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Wraparound care coordination has been demonstrated to promote positive mental health, residential, and cost outcomes for children and youth with serious emotional and behavioral disorders (SEBD) and their families. However, research also shows that positive outcomes are dependent on adequacy of Wraparound fidelity. The current study presents results from a series of studies that collectively assessed the factor structure, reliability, and validity of the Wraparound Fidelity Index, Short Form (WFI-EZ), a four section, multi-informant, self-report measure. Analyses of a sample of 10,955 caregivers of youth who received Wraparound and completed the WFI-EZ found a four-factor solution that aligned well with previous theories of change for Wraparound, with factors focused on team membership, team process, inclusion of natural supports, and intermediate outcomes, including increased family assets and more effective services and supports. Cronbach's alpha was 0.90 for the full index and acceptable for all four empirically derived factors (α = 0.61–0.91); preliminary test-retest reliability data for the composite WFI-EZ fidelity index drawn from two small samples was found to be high for caregivers (r = 0.94) and moderate for care coordinators (r = 0.72). Results of known-groups analyses found that WFI-EZ scores discriminated groups theoretically expected to differ on Wraparound fidelity, including whether basic elements of Wraparound were provided and whether provider organizations were measured as having high versus low supports for Wraparound. Results indicate the WFI-EZ is a reliable and valid measure of Wraparound fidelity, while also pointing to opportunities for future refinement, further research, and opportunities for improving Wraparound training and implementation support. Highlights: The Wraparound Fidelity Index, Short Form (WFI-EZ) was shown to be a reliable and valid fidelity measure. An underlying factor structure of the WFI-EZ was found that aligns with past theory on Wraparound that emphasizes the importance of Wraparound team membership, team process, and two routes to positive family outcomes: increased family assets and more effective services and supports. Wraparound provider factors such as leadership and staff morale were found to be associated with practice fidelity and caregiver satisfaction. The current study points to potential future refinements, including reduction in the number of items and revision of scoring rules. [ABSTRACT FROM AUTHOR]

Objective: Wraparound is a common method for coordinating care for children and adolescents with serious emotional disorders (SED), with nearly 100,000 youths served annually in the United States. The current systematic review and meta-analysis estimated effects on youth outcomes (symptoms, functioning, school, juvenile justice, and residential placement) and costs.Method: A literature search identified 17 peer-reviewed and gray literature studies meeting criteria, which were coded on characteristics of sample, design, implementation, and outcomes. Random effects modeling was conducted using Comprehensive Meta-Analysis Version 3.0. Effect sizes were calculated using Hedges g. Homogeneity of effects were assessed using Q statistics.Results: Medium-sized effects favored Wraparound-enrolled youths for costs (g = 0.391, CI = 0.282-0.500, p < .001), residential outcomes (g = 0.413, CI = 0.176-0.650, p = .001), and school functioning (g = 0.397, CI = 0.106-0.688, p = .007); small effects were found for mental health symptoms (g = 0.358, CI = 0.030-0.687, p = .033) and functioning (g = 0.315, CI = 0.086-0.545, p = .007). Larger effects were found for peer-reviewed studies, quasi-experimental designs, samples with a larger percentage of youths of color, and Wraparound conditions with higher fidelity.Conclusion: Results indicate positive effects for Wraparound, especially for maintaining youths with SED in the home and community. However, many studies showed methodological weaknesses, and fidelity measurement was largely absent, suggesting a need for additional research. Nonetheless, the results should aid decisions around resource allocation, referral practices, and system partnerships among child psychiatrists and other behavioral health professionals. [ABSTRACT FROM AUTHOR]

The National Training and Technical Assistance Center for Child, Youth, and Family Mental Health (NTTAC) supports the development and implementation of systems of care (SOC) for youth with serious emotional disorders (SED) and their families. This article presents results from a process evaluation of NTTAC, conducted to support the Center's quality improvement and contribute to the knowledge base around provision of technical assistance (TA). The evaluation used a mixed methods approach with data collection focused on a defined subset of NTTAC TA recipients-recipients of federal Comprehensive Community Mental Health Services for Children SOC grants. Data sources included coded administrative records from SOC grant sites, administrative data from NTTAC, standardized measures of SOC development, and stakeholder survey data. Results indicate that TA dosage matched needs and goals of TA recipients (SOC sites), overall levels of satisfaction with TA were high, and TA content was generally aligned with need. TA recipients reported significant progress on indicators of SOC development over time. Together, these findings suggest that it is possible to develop TA methods that reflect the level and type of TA recipients' goals and needs, and, in turn, positively impact SOC development and behavioral health service delivery. [ABSTRACT FROM AUTHOR]

Objective: Over the past few decades, women's roles in the United States military have expanded significantly. Currently women encounter more wartime experiences during deployment than in the past. Previous research with male service members has linked exposure to wartime events to subsequent development of post-traumatic stress disorder (PTSD) symptoms. However, because of the unique experiences of military women, research is needed to better understand the link between wartime experiences and mental health in female personnel. Methods: We examined the wartime experiences of deployed, active-duty female Airmen and their relations to PTSD. A large representative sample of active-duty female Air Force personnel, who responded to the U.S. Air Force Community Assessment Survey (CAS), was used to determine the relationships between wartime experiences and symptoms of PTSD. Previous research suggests the possibility that factors, including unit cohesion and self-efficacy, may mediate these relations. Results: Descriptive analyses indicate that the percentage of personnel experiencing PTSD symptoms increased as the number of wartime experiences increased. Logistic regression analyses revealed that wartime experiences were positively related to subsequent PTSD-related symptoms. Both unit cohesion and self-efficacy were negatively related to PTSD symptoms, but neither variable was found to moderate the relationship between wartime experiences and PTSD. Conclusions: Women are experiencing greater numbers of wartime experiences. Like men, as the number of wartime experiences increases, PTSD symptoms increase as well. Self-efficacy and unit cohesion were found to lower these symptoms, indicating that these factors may help decrease the negative impact of wartime experiences. [ABSTRACT FROM AUTHOR]