Purpose: The current structure and goals of the Kansas public mental health system as well as it development undergird this study. The public system in Kansas is comprised of supports that vary from highly restrictive (hospitals) to non-restrictive (Community Mental Health Centers or CMHCs). One guiding principle of the system of care is that services and supports are best provided in the community when possible. This principle was formalized with passage of the Mental Health Reform Act of 1990. Community-based services (CBS) for children are relatively new among services offered by CMHCs. Consistent with best practices, these services are expected to be provided through a strengths-based, family-centered, wraparound model. In the initial phase of implementing CBS, the focus was on establishing the array of services. The next step was to evaluate fidelity to the wraparound model and to compare outcomes by the degrees of fidelity to this model, which is the purpose of this study.

Methods: This three-year, state-wide, study included a sample of 377 children, ages four to 18, living with serious emotional disturbance. The study used a multi-pronged approach that included focus groups with parents and CMHC direct service staff, interviews with CMHC administrative staff, and randomly selected client record reviews during site visits to 23 CMHCs. As part of the process of monitoring quality assurance, all CMHCs in the State of Kansas submit quarterly Client Status Reports (CSRs) that contain extensive fields for tracking. Data collected from the records reviewed were merged with outcomes from CSRs. Two of the study questions were: What is the degree of fidelity to the wraparound model? Do outcomes for children whose services reflect a higher degree of model fidelity differ from those whose services reflect a lower degree of model fidelity?

Results: Findings indicate that services provided demonstrated high fidelity to the wraparound model, with variability between centers. Youth who had wraparound teams and youth whose services were family-centered had better outcomes on the variables of residential placement, law enforcement contact, academic performance, and school attendance than youth who did not have wraparound teams and whose services were not family-centered. With regard to change in Child Behavior Checklist (CBCL) scores, youth whose services were family-centered and delivered through a wraparound model showed significantly better improvement than those whose services were not delivered in this manner. Model adherence was substantiated by progress notes in the records reviewed and qualitative data from focus groups.

Implications: These findings, as part of the state's system of monitoring safeguards, serve as an evaluation of the system of care. Children who receive services most true to the wraparound model experience better outcomes than those who do not, confirming the importance of this evidence-based practice. Additionally, these findings, corroborating factors that constitute “best practices” in a large system of care, provide a basis for informed policy decisions and guide effective model utilization for serving children and families.

Pedagogy: Information will be presented orally with the aid of PowerPoint.