Usual care vs. wraparound facilitation: A randomized trial in ontario

Date Published: 
09/26/2016
Source: 

Browne, D., Puente-Duran, S., Shlonsky, A., Thabane, L., & Verticchio, D. (2014). A randomized trial of wraparound facilitation versus usual child protection services. Research on Social Work Practice, 26(2), 168-179, doi:10.1177/1049731514549630

Reviewed by: 
Emmaline Houston
Tara Black
Summary: 

To assess child protection services (CPS) models, the authors of this study evaluated the effectiveness of a wraparound facilitator in comparison to regular child protection services over a 20-month period. The wraparound model is a planning process, incorporating sociocultural and contextual influences by connecting children and their caregivers with a unique set of service agencies and existing supports.   

Families with a substantiated investigation for child maltreatment between 2007 and 2009 across three southern Ontario Children’s Aid Societies (CAS) were assessed for eligibility in this study, a total of 805 families. Families were ineligible if the referral involved serious intimate partner violence, or if the social worker indicated there was little likelihood of child reunification with parents. Of the 306 children and caregivers approached, 44 percent agreed to participate (n=135) and were randomized into the intervention group (implementation of the wraparound model) or the control group (received child protection services as usual). It was hypothesized that the intervention group would yield greater improvement in child and family functioning, as the wraparound process is a comprehensive care model. The authors measured six aspects of child and family functioning: 1) caregiver psychological distress, 2) parental stress, 3) family resources, 4) functional impairments, 5) behavioural and emotional strengths and 6) developmental milestones. The six aspects were measured using the Kessler 10, the Parental Stress Scale, the Family Resource Scale, the Child and Adolescent Functional Assessment Scale, the Behavioural and Emotional Rating Scale 2nd Editions and the Ages and Stages Questionnaire respectively. All families were assessed using the six measurements at baseline and at the 20-month follow-up.

Families in the intervention group were assigned a wraparound facilitator, who were master’s-level social workers trained in the model. The facilitator met with the family to gain an understanding of the families’ goals and critical factors to address throughout care, such as social determinants of health. After a preliminary meeting with the social worker, children and caregivers, a personalized team was created that included formal and informal supports such as friends and extended family. This team was scheduled to meet for two to five hours once a week, over the twenty month period and outcomes were continually tracked throughout the process. The families in the control group received standard CPS care, as outlined in the Child Protection Standards in Ontario (2007). The current standards dictate that workers and families must be in contact once a month, with formal reassessment every six months. The families in both groups evaluated their care plans using the Wraparound Fidelity Index (WFI), which validates the implementation and presence of the wraparound style processes.

The intervention effect was evaluated using intention-to-treat analyses. The effects of intervention (wraparound vs. usual care) and time (baseline and 20-month follow-up) were examined using 2 x 2 mixed ANOVA. In between the baseline and 20-month follow-up, the families of the intervention group and control group had regularly scheduled meetings, weekly or monthly respectively. However, the families’ attendance rates to these meetings are unknown to the reader. Children and their caregivers in both groups improved similarly at the 20-month follow-up on all outcome variables. Care provided to both groups was evaluated on the presence of the wraparound process, using the Wraparound Fidelity Index (WFI). The WFI monitors the implementation of 10 essential elements of the model. The WFI responses from the control group indicated that wraparound components were present in usual care. The authors noted that the presence of wraparound-style processes in the control group may have contributed to reasons why there was no observable added benefit for families having a wraparound facilitator in the intervention group. The wraparound facilitator did not create significant benefits that could be measured to the children and their caregivers in the intervention group when compared to the control group across conditions. Additional research needs to be conducted to explore these results. 

Methodological notes: 

Child welfare studies using randomized control trials in Canada are rare. As a randomized control trial, biases are reduced and confidence in the cause and effect of outcomes is increased. The authors created a single blind randomized controlled trial with concealment and stratification across three sites. The process of selecting the sampling frame and final number of participating families should be further explained for clarity. The authors do not explain how the child maltreatment cases for the initial 805 referrals were substantiated, as CAS do not record substantiation, only verification. While 89 families from the 805 referrals were accounted for as being ineligible, 410 additional families were not approached for unknown reasons.