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.     

A Comprehensive Review of Wraparound Care Coordination Research, 1986–2014

Wraparound is a team-based care coordination strategy for children and youth with complex behavioral health needs and their families. Despite widespread adoption, a review of the literature pertaining to Wraparound has not previously been conducted. To address this gap, we conducted a comprehensive review, ultimately identifying 206 unique Wraparound-related publications in peer-reviewed outlets. We then coded and analyzed the publications’ methods, main foci, measures, and findings. Eighty-three publications (40%) were non-empirical, most of which focused on defining Wraparound and advocating for its use, largely based on its alignment with the System of Care philosophy. Among empirical studies (n?=?123; 60%), 22 controlled studies were found, most finding positive or mixed evidence for Wraparound’s effectiveness. Other empirical studies examined implementation issues such as necessary system conditions and measurement and influence of fidelity. Major gaps include rigorous tests of Wraparound’s change mechanisms, workforce development models, peer support, and the use of specific treatments. We conclude that literature produced to date has provided useful information about Wraparound’s core components, program-level and system-level implementation supports, and applicability across systems and populations, as well as preliminary information about effectiveness and cost-effectiveness. The Wraparound research base would, however, benefit from additional studies of the model’s intervention and implementation components, as well as more rigorous effectiveness studies.     

Task-irrelevant sounds influence both temporal order and apparent-motion judgments about tactile stimuli applied to crossed and uncrossed hands

It has been suggested that judgments about the temporal–spatial order of successive tactile stimuli depend on the perceived direction of apparent motion between them. Here we manipulated tactile apparent-motion percepts by presenting a brief, task-irrelevant auditory stimulus temporally in-between pairs of tactile stimuli. The tactile stimuli were applied one to each hand, with varying stimulus onset asynchronies (SOAs). Participants reported the location of the first stimulus (temporal order judgments: TOJs) while adopting both crossed and uncrossed hand postures, so we could scrutinize skin-based, anatomical, and external reference frames. With crossed hands, the sound improved TOJ performance at short (≤300 ms) and at long (>300 ms) SOAs. When the hands were uncrossed, the sound induced a decrease in TOJ performance, but only at short SOAs. A second experiment confirmed that the auditory stimulus indeed modulated tactile apparent motion perception under these conditions. Perceived apparent motion directions were more ambiguous with crossed than with uncrossed hands, probably indicating competing spatial codes in the crossed posture. However, irrespective of posture, the additional sound tended to impair potentially anatomically coded motion direction discrimination at a short SOA of 80 ms, but it significantly enhanced externally coded apparent motion perception at a long SOA of 500 ms. Anatomically coded motion signals imply incorrect TOJ responses with crossed hands, but correct responses when the hands are uncrossed; externally coded motion signals always point toward the correct TOJ response. Thus, taken together, these results suggest that apparent-motion signals are likely taken into account when tactile temporal–spatial information is reconstructed.

     

Building Opportunity: Developing City Systems to Expand and Improve After School Programs

A growing body of research is examining the strengths and weaknesses of specific after school programs and their effect on youth outcomes. Few reviews, however, have sought to examine the components of citywide system-building—to understand intentional efforts to develop, support and sustain high quality after school programming across a community. Beginning in the mid-1990s and continuing through the present, private funders, public officials and program practitioners in cities across America have joined together to build systems to support the expansion and improvement of after school programs at the city-level. This paper presents the community context and underlying principles that drove the development of Baltimore’s After-School Strategy; articulates a set of system components derived from this experience and the available literature; and lays out future work to expand high quality after-school opportunities for youth in Baltimore and in other distressed urban environments.