Academic journal article New Zealand Journal of Psychology

An Investigation of the Fidelity to a Wraparound Process in New Zealand

Academic journal article New Zealand Journal of Psychology

An Investigation of the Fidelity to a Wraparound Process in New Zealand

Article excerpt

An Investigation of the Fidelity to the Wraparound Process in New Zealand

In recent years, there has been a growing emphasis on providing evidence-based treatments in the mental health field, particularly in child and adolescent mental health, to ensure accountability of services provided and to obtain better outcomes (American Psychological Association, 2006; Burns et al., 1999; Hoagwood, Burns, Kiser, Ringeisen, & Schoenwald, 2001). One intervention with an evidence base currently deemed as promising and research-based is the wraparound process (Suter & Bruns, 2009; Washington State Institute for Public Policy, 2016). Wraparound is an intensive and individualised care planning process guided by 10 philosophical principles (family voice and choice; individualised; strength-based; natural supports; collaboration; persistence; community based; culturally competent; team-based; and outcome based) and 4 phases (engagement, support and team preparation; initial plan development; implementation; and transition) which coordinates interventions, supports, and services for young people with serious mental health disorders and their families (Bruns, Walker, et al., 2004; Bruns et al., 2010; Burns et al., 1999). Originally pioneered in the United States of America (USA) in the 1980s it has since become increasingly popular and adopted around the world, including in New Zealand, as a community-based intervention to help young people remain and function more effectively in their communities (Bruns, Burchard, et al., 2004; Burns et al., 2000; Shailer et al., 2013). Studies investigating this process have indicated improved youth outcomes including reduced rates of hospitalisations, maintenance of youth within the community, reductions in mental health symptoms, and improved overall functioning (Anderson et al., 2008; Bruns et al., 1995; Kamradt, 2001; Mears et al., 2009; Vernberg et al., 2004; Yoe et al., 1996). While most studies have been conducted in the USA, with a diverse population; on average, study participants were most commonly identified as Caucasian 56.95% (SD = 29.99, range 0-88.24) and African American 23.10% (SD = 30.00, range 0-75.36) (Suter & Bruns, 2009). However, currently only limited research is available on this process within New Zealand (Shailer, Gammon, & de Terte, 2013).

Despite wraparound's popularity and studies supporting positive outcomes it has yet to be established as an evidence-based treatment (Bruns & Walker, 2010; Bruns et al., 2010; Suter & Bruns, 2008). Wraparound not being recognised as an evidence based treatment has constrained its implementation in New Zealand (Bruns & Walker, 2010; Bruns et al., 2010; Burns et al., 2000; Suter & Bruns, 2008). An important part of confirming wraparound or any intervention as evidence-based is to demonstrate its effectiveness in practice settings (American Psychological Association, 2006). To do this it must first be ensured that interventions have been implemented as they were intended by determining treatment fidelity so that conclusive statements can be made about treatment effects (Borrelli, 2011; Bruns et al., 2008; Dusenbury, Brannigan, Falco, & Hansen, 2003; Murphy & Gutman, 2012). In agreement, Walter and Petr (2008) assert that one of the main barriers to wraparound establishing a stronger evidence base is due to a lack of fidelity research.

The investigation of fidelity is particularly relevant for those interventions, such as wraparound, which are complex in their delivery and also serve complex populations (Leeuw, Goossens, de Vet, & Vlaeyen, 2009; Pullmann, Bruns, & Sather, 2013; Rast & Bruns, 2003). Measuring fidelity determines how adequately a programme, or in this case the wraparound process, has been delivered in practice compared to its original specification and design (Mowbray et al., 2003; Walter & Petr, 2008). For wraparound, measuring fidelity requires an assessment of the adherence to the basic philosophy, principles, phases and activities of the wraparound process as well as the supports and organisational systems in place (Bruns, 2008b). …

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