PREDICTORS OF IMPROVEMENT FOR CHILDREN SERVED IN DEVELOPING SYSTEMS OF CARE

The research base regarding the effectiveness of systems of care for children with serious emotional disturbances is limited. The incremental development of systems of care in Indiana provides an opportunity to compare the outcomes of children served in these child and family wraparound teams with the outcomes of a matched sample of children receiving usual public mental health services. Functional assessment data from a state database was examined using logistic regression models. The level of development of wraparound services was used as a fidelity measure.

Findings suggest circumstances in which systems of care are effective. Children with impairments related to affective disorders who are served through child and family teams with high wraparound fidelity are more likely to experience improvements than children served in usual services. Similar youth served by intermediately developed wraparound teams are predicated to do less well than children served in usual services. However, abused children in intermediate systems of care are predicted to have improvements in community functioning and experience less subsequent abuse. Most youth with disruptive behaviors, other than Hispanic youth, improve in wraparound teams. Families of children who live with their biological parents are more likely to improve than families whose children live in foster care, with extended family, or in out-of-home placements. Youth with serious emotional disturbance who use drugs or alcohol have poorer outcomes in wraparound.

Implications include targeting systems of care to subpopulations of children and families for whom there is evidence of greatest effectiveness. Results also indicate that additional training in effective treatment for affective disorders or higher levels of integration of care coordination with effective clinical services may be necessary to improve outcomes for developing systems of care. Integrated models of care may be needed for youth with co-occurring disorders. Additional attention to developing linguistic and cultural competence within wraparound services may be required to effectively serve the growing Hispanic community.