Research on the Wraparound Process: Intervention Components and Implementation Supports

In 1996, when the time since the advent of ‘‘systems of care’’ (Stroul and Friedman 1996) for youths with serious emotional and behavioral problems was still measured in terms of years and not decades, this journal provided the children’s services field with a landmark Special Issue focused on research on the wraparound process and individualized services for children with complex needs (Clark and Clarke 1996). The Special Issue aimed to provide the first comprehensive academic perspective on wraparound, which was at the time one of a variety of ‘‘innovative alternatives to highly restrictive, categorical services and costly institutional care’’ (p. 2), on which outcomes studies were only beginning to be published. The goals for the 1996 special issue were to: (a) provide a definition of the wraparound process and a rationale for its use, (b) illustrate potential applications of the approach, and (c) present results from studies that shed light on the potential for wraparound’s positive impact. As described by the Special Issue’s discussant (Rosenblatt 1996), the Special Issue also aimed to put this new strategy on a developmental pathway that would lead its specification and refinement to be guided by theory and research, rather than by ‘‘fad and fashion,’’ lest wraparound become yet another ‘‘program of great promise that fell by the wayside once [its] moment in the sun passed’’ (p. 114). Fifteen years later, we can report that far from falling by the wayside the wraparound process has become an organizing framework and prominent practice model through which community-based services for a broad range of populations with complex needs are delivered. As described by Bruns, Sather, Pullmann, and Stambaugh in this Special Section, it is estimated that the wraparound process is available via nearly 1,000 initiatives in nearly every one of the United States with the number of states taking implementation statewide increasing every year (Bruns et al. 2010). We also have observed that the field has continued to make progress in the areas discussed in the 1996 Special Issue. Wraparound’s principles, practice model, and organizational and system support conditions have undergone systematic examination over the past 10 years, in a way that intends to provide adequate specificity to permit replicability and quality assurance while maintaining the strategy’s ability to be adapted to local conditions and populations (Bruns et al. 2010; Walker and Bruns 2006; Walker et al. 2011). Nine controlled studies of wraparound are now in the peer reviewed literature (Bruns and Suter 2010), with a recently completed meta-analysis demonstrating significant positive effects and mean effect sizes ranging from 0.31 for mental health symptomotology to 0.44 for residential placement (Suter and Bruns 2009). Finally, examples of applications of wraparound continue to proliferate and gain national attention. The initiatives studied in the above reviews and meta-analysis span mental health, juvenile justice, and child welfare (Suter and Bruns 2009), and the wraparound process is now frequently referenced as a practice model that can facilitate integration of care for complex populations of all ages. Achieving E. J. Bruns (&) Division of Public Behavioral Health and Justice Policy, Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA e-mail: ebruns@u.washington.edu