Effects of the Wraparound Service Model for Maltreated Youth in a System of Care

描述（由申请人提供）：每年，有超过200万的国家儿童保护服务（CPS）调查涉嫌虐待，但有限的循证服务，降低CPS识别儿童的高发育和健康相关障碍率。对NIH探索性发展研究资助计划（R21：PA-10-069）的回应检查了证据支持的干预模式的效果，CPS识别的儿童和家庭被转介到全州儿童行为健康护理系统中的服务。一个有前途的做法，以增加服务的访问和减少随后的损害CPS确定的儿童是环绕式服务模式（WSM）。这种模式采用以家庭为中心、以团队为基础的规划过程，为儿童和家庭提供个性化的社区服务和自然支持。越来越多的州将WSM用于儿童福利人群，尽管对其有效性的研究有限，特别是在CPS内。本研究采用了严格的准实验设计，比较250 CPS确定的儿童提到的WSM或传统的非环绕式服务（NWS）在全州范围内的儿童和家庭护理系统。以前的研究表明，在这个研究网站中提到NWS的个人与在一系列儿童和家庭领域中提到WSM的人相当。本研究探讨了WSM的有效性，通过一种新的应用倾向评分方法与前瞻性队列设计，以调整潜在的组间差异，由于选择偏倚的条件。倾向评分法调整了影响研究条件分配的因素，并在假设检验前重新平衡了治疗组和对照组的特征。本研究的目的之一是测试6个月的干预效果的WSM改善儿童和家庭的临床，行为和功能的结果。另一个目的是研究假设的调解人（增强保真度WSM原则，增加家庭的支持，并更多地参与社区服务）对观察到的WSM效果。这一创新的结果将：a）为使用CPS人群的WSM制定系统级干预措施提供信息，B）确认在随机化不切实际或不可能的公共系统中进行有效性试验的倾向评分方法的可行性和适当性; c）推进CPS识别人群的WSM研究基础，以便为目前在该模型中投入资源的州提供信息; d）开展一项R 01研究，调查WSM在一个或多个州对受虐待儿童的有效性，这些州投资于这一服务模式; e）促进为CPS识别的儿童制定新的实践标准和公共政策; f）推进多个NIMH优先事项，以开发和测试干预研究的创新设计，加强在不同社区环境中使用心理健康干预措施，促进更个性化的治疗方法，并使用州一级的行政数据进行政策相关的精神卫生服务研究（例如，RFA-MH-09-050）。

DESCRIPTION (provided by applicant): Each year, there are over 2 million state child protective service (CPS) investigations of suspected maltreatment, but limited evidence-based services that reduce the high rates of developmental and health- related impairments for CPS-identified children. This response to NIH Exploratory Developmental Research Grant Program (R21: PA-10-069) examines the effects of an evidence-supported intervention model with CPS- identified children and families referred to services within a statewide children's behavioral health system of care. A promising practice to increase service access and reduce subsequent impairments for CPS-identified children is the wraparound service model (WSM). This model uses a family-centered, team-based planning process to provide individualized community-based services and natural supports for children and families. Increasingly, states use the WSM with child welfare populations, despite limited research on its effectiveness, particularly within CPS. This study employs a rigorous quasi-experimental design to compare 250 CPS- identified children referred to either the WSM or traditional non-wraparound services (NWS) in a statewide system of care for children and families. Previous research has shown that individuals referred to NWS in this study site are comparable to those referred to the WSM on a range of child and family domains. The present study examines the effectiveness of the WSM through a novel application of propensity score methods with a prospective cohort design to adjust for potential group differences due to selection bias across conditions. Propensity score methods adjust for factors that influence assignment to study conditions and re-balance characteristics of the treatment and comparison groups before hypothesis testing. One aim of this study is to test 6-month intervention effects of the WSM on improvements in child and family clinical, behavioral, and functional outcomes. Another aim is to study hypothesized mediators (enhanced fidelity to WSM principles, increased family support, and greater engagement in community services) on observed WSM effects. The results of this innovation will: a) inform the development of systems-level interventions using the WSM with CPS populations, b) confirm the feasibility and appropriateness of propensity score methods to conduct effectiveness trials in public systems where randomization is not practical or possible; c) advance the WSM research base for CPS-identified populations so as to inform states currently investing resources in this model; d) lead to the development of an R01 study to investigate the effectiveness of the WSM with maltreated children across one or more of the multiple states investing in this service model; e) promote the emergence of new standards of practice and public policy for CPS-identified children; and f) advance multiple NIMH priorities to develop and test innovative designs for intervention research, strengthen the use of mental health interventions in diverse community settings, promote more personalized treatment approaches, and use state- level administrative data for policy relevant mental health services research (e.g., RFA-MH-09-050).