. J Interprof Care 2017; 32:14-23. [PMID: 29058496 DOI: 10.1080/13561820.2017.1379961] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Interagency collaboration has many advantages, but seems hard to realise in practice. In Belgium, the need for collaboration between the practitioners in the field of child welfare and child psychiatry, especially for children and adolescents with complex health care needs, was identified. Children with complex health care needs require coordinated care and collaboration between the different sectors in child mental health care (child welfare, child psychiatry, disability care). The authors have developed a standardised protocol based on the wraparound principles, which support interagency collaboration with family participation, named Client Network Consultation (CNC). Focus groups evaluated the CNC by eliciting practitioners' views on the structure, content and impact of collaborative interagency protocols with family involvement. Thematic analysis revealed four core themes: (1) Empowering the child and the family; (2) Utilising the strength of the collective; (3) Being considerate versus constructive a dilemma for participants in CNC; and (4) The structure of a protocol offers opportunities and challenges. Results of the study offer implications for daily practice. Several challenges for interprofessional (IP) practice in the complex field of child and adolescent mental health care are described. The value of the CNC protocol to engage families in a clinical process is also discussed.
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Affiliation(s)
- Thirsa Van Dongen
- a Faculteit geneeskunde en gezondheidswetenschappen, Collaborative Antwerp Psychiatric Research Institute , Universiteit Antwerpen , Universiteitsplein 1, Wilrijk 2610 , Belgium
| | - Bernard Sabbe
- a Faculteit geneeskunde en gezondheidswetenschappen, Collaborative Antwerp Psychiatric Research Institute , Universiteit Antwerpen , Universiteitsplein 1, Wilrijk 2610 , Belgium
| | - Inge Glazemakers
- a Faculteit geneeskunde en gezondheidswetenschappen, Collaborative Antwerp Psychiatric Research Institute , Universiteit Antwerpen , Universiteitsplein 1, Wilrijk 2610 , Belgium
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Mullen J, Ryan SR, Mathias CW, Dougherty DM. Treatment Needs of Driving While Intoxicated Offenders: The Need for a Multimodal Approach to Treatment. Traffic Inj Prev 2015; 16:637-44. [PMID: 25664371 PMCID: PMC4481140 DOI: 10.1080/15389588.2015.1013189] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 01/25/2015] [Indexed: 05/10/2023]
Abstract
OBJECTIVE This study aimed to characterize and compare the treatment needs of adults with driving while intoxicated (DWI) offenders recruited from a correctional residential treatment facility and the community to provide recommendations for treatment development. METHOD A total of 119 adults (59 residential, 60 community) with at least one DWI offense were administered clinical diagnostic interviews to assess substance use disorders and completed a battery of questionnaires assessing demographic characteristics, legal history, psychiatric diagnoses, medical diagnoses, and health care utilization. RESULTS Almost all (96.6%) DWI offenders met clinical diagnostic criteria for an alcohol use disorder, approximately half of the sample also met diagnostic criteria for comorbid substance use disorders, and a substantial proportion also reported psychiatric and medical comorbidities. However, a high percentage were not receiving treatment for these issues, most likely as a result of having limited access to care, because the majority of participants had no current health insurance (64.45%) or primary care physician (74.0%). The residential sample had more extensive criminal histories compared to the community sample but was generally representative of the community in terms of their clinical characteristics. For instance, the groups did not differ in rates of substance use, psychiatric and medical health diagnoses, or the treatment of such issues, with the exception of alcohol abuse treatment. CONCLUSIONS DWI offenders represent a clinical population with high levels of complex and competing treatment needs that are not currently being met. Our findings demonstrate the need for standardized screening of DWI offenders and call for the development of a multimodal treatment approach in efforts to reduce recidivism.
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Affiliation(s)
- Jillian Mullen
- a Department of Psychiatry , The University of Texas Health Science Center at San Antonio , San Antonio , Texas
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Bruns EJ, Walker JS, Bernstein A, Daleiden E, Pullmann MD, Chorpita BF. Family voice with informed choice: coordinating wraparound with research-based treatment for children and adolescents. J Clin Child Adolesc Psychol 2013; 43:256-69. [PMID: 24325146 PMCID: PMC3954919 DOI: 10.1080/15374416.2013.859081] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The wraparound process is a type of individualized, team-based care coordination that has become central to many state and system efforts to reform children's mental health service delivery for youths with the most complex needs and their families. Although the emerging wraparound research base is generally positive regarding placements and costs, effect sizes are smaller for clinical and functional outcomes. This article presents a review of literature on care coordination and wraparound models, with a focus on theory and research that indicates the need to better connect wraparound-enrolled children and adolescents to evidence-based treatment (EBT). The article goes on to describe how recently developed applications of EBT that are based on quality improvement and flexible application of "common elements" of research-based care may provide a more individualized approach that better aligns with the philosophy and procedures of the wraparound process. Finally, this article presents preliminary studies that show the feasibility and potential effectiveness of coordinating wraparound with the Managing and Adapting Practice system, and discusses intervention development and research options that are currently under way.
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Affiliation(s)
- Eric J Bruns
- a Department of Psychiatry and Behavioral Sciences , University of Washington School of Medicine
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Pullmann MD, Bruns EJ, Sather AK. Evaluating fidelity to the wraparound service model for youth: application of item response theory to the Wraparound Fidelity Index. Psychol Assess 2013; 25:583-98. [PMID: 23544392 PMCID: PMC3755947 DOI: 10.1037/a0031864] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The wraparound process is a mechanism for multisystem planning and care coordination for youth with serious emotional and behavioral problems. Fidelity monitoring is critical to effective implementation of evidence-based practices in children's mental health, as it helps ensure that complex interventions like wraparound are implemented as intended. The 40-item Wraparound Fidelity Index, Version 4 (WFI-4; Bruns, Burchard, Suter, Leverentz-Brady, & Force, 2004) is the most frequently used measure of fidelity to the wraparound process, but analysis of its psychometric properties is insufficient. An item response theory approach, Rasch partial credit models for ordered polytomous data, was used on ratings from 1,234 facilitators, 1,006 caregivers, and 221 team members, focused on 1,478 youths (55% male). Results indicated the WFI-4 measured a unidimensional construct, with little evidence of item bias and good item and model fit. However, the item information curve was skewed, with most people endorsing high-fidelity responses, and several items had duplicative location estimates. A reduced 20-item measure is proposed. Internal reliability estimates for scores from this reduced measure were approximately equivalent to the longer measure. However, both versions would benefit from additional items located in the highest fidelity area of either version of the scale where scores by greater than half of our sample fall, but only 3 items are located.
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Affiliation(s)
- Michael D Pullmann
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98102, USA.
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Bruns EJ, Walker JS, Zabel M, Matarese M, Estep K, Harburger D, Mosby M, Pires SA. Intervening in the lives of youth with complex behavioral health challenges and their families: the role of the wraparound process. Am J Community Psychol 2010; 46:314-331. [PMID: 20859674 PMCID: PMC3086808 DOI: 10.1007/s10464-010-9346-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Wraparound is an individualized, team-based service planning and care coordination process intended to improve outcomes for youth with complex behavioral health challenges and their families. In recent years, several factors have led wraparound to become an increasingly visible component of service systems for youth, including its alignment with the youth and family movements, clear role within the systems of care and public health frameworks, and expansion of the research base. In this paper, we provide a review of the place of the wraparound process in behavioral health, including a discussion of the opportunities it presents to the field, needs for further development and research, and recommendations for federal actions that have the potential to improve the model's positive contribution to child and family well-being.
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Affiliation(s)
- Eric J Bruns
- University of Washington School of Medicine, Seattle, WA 98102, USA.
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