Evaluating wraparound services for seriously emotionally disturbed youth: pilot study outcomes in Georgia

Adolescence, Winter, 2007 by Hilary L. Copp, Patrick S. Bordnick, Amy C. Traylor, Bruce A. Thyer

In the United States, nearly 21% of children and adolescents aged 9-17 are diagnosed with a mental health or addictive disorder that causes at least minimal impairment in daily functioning (U.S. Department of Health and Human Services [USDHHS], 1999). The most prevalent diagnoses are anxiety disorders (13%), disruptive disorders (10.3%), and mood disorders (6.2%) (USDHHS, 1999). Approximately 9-13% of all children and adolescents (6-9 million) are diagnosed with a severe emotional disturbance [SED] (Friedman et al., 1996), a legal term defined in 1993 by the Substance Abuse and Mental Health Services Administration [SAMHSA] as:

   Persons from birth up to age 18 who currently or at any time during
   the past year had a diagnosable mental, behavioral, or emotional
   disorder of sufficient duration to meet diagnostic criteria
   specified within the DSM-III-R, and that resulted in functional
   impairment which substantially interferes with or limits the
   child's role or functioning in family, school, or community
   activities (p. 29425).

These children may have legal, school, family, and social problems and require services from a number of different providers, but families are often left without the proper resources to manage the disorders or provide care for their child(ren) across service agencies. Navigating the many agencies providing services can be a daunting or impossible task for parents and caregivers. This approach leads to gaps in care and results in a lack of cohesion of services, leaving families without necessary resources. Given these serious issues, families of children with SEDs are in need of a comprehensive system of care to provide coordination of care.

In response to this need for coordination, the Substance Abuse and Mental Health Services Administration (SAMHSA) in the U.S. Department of Health and Human Services initiated the Comprehensive Community Mental Health Services for Children and Their Families Program in 1992 so as to provide grants to establish local systems of care for children with SEDs and their families in select communities throughout the U.S. and its territories; to date, 92 programs have been funded (USDHHS, 2004). The system of care model is based upon four primary concepts: that services should be family-centered and strengths-based; that services should be collaborative and community-based; that services should be culturally appropriate; and that families should be partners in the system of care (USDHHS, 2004). In 2001, SAMSHA awarded one such grant to a site in Georgia, where services were intended to serve families in three rural counties.

The SAMSHA Wraparound System of Care model is the largest mental health initiative ever undertaken in the United States, in terms of financing and scope. It has been widely adopted to deal with children's emotional problems, educational deficiencies, and juvenile delinquency issues (e.g., Hansen, Litzelman, Marsh, & Milspaw, 2004; Huffine, 2002; Walker & Schutte, 2004) and is beginning to have an impact on graduate training programs in the human services (e.g., Herrick, Arbuckle, & Claes, 2002). Relatively few empirical evaluations of comprehensive wraparound services appear to have been published, which is a conspicuous omission given the considerable public resources that have been expended on promulgating this model. Those that have been conducted seem to find comparatively few improvements among those children and families receiving wraparound services in comparison to those exposed to treatment-as-usual care available via the public educational, social service, mental health, and juvenile justice systems (Bickman, Smith, Lambert, & Andrade, 2003; Carney & Buttell, 2003).

This paper focuses on three primary objectives of the initial evaluation efforts for the Georgia site. The first objective was to examine the feasibility of implementing a comprehensive computer-based assessment protocol used to evaluate participant functioning. The second objective was to conduct an evaluation of children and families enrolled in the system of care at intake and at 6 months. The third objective was to provide empirically based feedback to the system of care service providers in order to improve program services and evaluation efforts.

METHOD

Procedures

To complete the first objective, laptop computers were loaded with standardized evaluation/instrumentation software developed by Macro International Inc., a private program-evaluation company that is the primary contracted evaluator for the national wraparound demonstration program sites. All laptop computers were synched with a web-based data upload system (Quick SAT Version 3.1, Macro International Inc.), which allows sites to upload evaluation data, track completion status, correct errors, receive feedback on progress of data collection, and download individual and cumulative reports. Three graduate-level social workers were trained in the use of the laptop-based Macro International software, interview protocol, clinical assessment instruments, and data upload procedures. Upon completion of training, all interviewers were prepared to conduct field interviews for the evaluation project.