Systematic Review and Meta-analysis: Effectiveness of Wraparound Care Coordination for Children and Adolescents.

OBJECTIVE Wraparound is a common method for coordinating care for children and adolescents with serious emotional disorders (SED), with nearly 100,000 youth served annually in the U.S. 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 grey 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 youth for costs (g =.391, CI = [.282, .500], p < .001), residential outcomes (g = .413, CI = [.176, .650], p = .001), and school functioning (g = .397, CI = [.106, .688], p = .007); small effects were found for mental health symptoms (g = .358, CI = [.030, .687], p = .033) and functioning (g = .315, CI = [.086, .545], p = .007). Larger effects were found for peer-reviewed studies, quasi-experimental designs, samples with a larger percentage of youth of color, and Wraparound conditions with higher fidelity. CONCLUSION Results indicate positive effects for Wraparound, especially for maintaining youth with SED in 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.