OBJECTIVE: Wraparound is a common method for coordinating care for children and adolescents with serious emotional disorders (SED), with nearly 100,000 youths served annually in the United States. The current systematic review and meta-analysis estimated effects on youth outcomes (symptoms, functioning, school, juvenile justice, and residential placement) and costs.
METHOD: A literature search identified 17 peer-reviewed and gray literature studies meeting criteria, which were coded on characteristics of sample, design, implementation, and outcomes. Random effects modeling was conducted using Comprehensive Meta-Analysis Version 3.0. Effect sizes were calculated using Hedges g. Homogeneity of effects were assessed using Q statistics.
RESULTS: Medium-sized effects favored Wraparound-enrolled youths for costs (g=0.391, CI=0.282-0.500, p < .001), residential outcomes (g=0.413, CI=0.176-0.650, p=.001), and school functioning (g=0.397, CI=0.106-0.688, p=.007); small effects were found for mental health symptoms (g=0.358, CI=0.030-0.687, p=.033) and functioning (g=0.315, CI=0.086-0.545, p=.007). Larger effects were found for peer-reviewed studies, quasi-experimental designs, samples with a larger percentage of youths of color, and Wraparound conditions with higher fidelity.
CONCLUSION: Results indicate positive effects for Wraparound, especially for maintaining youths with SED in the home and community. However, many studies showed methodological weaknesses, and fidelity measurement was largely absent, suggesting a need for additional research. Nonetheless, the results should aid decisions around resource allocation, referral practices, and system partnerships among child psychiatrists and other behavioral health professionals.
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