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）调查疑似虐待，但基于证据的服务有限，以减少CPS确定的儿童的发展和健康相关损害的高比例。本研究是对美国国立卫生研究院探索性发展研究资助计划（R21: PA-10-069）的回应，研究了一种证据支持的干预模式的效果，该模式涉及全国范围内儿童行为卫生保健系统内的儿童和家庭服务。围绕式服务模型（wraparound service model， WSM）是一种很有前景的做法，可以增加服务可及性，并减少被识别为cps的儿童的后续损害。该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。各州越来越多地在儿童福利人群中使用WSM，尽管对其有效性的研究有限，特别是在CPS内。本研究采用严格的准实验设计来比较250名CPS识别的儿童，这些儿童在全州范围内的儿童和家庭护理系统中被称为WSM或传统的非环绕服务（NWS）。先前的研究表明，在本研究网站中，被称为NWS的个体与被称为WSM的个体在一系列儿童和家庭领域上是相当的。本研究通过一种新颖的应用倾向评分方法和前瞻性队列设计来检验WSM的有效性，以调整由于不同条件下的选择偏倚而导致的潜在组差异。倾向评分方法在假设检验之前调整影响研究条件分配的因素，并重新平衡实验组和对照组的特征。本研究的目的之一是测试6个月WSM对改善儿童和家庭临床、行为和功能结果的干预效果。另一个目的是研究观察到的WSM效应的假设中介（增强对WSM原则的忠诚，增加家庭支持和更多地参与社区服务）。这一创新的结果将：a)为在CPS人群中使用WSM的系统级干预措施的开发提供信息，b)确认倾向评分方法在随机化不实际或不可能的公共系统中进行有效性试验的可行性和适宜性；c)推进针对cps识别人群的WSM研究基地，以便告知目前在该模式中投入资源的国家；d)开展一项R01研究，以调查在投资该服务模式的多个州中的一个或多个州，WSM对受虐待儿童的有效性；(e)促进为被确认为残疾儿童的儿童制定新的实践标准和公共政策；f)推进NIMH的多个优先事项，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与政策相关的心理健康服务研究（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).