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Wraparound Process

Wraparound is a youth-guided, family-driven team planning process that provides coordinated and 

individualized community-based services for youths and their families to help them achieve positive 

outcomes. It is a multifaceted, system-level intervention designed to keep youths with serious 

emotional and behavior disorders (SEBDs) at home and out of institutions whenever possible (Suter 

and Bruns 2006; Bruns et al. 2010; Winters and Metz 2009). As the name suggests, this process involves 

“wrapping” a comprehensive array of individualized services and support networks “around” young 

people in the community, rather than forcing them to enroll in predetermined, inflexible treatment 

programs (National Wraparound Initiative Advisory Group 2003). The approach emerged during the 

1980s as a community-based alternative to institutionalization for youth with complex behavioral 

problems. Wraparound was designed to address the gaps in the system that youths and their families 

often encountered when seeking help for SEBDs, such as uncoordinated and delayed service responses, 

and inadequate services that did not provide youth with required treatment (Wilson 2008). Annually, 

about 100,000 youths around the country engage in a well-defined wraparound process (Bruns 2008). 

Wraparound was first developed and implemented in the mental health field for children and 

adolescents with SEBDs, but various other child-serving agencies (including juvenile justice, education, 

and child welfare) have begun to integrate the wraparound process into their systems as well. In the 

juvenile justice system, wraparound has generally been used as a way to divert youths from detention, 

but the process has also helped provide coordinated services to youths as they transition back into the 

community following placement in secure, residential facilities (Bruns 2008). Often youths with SEBDs 

are involved in more than one child-serving agency (for example, the juvenile justice and child welfare 

system). The wraparound process provides coordination across the various agencies, so that youths 

receive the services they need without complication. For example, Wraparound Milwaukee, a wellknown wraparound program in Wisconsin, is part of the Milwaukee County Human Services 

Department and provides services to youths involved in the juvenile justice and child welfare systems. 

Services include in-home therapy, medication management, psychiatric assessment, outpatient 

individual family therapy, treatment foster care, and alcohol/substance abuse counseling, among many 

others (Kamradt 2000). 

Although one of the central features of the wraparound approach is individual case management, 

wraparound interventions should not be confused with traditional case management programs. 

Conventional case management programs merely provide youths with individual case managers (or 

probation officer) who guides them through the existing social services or juvenile justice system 

(Burchard, Bruns, and Burchard 2002). These case management programs do not operate in the same

Suggested Reference: Development Services Group, Inc. 2014. “Wraparound Process.” Literature review. Washington, D.C.: 

Office of Juvenile Justice and Delinquency Prevention. https://www.ojjdp.gov/mpg/litreviews/Wraparound_Process.pdf Prepared 

by Development Services Group, Inc., under cooperative agreement number 2013–JF–FX–K002. Points of view or opinions 

expressed in this document are those of the author and do not necessarily represent the official position or policies of OJJDP or 

the U.S. Department of Justice.
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highly structured, integrated services environment that characterizes true wraparound initiatives. 

The wraparound process is closely tied with the system-of-care (SOC) framework. The SOC framework 

was developed by the Child and Adolescent Service System Program (CASSP) and is defined as a 

“comprehensive spectrum of mental health and other services and supports organized into a 

coordinated network to meet the diverse and changing needs of children and adolescents with severe 

emotional disorders and their families” (Winters and Metz 2009, 136). Wraparound is viewed as an 

approach to provide youth with complicated and multidimensional behavioral problems with 

individualized, comprehensive services within a SOC (Burns and Goldman 1999, 11). Wraparound 

interventions are generally a part of SOC frameworks and align with the basic principles of SOC, thus 

the two initiatives are often thought of interchangeably. However, the evidence and research examining 

the effectiveness of SOC does not necessarily speak to the effectiveness of the wraparound process, and 

vice versa (Suter and Bruns 2009). Unfortunately, there is limited research looking at the impact of 

either approach on youth-related outcomes and therefore comparing the effectiveness of wraparound 

and SOC is difficult.

Lack of a Standard Definition

Numerous public agencies and research organizations—including the National Mental Health 

Association, the U.S. Surgeon General’s Office, the National Wraparound Initiative, and the Substance 

Abuse and Mental Health Services Administration—have offered their own definitions of what 

constitutes a fully realized wraparound program. 

While definitions may vary, there is a general consensus that true wraparound programs feature several 

basic elements, including

 A collaborative, community-based interagency team that is responsible for designing, 

implementing, and overseeing the wraparound initiative in a given jurisdiction. This team 

usually consists of representatives from the juvenile justice system, the public education system, 

and local mental health and social service agencies. In most cases, one specific agency is 

designated the lead agency in coordinating the wraparound effort.

 A formal interagency agreement that records the proposed design of the wraparound initiative 

and spells out exactly how the wraparound effort will work. At a minimum, this agreement 

should specify the target population for the initiative; how they will be enrolled in the program; 

how services will be delivered and paid for; what roles different agencies and individuals will 

play; and what resources will be committed by various groups. 

 Care coordinators who are responsible for helping participants create a customized treatment 

program, as well as for guiding youths and their families through the system of care. In most 

wraparound programs, these care coordinators are employees of the designated lead agency, 

which may be a public program or a private nonprofit agency.

 Child and family teams consisting of family members, paid service providers, and community 

members (such as teachers and mentors), who know the youth under treatment and are familiar 
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with his or her changing needs. Assembled and led by the care coordinator, these teams work 

together to ensure that the child’s needs are being met across all domains—in the home, in the 

educational sphere, and in the broader community at large.

 A unified plan of care developed and updated collectively by all the members of the child and 

family team. This plan of care identifies the child’s specific strengths and weaknesses in different 

areas, targets specific goals for them, and outlines the steps necessary to achieve those goals. It 

also specifies the role each team member (including the child and family) will have in carrying 

out the plan. Ideally, the plan is updated constantly to reflect the child’s changing needs and 

progress.

 Systematic, outcomes-based services. Almost all wraparound programs require clearly defined 

performance measures, which are used to track the progress of the wraparound initiative and 

guide its evolution over time.

In an effort to better refine a definition, Walker and Bruns (2006) organized a multidisciplinary advisory 

group of 29 individuals (including researchers, family advocates, and program administrators) familiar 

with the wraparound process. The group was asked to respond to a proposed set of 31 activities that 

had been synthesized from various manuals and model descriptions of the wraparound process. The 

specific activities were divided into four phases of the wraparound process: 

1. Engagement and team preparation

2. Initial plan development

3. Plan implementation

4. Transition

Overall, the advisory group was in unanimous or near-unanimous agreement that 23 of the activities 

were essential to implementing the wraparound process, including orienting the youth and family to 

wraparound, asking family and youth about immediate crisis concerns, determining the ground rules 

of an initial plan of care, tracking the progress on action steps from the individualized plan, and creating 

a transition plan (for a full list of the 23 activities, see Walker and Bruns 2006, 1583). 

Theoretical Framework (10 Principles of the Wraparound Process)

In response to the need for a standard definition and guiding framework, the National Wraparound 

Initiative (NWI) has produced several resource guides to enhance understanding of wraparound and 

assist in high-quality implementation of the process. The NWI organized 10 principles of the 

wraparound process that can guide policymakers and practitioners interested in adopting the process. 

Those 10 principles are

1. Family voice and choice. Family and youth/child perspectives are intentionally elicited and 

prioritized during all phases of the wraparound process. Planning is grounded in family 

members’ perspectives, and the team strives to provide options and choices such that the plan 

reflects family values and preferences.
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2. Team based. The wraparound team consists of individuals agreed on by the family, and 

committed to the family through informal, formal, and community support and service 

relationships.

3. Natural supports. The team actively seeks out and encourages the full participation of team 

members drawn from family members’ networks of interpersonal and community 

relationships. The wraparound plan reflects activities and interventions that draw on sources of 

natural support.

4. Collaboration. Team members work cooperatively and share responsibility for developing, 

implementing, monitoring, and evaluating a single wraparound plan. The plan reflects a 

blending of team members’ perspectives, mandates, and resources. The plan guides and 

coordinates each team member’s work toward meeting the team’s goals.

5. Community based. The wraparound team implements service and support strategies that take 

place in the most inclusive, most responsive, most accessible, and least restrictive settings 

possible, and that safely promote child and family integration into home and community life.

6. Culturally competent. The wraparound process demonstrates respect for and builds on the 

values, preferences, beliefs, culture, and identity of the child/youth and family, and of their 

community.

7. Individualized. To achieve the goals laid out in the wraparound plan, the team develops and 

implements a customized set of strategies, supports, and services.

8. Strengths based. The wraparound process and the wraparound plan identify, build on, and 

enhance the capabilities, knowledge, skills, and assets of the child and family, and their 

community, and other team members.

9. Unconditional. A wraparound team does not give up on, blame, or reject children, youths, and 

their families. When faced with challenges or setbacks, the team continues working toward 

meeting the needs of the youth and family and toward achieving the goals in the wraparound 

plan until the team reaches agreement that a formal wraparound process is no longer necessary.

10. Outcome based. The team ties the goals and strategies of the wraparound plan to observable or 

measurable indicators of success, monitors progress in terms of these indicators, and revises the 

plan accordingly. [Bruns, Walker, and National Wraparound Initiative Advisory Group 2008, 

3–9] 

Although the principles provide the value base of the wraparound process, some have argued that 

there is not enough specific description for practitioners or services providers to implement the model 

in a real-world setting (Walker and Bruns 2006). The NWI has updated the online “Resource Guide to 

Wraparound” to provide information about the implementation process (the guide is available at 

http://www.nwi.pdx.edu/NWI-book/index.shtml). For example, a few fidelity assessment tools have 

been developed for practitioners. A Wraparound Fidelity Index assesses adherence to the philosophical 
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principles by interviewing team members while the Wraparound Observation Form was designed to 

determine whether essential elements are used during team meetings (Walker and Bruns 2006). 

However, the team meetings are only one part of the wraparound process, and specific, comprehensive 

guides are still needed.

Outcome Evidence

Suter and Bruns (2008) conducted a narrative review of outcome studies examining wraparound 

services provided to children and adolescents with SEBDs, including youths involved in the juvenile 

justice system. The search process for the narrative review yielded 36 unique studies, including singlecase design studies, single-group pretest/posttest studies, quasi-experimental group comparison 

studies, and experimental randomized controlled trial studies. The authors found that the majority of 

studies had serious methodological limitations (including a lack of comparison groups in several 

instances). Overall, the results from the outcome studies were mixed, with some studies showing strong 

positive results, others showing no significant results, and some studies showing negative effects.

In 2009, Suter and Bruns conducted a meta-analysis of outcome studies examining the effectiveness of 

the wraparound process. Because they included only experimental and quasi-experimental design 

studies, the search process yielded only seven controlled outcome studies, of which two specifically 

targeted juvenile justice–involved youth (the authors noted that 80 percent of the outcome studies 

identified for the 2008 narrative review could not be included in the current meta-analysis because of 

the study designs). The overall mean effect size across all of the studies (0.33) was moderate and 

significant, suggesting that the average youth receiving wraparound services was better off than 63 

percent of those receiving conventional services or treatment as usual. When examining specific 

outcomes (such as mental health and youth functioning), the effect sizes were positive (favoring the 

youths receiving wraparound services) and significant, but mostly small. The juvenile justice–related 

outcome (which was not defined in the review) also had a significant, but small, effect size. The findings 

suggest the wraparound process could make positive impacts on youth. However, the authors caution 

that a major limitation of the current review is the variability in the methodological quality of the 

included studies. They note concerns about the studies’ designs, the comparability among groups, and 

unreported levels of attrition. Based on the limited research, the authors concluded that “the 

wraparound process shows modest evidence of both efficacy and effectiveness, but does not meet the 

strict criteria for EBTs [evidence-based treatments]” (Suter and Bruns 2009, 346).

Although there have been evaluation studies examining the effectiveness of the wraparound process 

on youth-related outcomes, there have only been a few that have specifically included youth involved 

in the juvenile justice system, and the results from those evaluations have shown inconsistent results. 

One example of a juvenile justice–focused evaluation is the study of the Connections program in Clark 

County, Wash. A part of Washington state’s broader SOC initiative, Connections uses the wraparound 

model to engage youths with mental health needs who are involved in the juvenile justice system. 

Youth and family teams are convened to identify needs and coordinate services among multiple service 

providers. Services may include family therapy, clinical therapy, substance abuse treatment, special 

education, medication, caregiver support, public assistance, housing, and mental health care. An 

evaluation of the program found that youths in the Connections program were significantly less likely 

to commit any type of offense, were significantly less likely to commit a felony offense, and spent 

significantly fewer days in detention compared with youths in the comparison group who were not a 

part of the program (Pullman et al. 2006).

Conversely, evaluations of the Repeat Offender Prevention Program (ROPP) in California did not find 

significant positive effects on youth. From 1996 to 2002, California’s multisite demonstration program, 
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ROPP, offered wraparound services to a wide variety of at-risk youths between the ages of 8 and 15, 

including first-time offenders, youth with chronic truancy problems, gang-involved youth, and 

substance-abusing youth. Participants in the program were constantly assessed and monitored by 

multidisciplinary teams (including family members), who created individualized intensive supervision 

programs for each child. However, a 2002 study conducted by Howard and colleagues in San Diego 

County, Calif., found there were no significant differences between the ROPP group and the control 

group on petitions for new offenses, measures of warrant status, days spent in custody, and education 

outcomes (including grade-point averages). The ROPP group did have significantly more petitions filed 

for probation violations compared with the control group. A 2005 study by Zhang and Zhang upstate 

in Los Angeles County found no significant differences between the ROPP group and the control group 

on petitions for new offenses, petitions for probation violations, and education outcomes. (Notably, the 

ROPP was implemented in conjunction with intensive supervision, and was not strictly a wraparound 

intervention. In addition, ROPP was implemented slightly differently at the various sites participating 

in the demonstration program).

For more information on the programs, please click on the links below.

Connections

California’s Repeat Offender Prevention Program (ROPP)

Overall, the evidence suggests that implementing a wraparound process could have positive benefits 

for youth. However, there is a need for more rigorous evaluation research on the effectiveness of the 

wraparound process, and a specific need for research concentrating on youth involved in the juvenile 

justice system. For example, although Wraparound Milwaukee is well known for employing the 

wraparound approach with youth in the juvenile justice system, a rigorous experimental or quasiexperimental study has not yet been undertaken to examine the program’s impact on youth (Kamradt 

2000).

References

Bruns, Eric J. 2008. “The Evidence Base and Wraparound.” In Eric J. Bruns and Janet S. Walker (eds.). 

The Resource Guide to Wraparound. Portland, Ore.: Portland State University, National Wraparound 

Initiative, Research and Training Center for Family Support and Children’s Mental Health.

Bruns, Eric J., Janet S. Walker, and the National Wraparound Initiative Advisory Group. 2008. “Ten 

Principles of the Wraparound Process.” In Eric J. Bruns and Janet S. Walker (eds.). The Resource 

Guide to Wraparound. Portland, Ore.: Portland State University, National Wraparound Initiative, 

Research and Training Center for Family Support and Children’s Mental Health.

Bruns, Eric J., Janet S. Walker, Michelle Zabel, Marlene Matarese, Kimberly Estep, Deborah 

Harburger, Madge Mosby, and Sheila A. Pires. 2010. “Intervening in the Lives of Youth With 

Complex Behavioral Health Challenges and Their Families: The Role of the Wraparound Process.” 

American Journal of Community Psychology 46(3–4):314–31.

Burchard, John D., Eric J. Bruns, and Sara N. Burchard. 2002. “The Wraparound Process.” In Barbara 

J. Burns, Kimberly Hoagwood, and M. English (eds.). Community-Based Treatment for Youth. New 

York, N.Y.: Oxford University Press.

Burns, Barbara J., and Sybil K. Goldman (eds.). 1999. “Promising Practices in Wraparound for 

Children With Serious Emotional Disturbance and Their Families.” Systems of Care: Promising 

Practices in Children’s Mental Health, 1998 Series, Volume 4. Washington, D.C.: Center for Effective 

Collaboration and Practice, American Institutes of Research.
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Howard, Lisbeth, Gina Misch, Cynthia Burke, and Susan Pennell. 2002. San Diego County Probation 

Department’s Repeat Offender Prevention Program Final Evaluation Report. San Diego, Calif.: San 

Diego Association of Governments.

Kamradt, Bruce J. 2000. “Wraparound Milwaukee: Aiding Youth With Mental Health Needs.” Juvenile 

Justice 7(1):14–23.

National Wraparound Initiative Advisory Group. 2003. History of the Wraparound Process. Focal Point 

Bulletin. Portland, Ore.: Portland State University, National Wraparound Initiative, Research and 

Training Center on Family Support and Children’s Mental Health.

Pullman, Michael D., Jodi Kerbs, Nancy Koroloff, Ernie Veach–White, Rita Gaylor, and DeDe Sieler. 

2006. “Juvenile Offenders With Mental Health Needs: Reducing Recidivism Using Wraparound.” 

Crime and Delinquency 52(3):375–97.

Suter, Jesse C., and Eric J. Bruns. 2008. A Narrative Review of Wraparound Outcome Studies. In Eric J. 

Bruns and Janet S. Walker (eds.). The Resource Guide to Wraparound. Portland, Ore.: National 

Wraparound Initiative Research and Training Center for Family Support and Children’s Mental 

Health.http://www.nwi.pdx.edu/NWI-book/Chapters/Suter-3.3-%28review-of-wrap-lit%29.pdf

Suter, Jesse C., and Eric J. Bruns. 2009. “Effectiveness of the Wraparound Process for Children with 

Emotional and Behavioral Disorders: A Meta-Analysis.” Clinical Child and Family Psychology 

Review 12:336–51.

State of California Board of Corrections. 2002. Repeat Offender Prevention Program. Sacramento, Calif.: 

State of California Board of Corrections.

Walker, Janet S., and Eric J. Bruns. 2006. “Building on Practice Based Evidence: Using Expert 

Perspectives to Define the Wraparound Process.” Psychiatric Services 57(11):1579–85.

Wilson, Kate J. 2008. Literature Review: Wraparound Services for Juvenile and Adult Offender Populations. A 

report prepared for the California Department of Corrections and Rehabilitation. Davis, Calif.: 

University of California, Davis, Center for Public Policy Research. 

http://www.cdcr.ca.gov/Adult_Research_Branch/Research_Documents/Wraparound_Services_

UCDAVIS_Jan_2008.pdf

Winters, Nancy C., and W. Peter Metz. 2009. “The Wraparound Approach in Systems of Care.” 

Psychiatric Clinics of North America 32:135–51.

Zhang, Sheldon X., and Lening Zhang. 2005. “An Experimental Study of the Los Angeles County 

Repeat Offender Program: Its Implementation and Evaluation.” Criminology and Public Policy

4(2):205–36.