Outcomes of the Wraparound Service Model

描述(申请人提供)：在过去的几年里，人们开始就综合服务模式(WSM)的原则、程序和实施措施达成共识。WSM是一种流行的个性化和基于团队的护理管理流程，适用于患有严重情绪障碍(SED)的儿童及其家庭。这项拟议的研究将使用随机设计，为患有SED并在内华达州克拉克县护理系统中得到服务的儿童和青少年试行一种明确规定的和手动的WSM。这项对标准化水资源管理的探索性研究将作为一项重要的第一次试点测试；尽管在全国数百个社区实施，但由于干预程序不够具体和研究基础不发达，水资源管理潜在影响的确定一直受到阻碍。利用内华达州立法授权的行为医疗服务重新设计带来的机会，与该州SAMHSA资助的护理系统拨款相关，以及该州最近收到SAMHSA州基础设施拨款(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标准化和标准化的质量保证方法实施WSM是否比随机接受非概括性病例管理计划(典型病例管理或中医)的儿童更遵守概括性原则。其次，它将确定经历SED并随机接受西药治疗的儿童和青少年是否比随机接受中医治疗的儿童获得更好的行为和功能结果，并确定对西药过程的忠诚度作为临床和功能结果的调节因素所起的作用。第三，根据这项研究的探索性性质，将分析数据，以扩大目前对研究中使用的WSM保真度测量的心理测量学的理解，检查儿童和青年亚群的结果，并探索两个研究小组接受的服务的差异。鉴于全国保健系统对“环绕式”程序的广泛关注和实施，这项研究的结果将立即产生政策影响，并为进一步进行大规模的功效和效果研究奠定基础。

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.