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.     

On the Road to Emmaus: Together towards Life as Conversation Partner in Missiological Research

This article argues that the Emmaus narrative in Luke 24:13‐40 illustrates a messianic paradigmatic missiological approach to costly discipleship making. The central motif in this approach is critical emancipatory conversation, which is not merely the means to data gathering but an end in itself. Using Luke's story as a paradigmatic approach to missiological research, I demonstrate how Together towards Life as a research tool could creatively and innovatively engage with African theological education.     

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.     

The Role of Fidelity and Feedback in the Wraparound Approach

Wraparound approaches are being implemented with children in many mental health systems around the country. Evidence for the effectiveness of the wraparound approach, however, is limited. In addition, the degree to which wraparound interventions adhere to the principles of wraparound has rarely been assessed. We examined the influence of adherence to wraparound principles and outcome feedback within the wraparound approach. Children participating in family team meetings were enrolled in a feedback or no feedback condition. Teams receiving feedback were given a brief report regarding outcome progress four times over a three-month period. In addition, adherence to wraparound principles was assessed in the initial team meeting and examined in relationship to outcome at three months and nine months. Although youth in both feedback and non-feedback groups improved with intervention, there were few differences between the groups based on outcome feedback. Similarly, adherence was uniformly high and did not influence the outcome for individual cases. Although the wraparound approach was helpful for youth in our sample, outcome feedback and adherence to wraparound principles had limited influence on these effects.     

Evaluating the vermont system of care: Outcomes associated with community-based wraparound services

Evaluation of innovative community-based interventions is becoming a high priority for child and adolescent mental health service system research. The present study examined outcomes for a sample of Vermont children (N=27) experiencing emotional and behavioral problems and receiving individualized, wraparound services. One year after initiation of wraparound care, incidence of negative behaviors rated as placing a child at risk of removal from the community had decreased significantly, compliance behavior had increased, and a significant decline in Total Problem Behavior scores on the Child Behavior Checklist was observed. In addition, though 70% of the participants had previously required inpatient or residential treatment, 89% were maintained in the community after one year of services, and the total cost of services was less than that of out-of-state residential care. Although further comparative research is needed, this study suggests that for many of these children, wraparound services may be a more efficient intervention than long-term psychiatric hospitalization or residential treatment.     

Child and Family Team Meeting Characteristics and Outcomes in a Statewide System of Care

Systems of care (SOC) have relied on the wraparound care process to individualize community‐based services for children and youth with serious emotional and behavioral difficulties. A core element of wraparound care is Child and Family Team meetings (CFTs), which are designed to give youth and families a leadership role in developing and guiding their plan of care. The National Wraparound Initiative (NWI) has identified Practice Standards regarding CFT implementation. This study examined CFT characteristics and the association between those characteristics and youth and family outcomes in a statewide SOC. Participants were 363 youth (M_age = 10.89, SD = 3.72) and their caregivers. Families completed measures of youth and caregiver functioning and symptoms at enrollment and 6‐month follow‐up. Care coordinators completed a survey assessing CFT implementation and characteristics following each meeting. Multiple regression analyses were used to examine the relationship between CFT characteristics and youth and caregiver outcomes. Results indicated that a higher number of CFTs was associated with poorer outcomes, while a higher percentage of natural supports at meetings was associated with better youth outcomes. Number of days to the first CFT was associated with greater caregiver strain. Implications for CFT implementation within wraparound are discussed.     

Using a Theory of Change to Drive Human Resource Development for Wraparound

Achieving coherence and integration across staff professional development activities is facilitated when training, coaching and staff evaluation are guided by a clearly articulated program theory or “theory of change” that describes how skillful practice promotes desired outcomes. We focus on a theory of change for wraparound, a widely implemented approach to providing community-based care for children with high levels of mental health and related needs. Training, coaching and staff evaluation efforts within wraparound programs have typically been linked only very loosely to theory. We argue that wraparound’s unique history allowed it to evolve with limited theoretical grounding, and we then describe a theory of change for wraparound, focusing on the major causal routes that are hypothesized to lead to outcomes. Finally, we provide an extended illustration of how the theory can provide the basis for a coherent and integrated approach to developing the skills and capacities of staff members playing key roles in wraparound implementation.     

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.     

National Trends in Implementing Wraparound: Results of the State Wraparound Survey, 2013

The wraparound process aims to provide an effective practice-level approach to coordinating care for youths with complex behavioral health needs, and reformed system structures to support such integration of care. The current study provides an update to two prior surveys of state children’s mental health directors, completed in 1998 and 2007, on the extent of wraparound implementation in the United States and implementation supports that have been employed. Results from 2013 found that 100 % of states reported having some type of wraparound program that conformed to the definition and yielded an estimate of 75,000 children and families served via wraparound in that year. States reported a continued increase in use of wraparound standards; however, fewer states reported collection of fidelity data, and availability of internal resources for training and coaching. Over three-quarters of states reported availability of parent to parent peer support, and 46 % of states are supporting wraparound implementation by blending or braiding funding across child-serving systems. Results also revealed that 61 % of states had a centralized oversight entity for wraparound, an important finding given that such “statewideness” was also associated with more youth served, greater accountability, use of standards, and other implementation supports.     

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.     

The <Emphasis Type="Italic">Community Supports for Wraparound Inventory</Emphasis>: An Assessment of the Implementation Context for Wraparound

The wraparound process has emerged as perhaps the most frequently implemented comprehensive approach for planning and providing individualized, community-based care for children and adolescents with serious mental health conditions. Providing comprehensive care through the wraparound process necessarily requires a high level of collaboration across organization and agency boundaries. This need for significant inter-agency or “system-level” collaboration creates a complex implementation environment for wraparound. It is therefore not surprising that creating and sustaining a hospitable implementation environment has proven to be extremely challenging. For the people who are responsible for managing the inter-organizational collaboration, it is not easy to evaluate the adequacy of local system-level support for wraparound and to see exactly what kinds of supports are lacking or where system-development efforts should focus. Furthermore, as system-development strategies are put into practice, it can be difficult to assess whether or not meaningful progress is occurring. The Community Supports for Wraparound Inventory (CSWI) was developed to respond to the need for an assessment of the extent to which a community has developed system-level capacity to implement wraparound. This article reports on a study that evaluated the reliability and validity of the CSWI for use in communities implementing wraparound. Findings indicate that the CSWI shows promise as a reliable, valid and useful tool.     

Clinical Supervision Dilemmas Related to Child Abuse in Wraparound Treatment

We conducted two separate, exploratory studies to evaluate the differences between the supervision of wraparound (in-home) and outpatient (office) child treatment interventions. Study one (n = 96) examined the structure and norms of supervision between groups as well as rates of general disclosure to direct supervisors. Study two (n = 116) specifically examined the frequency of child abuse and neglect encountered in each intervention setting, and the level of disclosure in supervision of these mandatory reporting events. Findings from the first study suggest that wraparound clinicians received significantly less individual supervision and colleague consultation than their office-based counterparts. Additionally, wraparound clinicians were significantly more likely to withhold information about client cases from their direct supervisors. In the second study, wraparound clinicians endorsed significant increases for observed child abuse, observed child neglect, and verbally reported child neglect compared to their office-based counterparts. In regards to mandatory reporting issues with children, wraparound clinicians were found to be significantly less likely to disclose issues pertaining to child neglect to their direct supervisors than office-based clinicians. Our studies show preliminary evidence for a needed increase of individual supervision in wraparound practice, in addition to a greater focus on clinician disclosures related to incidents of child abuse and neglect.     

Remembering (Short-Term) Memory: Oscillations of an Epistemic Thing

This paper provides an interpretation of Hans-J?rg Rheinberger’s notions of epistemic things and historical epistemology. I argue that Rheinberger’s approach articulates a unique contribution to current debates about integrated HPS, and I propose some modifications and extensions of this contribution. Drawing on examples from memory research, I show that Rheinberger is right to highlight a particular feature of many objects of empirical research (“epistemic things”)—especially in the contexts of exploratory experimentation—namely our lack of knowledge about them. I argue that this analysis needs to be supplemented with an account of what scientists do know, and in particular, how they are able to attribute rudimentary empirical contours to objects of research. These contours are closely connected to paradigmatic research designs, which in turn are tied to basic methodological rules for the exploration of the purported phenomena. I suggest that we engage with such rules in order to develop our own normative (epistemological) categories, and I tie this proposal to the idea of a methodological naturalism in philosophy of science.     

Applying multiple models to predict clinicians’ behavioural intention and objective behaviour when managing children's teeth

This study used multiple theoretical approaches simultaneously to predict an objectively measured clinical behaviour. The six theoretical approaches were: The Theory of Planned Behaviour (TPB), Social Cognitive Theory (SCT), Common Sense Self-Regulation Model (CS-SRM), Operant Learning Theory (OLT), Action Planning (AP) and the Precaution Adoption Process (PAP), with knowledge as an additional predictor. Data on variables from these models were collected by postal survey. Data on the outcome behaviour, the evidence-based practice of placing fissure sealants, was collected from clinical records. Participants were 133 dentists (64% male) in Scotland. Variables found to predict the behaviour were: intention, attitude, perceived behavioural control, risk perception, outcome expectancies, self efficacy, habit, anticipated consequences, experienced consequences and action planning. The TPB, SCT, AP, OLT and PAP significantly predicted behaviour but the CS-SRM did not. A combined (Stepwise) regression model included only intention and action planning. Post hoc analyses showed action planning mediated effect of intention on behaviour. Taking a theory-based approach creates a replicable methodology for identifying factors predictive of clinical behaviour and for the design and choice of interventions to modify practice as new evidence emerges, increasing current options for improving health outcomes through influencing the implementation of best practice.     

The Building of Models as Pathway to Understand the Therapeutic Process

The present work highlights the necessity to re-think the paradigmatic, methodological and theoretical assumptions which for a long time have regulated the practices of research in the field of the study of therapeutic processes. Following this suggestion, and commenting on Ribeiro and Gonçalves (2011), and Faccio, Centomo and Mininni (2011), I highlight the need to reframe the therapeutic change research in terms of a modelling approach. According to such perspective models arise through focusing on the general rule of the functioning of a change process within the local domain of a particular therapeutic encounter, making it possible both to manage it in line with the specific local aims, and to promote the deepening and the develop of scientific knowledge. This is a step towards a new research perspective able to promote the integration of empirical research and clinical practice.     

The Impact of Child and Family Team Composition on Wraparound Fidelity: Examining Links Between Team Attendance Consistency and Functioning

Although a growing body of literature has examined wraparound implementation and fidelity, child and family team (CFT) members’ levels of participation and the consistency of their attendance have not been systematically examined. This study explored the relationship between CFT member attendance consistency and the fidelity of wraparound team level implementation processes in a System of Care (SOC). Specifically, utilizing Participant Rating Form (PRF) data collected from caregivers, facilitators, youth, supportive persons, and service providers, as well as meeting attendance records, the relationship between team attendance consistency and fidelity of wraparound implementation was explored. Records for 88 teams, with a total of 2,643 members’ ratings of CFT meetings between 2004 and 2009, were examined. Analyses indicate that the structural team factors of attendance consistency and mean team members present relate to CFT members’ ratings of team functioning and the degree to which meeting processes are consistent with the tenets of wraparound. Team attendance variables related to the views of meeting functioning by facilitators, service providers, and caregivers, the individuals most often responsible for implementation of the plan of care, but not ratings by youth or supportive persons. These findings have implications for policy and the successful implementation of wraparound, underscoring the relevance of attending to and tracking the composition of the CFT and more actively encouraging consistent meeting attendance. Results also highlight the need to measure structural variables that may have salience in fidelity and implementation assessments and, more globally, the effectiveness of SOCs.     

Patterns of argumentation in Galileo's Discorsi

In this contribution I intend to reconstruct and evaluate one of Galileo's famous arguments given in the Discorsi against a well‐entrenched thesis of Aristotelian physics. It will be shown that Galileo's reduction‐to‐the‐absurd type of counterargument is, although seemingly cogent, after all fallacious. I ascribe Galileo's committing of this fallacy to his looking at the Aristotelian physics through the (Kuhnian type) paradigmatic “spectacles” of his own new physics.     

Contextualizing Falk's Identity-Related Visitor Motivation Model

ABSTRACT

This article represents a companion to an article critiquing Falk's identity-related visitor motivations model. Provided here are a summary of the theory and assumptions that underlie the identity-related visitor motivations model and the empirical approaches that were used to develop the model. Particular attention is directed to clarifying the ways in which the identity-related visitor motivations model has and can be used as a segmentation tool, and the growing body of data from a wide range of institutions that support the basic validity and reliability of using the model for this purpose. The paradigmatic foundation of the model, pragmatism, is described. Pragmatism is an approach that emphasizes that knowledge is best gained through, and directed toward action; an approach that gives preference to practicality over theoretical discourses. Finally, thoughts on both the strengths and limitations of the identity-related visitor motivations model as a mechanism for better understanding museum visitors are presented.     

The Normative Significance of Forgiveness

P.F. Strawson claimed that forgiveness is such an essential part of our moral practices that we could not extricate it from our form of life even if we so desired. But what is it about forgiveness that would make it such a central feature of our moral experience? In this paper, I suggest that the answer has to do with what I will call the normative significance of forgiveness. Forgiveness is normatively significant in the sense that, in its paradigmatic instances, forgiving alters the operative norms bearing on the interaction between the victim and the wrongdoer in certain characteristic ways. My project here is, first, to clarify the ways that paradigmatic cases of forgiveness alter the norms of interaction between victim and wrongdoer and to argue that it is in this respect that forgiveness is a normatively significant feature of our moral responsibility practices. Second, I show that most extant theories of forgiveness fail to explain the characteristic ways in which forgiving alters norms. Third, I offer a theory of forgiveness that accounts for this significant normative feature. I conclude by addressing two objections to my proposal.