Caregiver perceptions of Parent Peer Support Services within the Wraparound Service Delivery Model

This qualitative study examined caregivers’ perceptions of Parent Peer Support (PPS) services, embedded in the Wraparound service delivery model for youth with severe emotional and behavioral disturbances (SEBD), to identify potential engagement facilitators and barriers. Wraparound is a holistic process involving multiple formal and informal providers to collectively implement an individualized, family-centered plan of care focused on maintaining youth with SEBD within the community. PPS are frequently referred to caregivers involved in Wraparound to provide additional support. Caregivers (n?=?35) previously involved in an evaluation of one state’s Wraparound model participated in a single 30–60-min interview. Interview questions examined caregivers’ expectations about PPS, reasons for accepting or refusing PPS, and caregivers’ perceived impact of PPS. Transcribed interviews were analyzed using strategies from grounded theory methodology. Perceived need, as well as desire for shared experiences, knowledge, and assistance in accessing resources, facilitated accepting the PPS service. Barriers included inaccurate expectations of PPS, time limitations on Wraparound services, escalating youth behavior requiring more restrictive placements, scheduling difficulties, perceived unresponsiveness, and caregivers feeling overwhelmed by the number of providers. Caregivers indicated that PPS provided several benefits for themselves, youth in the care, and their families. However, potential barriers to ongoing engagement included perceived intrusiveness, as well as misalignment between services offered and caregivers’ needs.     

National Trends in Implementing Wraparound: Results from the State Wraparound Survey

The wraparound process has been promoted in the children’s services field as a mechanism to achieve collaborative service planning and delivery for families of young people with complex emotional and behavioral needs that span multiple agencies. We compared results of two surveys of state children’s mental health directors, completed in 1998 and 2008, to derive estimates of the extent of wraparound implementation in the United States and to better understand trends in how wraparound has been implemented and supported over time. Results from 2008 found that 88% of states reported having some type of wraparound program that conformed to the definition and provided an estimate of 100,000 children and families served via wraparound in that year. Between 1998 and 2008, states reported increased application of wraparound standards, a greater number of agencies involved in wraparound initiatives, and more formal evaluations of wraparound initiatives. Results provide substantiation of the widespread implementation of wraparound implementation in the United States, and evidence that the model is becoming more consistently supported by formal implementation structures over time.     

Implementation Research and Wraparound Literature: Building a Research Agenda

We used the framework identified by the National Implementation Research Network’s (NIRN) analysis of 35 years of implementation outcomes literature from diverse fields of endeavor to review the current state of wraparound implementation research. Model definition, model fidelity and intervention outcomes were areas of relatively greater development, while target population, theory base and theory of change, organizational context and readiness, staff selection, training, supervision or coaching, purveyor selection, and program installation were less examined or even overlooked. We conclude with suggestions for building a research agenda on wraparound implementation.     

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.     

Collective Apologies and Their Effects on Forgiveness: Pessimistic Evidence but Constructive Implications

In the last three decades, there has been an explosion in the frequency with which leaders of groups have issued official apologies for collective transgressions. These apologies are commonly assumed to lay a pathway to forgiveness and reconciliation, but empirical examination of the downstream consequences of collective apologies is still in its infancy. In this article, we review a series of studies—including interview studies, survey studies, and experiments—that question the assumed wisdom that collective apologies lead to intergroup forgiveness. Reasons for the muted evidence of an apology–forgiveness link at the intergroup level are elaborated, and implications for how best to issue gestures of reconciliation and remorse are discussed.     

Expansion of Genetic Services Utilizing a General Genetic Counseling Clinic

We established a general genetic counseling clinic (GCC) to help reduce long wait times for new patient appointments and to enhance services for a subset of patients. Genetic counselors, who are licensed in Tennessee, were the primary providers and MD geneticists served as medical advisors. This article describes the clinic referral sources, reasons for referral and patient dispositions following their GCC visit(s). We obtained patients by triaging referrals made to our medical genetics division. Over 24 months, our GCC provided timely visits for 321 patients, allowing the MD geneticists to focus on patients needing a clinical exam and/or complex medical management. Following their GCC visit(s), over 80 % of patients did not need additional appointments with an MD geneticist. The GCC allowed the genetic counselor to spend more time with patients than is possible in our traditional medical genetics clinic. Patient satisfaction surveys (n?=?30) were very positive overall concerning the care provided. Added benefits for the genetic counselors were increased professional responsibility, autonomy and visibility as health care providers. We conclude that genetic counselors are accepted as health care providers by patients and referring providers for a subset of clinical genetics cases. A GCC can expand genetic services, complement more traditional genetic clinic models and utilize the strengths of the genetic counselor health care provider.