Impact of a Web-Based Electronic Health Record on Behavioral Health Service Delivery for Children and Adolescents: Randomized Controlled Trial.

Background: Electronic health records (EHRs) have been widely proposed as a mechanism for improving health care quality. However, rigorous research on the impact of EHR systems on behavioral health service delivery is scant, especially for children and adolescents.

Objective: The current study evaluated the usability of an EHR developed to support the implementation of the Wraparound care coordination model for children and youth with complex behavioral health needs, and impact of the EHR on service processes, fidelity, and proximal outcomes.

Psychometrics, Reliability, and Validity of a Wraparound Team Observation Measure.

Wraparound is a widely-implemented team-based care coordination process for youth with serious emotional and behavioral needs. Wraparound has a positive evidence base; however, research has shown inconsistency in the quality of its implementation that can reduce its effectiveness. The current paper presents results of three studies used to examine psychometrics, reliability, and validity of a measure of wraparound fidelity as assessed during team meetings called the Team Observation Measure (TOM).

Applying User Input to the Design and Testing of an Electronic Behavioral Health Information System for Wraparound Care Coordination.

Health information technology (HIT) and care coordination for individuals with complex needs are high priorities for quality improvement in health care. However, there is little empirical guidance about how best to design electronic health record systems and related technologies to facilitate implementation of care coordination models in behavioral health, or how best to apply user input to the design and testing process. In this paper, we describe an iterative development process that incorporated user/stakeholder perspectives at multiple points and resulted in an electronic behavioral health information system (EBHIS) specific to the wraparound care coordination model for youth with serious emotional and behavioral disorders.

Effectiveness of wraparound versus case management for children and adolescents: results of a randomized study.

In this study, we compared service experiences and outcomes for youths with serious emotional disorder (SED) randomly assigned to care coordination via a defined wraparound process (n = 47) versus more traditional intensive case management (ICM; n = 46) The wraparound group received more mean hours of care management and services; however, there ultimately were no group differences in restrictiveness of residential placement, emotional and behavioral symptoms, or functioning. Wraparound implementation fidelity was found to be poor. Organizational culture and climate, and worker morale, were poorer for the wraparound providers than the ICM group.

Evaluating fidelity to the wraparound service model for youth: application of item response theory to the Wraparound Fidelity Index.

The wraparound process is a mechanism for multisystem planning and care coordination for youth with serious emotional and behavioral problems. Fidelity monitoring is critical to effective implementation of evidence-based practices in children's mental health, as it helps ensure that complex interventions like wraparound are implemented as intended. The 40-item Wraparound Fidelity Index, Version 4 (WFI-4; Bruns, Burchard, Suter, Leverentz-Brady, & Force, 2004) is the most frequently used measure of fidelity to the wraparound process, but analysis of its psychometric properties is insufficient.