Evaluation of a Congressionally Mandated Wraparound Demonstration

In order to determine whether expenditures for mental health could be reduced and quality improved, Congress mandated that the Department of Defense conduct a demonstration project utilizing a wraparound mental health service system for child and adolescent military dependents. A longitudinal quasiexperimental design was used to evaluate the cost-effectiveness of the demonstration. The results showed that children in the Wraparound Group received more wraparound services than those in the treatment as usual (TAU) Comparison Group. These services included case management, in-home treatment, and other nontraditional services. The Demonstration also provided better continuity of care. Multiple methods were used to investigate the impact of wraparound. Both groups showed some improvement on some measures but there were no differences between the groups in functioning, symptoms, life satisfaction, positive functioning, or sentinel events. Regardless of which statistical model was used to estimate costs, the Demonstration was also more expensive. The higher level of expenditures for the Wraparound group was a result of some expensive traditional care and the addition of nontraditional services. Several possible explanations of these results are provided.     

Adherence to Wraparound Principles and Association with Outcomes

Maintaining fidelity to the principles of the Wraparound process in serving children with emotional and behavioral disorders is a high priority. However, the assumption that greater adherence to the model will yield superior outcomes has not been tested. The current study investigated associations between adherence to Wraparound principles, as assessed by the Wraparound Fidelity Index, second version (WFI), and child and family outcomes in one federally funded system-of-care site. Results demonstrated that higher fidelity was associated with better behavioral, functioning, restrictiveness of living, and satisfaction outcomes. No associations were found for several additional outcomes making interpretation difficult. Our study provides initial support for the hypothesis that maintaining fidelity to the philosophical principles of Wraparound is important to achieving outcomes. The study also provides support for the construct validity of the WFI as a service process measure.     

An Investigation of Treatment Integrity and Outcomes in Wraparound Services

Research on wraparound services has been generally positive, but has failed to include data regarding treatment integrity. Without such data, conclusions drawn from such studies are weakened. This study followed 28 children and adolescents receiving wraparound services in rural central Pennsylvania. Treatment integrity was defined as the percentage of service hours prescribed vs. received, and behavioral outcomes were defined as Total Problem Behavior T Scores on the Child Behavior Checklist. Preliminary analyses failed to reveal significant differences in sample means between included subjects and those excluded due to missing data. Outcome behavior ratings were significantly improved over baseline ratings. Regression analyses, however, failed to find a significant effect for treatment integrity when used in an outcome prediction equation for Therapeutic Support Staff, Mobile Therapy services, or Behavioral Specialist wraparound services. These results suggest that adherence to prescribed treatment hours may not be related to behavioral outcomes in a wraparound service setting.     

Deciphering the Tower of Babel: Examining the Theory Base for Wraparound Fidelity

I present the results of a study that examined a theoretical and paradigmatic basis to better define fidelity in a wraparound approach to service delivery. I first examined the literature to clarify terms and to suggest a paradigmatic and theoretical base for the easily misinterpreted, value-laden philosophy of wraparound. Two deceptively simple constructs were identified and examined through a multi-case, multi-method design. Results suggested that wraparound is an emerging collaborative model based in critical and constructivist thought and in ecological systems theory. My study provides a preliminary but essential step in clarifying the process of implementation and evaluation of the wraparound approach.     

Reliability of the Wraparound Observation Form: An Instrument to Measure the Wraparound Process

Within the past decade, the wraparound approach has gained significant popularity in providing services to children with challenging social and family needs. While a plethora of wraparound programs have been developed and studies have been conducted to assess their effectiveness, the need to develop instruments that measure the implementation of wraparound services is clear. The purpose of the present study was to evaluate the reliability of a scale that measures wraparound services. In this study, the Wraparound Observation Form (WOF), was developed to evaluate the implementation of the wraparound process in treatment planning meetings. The WOF includes 34 closed-ended items that requires the respondent to note the occurrence or non-occurrence of specific events or behaviors at treatment planning meetings. In the present study, two data collectors attended planning meetings and independently completed the WOF. The inter-rater reliability was 95%. The WOF appears to be a reliable instrument and be appropriate in evaluating wraparound services.     

Quality and Individualization in Wraparound Team Planning

In children’s mental health, collaborative, team-based individualized service planning is most commonly known as wraparound, and has become one of the primary strategies for improving services and outcomes for children with the highest levels of need. We report on analyses of data gathered at 72 wraparound team meetings from communities around the United States. We describe the composition of the teams and the quality of the planning process they engaged in, and explore the extent to which these factors were associated with team member satisfaction and the individualization of plans. Teams in our study were numerically dominated by professionals. Parents attended a large majority of meetings, participation by youth and family advocates was frequent, participation by other family members infrequent, and participation by other members of the family’s informal or natural support networks rare. Observed teams varied considerably in the quality of their planning process and the degree of individualization of plans. Higher-quality planning was significantly associated with increased individualization of plans and with team member satisfaction with meeting productivity.     

Exploring the Theory and Paradigm Base for Wraparound

Until recently, family-centered policy and practice used expert models which defined families of children with serious emotional disturbance as dysfunctional A collaborative model, called wraparound, is emerging which engages these families as decision making participants, using naturally occurring strengths to wrap individualized supports around the child and family. However, because wraparound has been defined only through value-based principles, the fidelity of the model is threatened by a developmental paradox. Those who have received training and whose careers have been shaped in more traditional expert models of deficit remediation can interpret these value-based principles as an emergent form of case management methodology. Critical and constructivist paradigms, and ecological systems theory, form a basis for negotiating this paradox to maintain fidelity of wraparound process. Anchored in this base, and derived from wraparound's value-based principles, a single construct with an operative focus is suggested to ensure the integrity of this collaborative model.     

反馈在自我调节学习中的作用

反馈一直是学习研究领域中非常重要的主题之一。随着学习理论的发展,人们对反馈的研究逐渐深化与综合化。一方面从自我调节学习的过程模型出发,考察了反馈的不同因素对自我调节学习过程和结果的作用;另一方面以自我调节学习的社会认知理论为框架,探讨了情绪、学业成绩等个体因素以及目标定向、任务难度等情境因素对反馈作用的交互影响。未来研究需要进一步探讨内部反馈信息以及学习者元认知监控的调节作用,结合个体和情境因素揭示反馈对自我调节学习的整体动态过程的影响,并设计出促进学习和教学实践的反馈方案。     

The Role of Schools in Outcomes for Youth: Implications for Children's Mental Health Services Research

We explore the role of schools in children's mental health services research. Recent literature has suggested that schools play an important role in delivering services to children and adolescents with emotional and behavioral problems. Research in services research, though, has taken a fairly narrow view of which dimensions of school environments are relevant for inclusion in studies. We suggest that a broader view of school environments is appropriate and potentially beneficial to the field. Using Bronfenbrenner's ecological model as a guide, we conceptualize schools as microsystems. Such an approach suggests that all aspects of school environments (treatment as well as non-treatment) are likely to influence many of the outcomes that children's mental health services research frequently targets (e.g., behavioral problems, problematic peer relationships, academic achievement, school attendance). We review literature from a variety of disciplines to suggest relevant features of schools, with particular attention to the role of peer dynamics within schools. We conclude with implications of this expanded conceptualization of schools for children's mental health services research.     

Bows and ribbons,tape and twine: Wrapping the wraparound process for children with multi-system needs

The wraparound process for children with multi-system needs is one of the most innovative and popular reform efforts in children's services. Nonetheless, the articles in this special issue are indicative of a service reform process that is still maturing and evolving. In this commentary, three key questions regarding the wraparound process are posed: (a) What is wraparound? (b) What is the current state of research regarding wraparound services? and (c) What are the implications for the future? It is argued that the future of wraparound depends at least in part on: (a) carefully defining the wraparound process, including how to best integrate the process with reforms based on the principles of a comprehensive system of care; and (b) making a strong commitment at all levels to the process of cumulative knowledge, of building and creating innovative research and program efforts over time, one upon the other. It is concluded that a failure to invest in careful definition, refinement, implementation, and research on the wraparound process consitutes a failure to invest in children and families with multi-system needs.     

正式反馈的发展与临床应用

摘要:正式反馈通过系统收集当事人的效果反馈来追踪其治疗进展,进而识别缺乏治疗进展的个案,并通过促进治疗策略的调整来阻止治疗失败。正式反馈是近20年来发展出的一种循证治疗手段,其目的为进一步提高当事人的咨询效果。正式反馈的发展大致经历了临床有效性检验和实用性发展两个阶段。正式反馈可用于促进个体、夫妻和团体咨询的效果,也可用于评估临床督导效果、确定督导个案和指导临床督导。未来研究可探讨咨询师对待正式反馈的态度,拓展正式反馈的使用价值,建立正式反馈系统的本土化常模。     

Predicting Resource Utilization by Children with Serious Emotional Disturbance and Their Families

Our study represents a rural case management agency's use of its data to aid in its transition from being funded by federal grant funds to self-sustainment. We wanted to learn if some characteristics of those children served could predict the resources needed to serve them. We analyzed data on 90 children and adolescents living in a rural community. Using multiple regression analysis we found that CAFAS total and CBCL total problem scores predicted Medicaid reimbursements but not flexible funds spending or case management hours. History of psychiatric hospitalization, however, predicted flexible funds spending and case management hours. Using one-way ANOVA and post hoc analysis we found that the staff members' assessments of each child and family's level of service needs were reflected in differences in mean CAFAS total scores, Medicaid reimbursements and case management hours, but not CBCL total problem scores or flexible funds spending.     

Connecting the Dots: Stages of Implementation,Wraparound Fidelity and Youth Outcomes

Several necessary system and organizational support conditions for wraparound have been identified (Walker et al. 2003). Yet, the relationship between these necessary system level conditions and wraparound fidelity has only recently begun to be examined. Similarly, few studies have included a measure of wraparound fidelity when examining the relationship between wraparound implementation and youth outcomes. The statewide implementation of a wraparound demonstration grant offers the opportunity to explore these relationships and to identify factors that predict improvement in functioning for youth receiving wraparound. Findings suggest that significant relationships exist between (1) the stage of development of necessary support conditions for wraparound and wraparound fidelity and (2) wraparound fidelity and improvement in youth outcomes. Specific elements of wraparound (i.e., outcomes based and community based) and baseline needs and strengths (e.g., high levels of anxiety and conduct issues, poor functioning at home and in school, judgment, and risks) were found to predict a reduction in youth needs. Other unexpected relationships between youth outcomes and the cultural competence element of wraparound and being multi-racial were also discovered. These findings reinforce the importance of supporting high fidelity wraparound for youth and their families in a recovery focused behavioral health system.     

Children with SED and Their Families in an Urban Public Mental Health System: Characteristics, Needs, and Expectations

We present information with implications for the design of comprehensive systems of care for children with severe emotional disturbance and their families. Combining quantitative data derived from children and caregivers on multiple standardized assessments and qualitative data based on the caregivers' personal comments, we provide a detailed account of child clinical status, service needs, involvement in normative childhood activities, aspects of family coping and functioning, and expectations of mental health services. Research participants were from a random sampling of children, 9 to 11 years of age, receiving an above average number of services from a large urban public mental health system. Results from this comprehensive needs assessment demonstrate the serious nature of the children's disabilities, illuminate the corresponding challenges for families, and provide direction for enhancing the system of care. The caregivers rated recreation and after school programs as their first priority. Since traditional mental health services are fairly well articulated and evolved, we concentrate on using information about child functioning and family context to inform the development of recreation and after school programs that can accommodate children with extremely challenging behaviors.     

The Role of Visual Feedback about Motion of the Ground on Postural Sway

Abstract

We asked whether body sway would be influenced by visual information about motion of the ground surface. On a ship at sea, standing participants performed a demanding visual search task or a simple visual inspection task. Display content was stationary relative to the ship or relative to the Earth. Participants faced the ship’s bow or its port side. Performance on the visual search task was representative of terrestrial studies. Body sway was greater during viewing of the Earth Stationary displays than during viewing of the Ship Stationary displays. We discuss possible implications of these results for theoretical and applied issues.     

绩效反馈研究的回顾与展望

绩效反馈是组织中鼓励先进、鞭策落后、激发员工潜能的很重要的管理手段。该概要回顾了有关反馈的研究,分析了反馈研究的发展趋势,认为不同反馈来源中上级反馈的影响越来越重要;表扬还是批评的信息对员工的影响值得进一步探讨;反馈接受者本人的特点对反馈效果的影响研究应更加深入。     

反馈干预对绩效的影响研究

反馈干预是由外部动因提供的关于个体任务操作或过去行为的信息活动,它有反馈对象、反馈效价和反馈提供方式三个维度。研究结果表明反馈效价、反馈提供方式对绩效的影响具有主效应,且两者的之间交互作用对绩效也存在主效应。积极反馈效价、信息型提供方式有助于提高个体的绩效水平。     

Wraparound care in vermont: Program development,implementation, and evaluation of a statewide system of individualized services

Over the past decade, there has been a dramatic shift in the provision of mental health services to children, adolescents, and their families. This shift has been marked by a movement away from restrictive treatment options toward the development of comprehensive community-based systems of care designed to keep the most challenging children in their homes, schools, and communities. Based on a model of intensive case management referred to as Wraparound Care, Vermont's statewide approach emphasizes aggressive outreach, use of the least restrictive treatment options, and care that is flexible, unconditional, and child- and family-centered. We chart the development of Vermont's Wraparound Care Initiative and present residential, educational, and behavioral outcome data for a cohort of 40 youth receiving Wraparound Care over a 12-month period. The results showed that after 12-months, youth who had been previously removed from their homes or were at imminent risk of such removal, were residing in significantly less restrictive community-based living arrangements and exhibiting significantly fewer problem behaviors than at intake. These results are discussed in light of recent national studies and previous studies on similar cohorts of Vermont youth receiving Wraparound Care.     

自尊在四川地震孤儿的同伴关系和心理健康之间的调节作用

本研究基于心理弹性来考察汶川地震孤儿群体的自尊在其同伴关系和心理健康之间的调节作用。方法：采用自尊量表（SES）、同伴提名问卷及中国心理健康量表（CMHI）对401名五年级到初二的地震孤儿和对照组儿童进行自尊水平、同伴关系及其心理健康状况调查,使用结构方程模型来探查自尊在同伴关系和心理健康之间的调节作用。结果：自尊量表总评分对照组显著高于四川儿童;震后孤儿组在同伴接受方面程度最高;对照组的心理健康总评分和四川儿童没有显著差异;震后孤儿更多的投注于同伴接受,通过影响自我否定来间接影响心理健康;灾区非孤儿通过自我肯定的中介,调节了同伴拒绝对心理健康的影响。 结论：自尊在四川地震儿童的同伴关系和心理健康之间起着重要的调节作用,体现了自我修复的力量