Outcomes of the Wraparound Service Model

描述（由申请人提供）：在过去的几年里，围绕服务模式（WSM）的原则、程序和实施措施开始形成共识，WSM是一种流行的针对严重情绪障碍儿童（SED）及其家庭的个性化和团队化护理管理流程。该研究将采用随机设计，对内华达州克拉克县护理系统中经历SED的儿童和青少年进行详细说明和手册化的WSM试点测试。这一标准化WSM的探索性研究将作为重要的首次试点试验；尽管在全国数百个社区实施了WSM，但由于干预程序不规范和研究基础不发达，对WSM潜在影响的确定受到了阻碍。利用内华达州立法授权的行为卫生保健服务重新设计提供的机会，与该州SAMHSA资助的护理系统赠款相关联，并得到该州最近收到的SAMHSA州基础设施赠款（SIG）的支持，拟议的研究将实现三个主要目标。首先，它将确定在内华达州使用手动和标准化的质量保证方法实施WSM是否比随机分配到非一揽子病例管理计划（典型病例管理或中医）的儿童更遵守一揽子原则。其次，它将确定接受SED和WSM的儿童和青少年是否比随机接受中医治疗的儿童有更好的行为和功能结果，并确定WSM过程的保真度在临床和功能结果中的调节作用。第三，为了与研究的探索性保持一致，将对数据进行分析，以扩展目前对研究中使用的WSM保真度测量的心理测量学的理解，检查儿童和青少年亚人群的结果，并探讨两个研究组接受服务的差异。鉴于在全国范围内的护理系统中广泛关注和实施“全面”型过程，该研究的结果将立即产生政策影响，并为进一步的大规模功效和有效性研究奠定基础。

DESCRIPTION (provided by applicant): Over the past several years, consensus has begun to emerge on the principles, procedures, and implementation measures for the wraparound service model (WSM), a popular individualized and team based care management process for children with serious emotional disturbance (SED) and their families. The proposed study will use a randomized design to pilot test a well-specified and manualized WSM for children and adolescents experiencing SED and being served within the Clark County, Nevada, system of care. This exploratory study of a standardized WSM will serve as an important first pilot test; despite being implemented in hundreds of communities nationally, determination of WSM's potential for impact has been hampered by inadequate specification of the intervention procedures and a poorly-developed research base. Capitalizing on an opportunity presented through a legislatively mandated behavioral health care services redesign in Nevada, associated with the state's SAMHSA-funded system-of-care grant, and supported by the state's recent receipt of a SAMHSA state infrastructure grant (SIG), the proposed study will accomplish three primary aims. First, it will determine if implementation of WSM in Nevada using manualized and standardized quality assurance methods results in greater adherence to wraparound principles than for children randomized to a non-wraparound case management program (typical case management or TCM). Second, it will determine if children and adolescents experiencing SED and randomized to WSM experience superior behavioral and functional outcomes than children randomized to the TCM condition and determine the role of fidelity to the WSM process as a moderator of clinical and functional outcomes. Third, in keeping with the study's exploratory nature, data will be analyzed to extend the current understanding of psychometrics of the WSM fidelity measures employed in the study, examine outcomes for subpopulations of children and youth, and explore differences in services received by the two study groups. Given the widespread interest and implementation of "wraparound" type processes in systems of care nationwide, results of the study will have immediate policy implications, as well as set the stage for further large scale efficacy and effectiveness studies.