Outcomes of Wraparound Care Coordination for Youth with Complex Behavioral Health Needs

Thesis (Master's)--University of Washington, 2019Background. Approximately 10% of youth in the US are estimated to experience “serious emotional disorder,” or SED. Wraparound is a commonly implemented care coordination process for youth with SED and complex needs, but effectiveness research is sparse, and results have been mixed. RCTs have found favorable effects of Wraparound on child welfare placements and service utilization in their samples, but only two RCTs have measured youth emotional and behavioral functioning outcomes directly, and they have found null results. Thus, the need for more evidence about the effectiveness of Wraparound on youth functioning remains. This study uses a propensity-score-matched comparison group to measure the effectiveness of Wraparound on youth functioning across multiple areas of need. Methods. Data from this study come from a large 501(c)(3) non-profit behavioral health provider agency with multiple locations in California. All youth who received services through this agency between October 1, 2015 and December 17, 2018 and who completed assessments of emotional and behavioral functioning at intake and six-months after enrollment were eligible for inclusion in the study. A total of 129 Wraparound-enrolled youth were included. These youth were propensity-score-matched on 13 relevant demographic and clinical acuity variables to youth who received services other than Wraparound (N = 1,154 youth). After matching, 122 Wraparound-enrolled and 122 comparison youth were included for analyses. Youth functioning was measured using the Child and Adolescent Needs and Strengths (CANS), an assessment that rates youth functioning with respect to the “actionability” of discrete needs. We measured change in three ways: the net change in number of needs considered “actionable,” the number of needs resolved after six months, and the number of new needs after six months. Matching successfully balanced youth with respect to baseline functioning. Linear regressions and negative binomial regressions were used to compare change scores between the Wraparound-enrolled and comparison youth. Results. Wraparound youth experienced a greater net reduction in actionable needs after six months (Mean Difference: -0.36, 95%CI: -2.03, +1.32), though confidence intervals were wide such that this difference was non-significant. Similarly, Wraparound youth experienced both a greater reduction in actionable needs (IRR: 1.32, 95%CI: 0.98, 1.79) and had new needs discovered more often than non-Wraparound youth (IRR: 1.23, 95%CI: 0.92, 1.65), though neither of these outcomes differed significantly between the two groups. Conclusions. Our results contribute to the growing effectiveness research base on the behavioral, emotional, and functional impacts of Wraparound. Although the estimated effects of Wraparound in this study only approached significance, between-group differences were clinically meaningful as per conventions for interpreting results from the CANS. The resolution and discovery of more needs after six months may be explained by the additional and intensive time spent with families by Wraparound provider staff