Building on practice-based evidence: using expert perspectives to define the wraparound process.
OBJECTIVE
In order to expand the research base on effective community-based mental health treatments, methods are needed to define and evaluate promising interventions that have not been systematically developed and tested. In this report, the authors describe the results of an effort to better define the wraparound process for children and adolescents with serious emotional and behavioral problems.


METHODS
A broad review of wraparound treatment manuals and model descriptions was conducted. With the help of a small group of experts, this review was synthesized into an initial description of the phases and activities of the wraparound process. This model was then presented to a multidisciplinary advisory panel of 31 experts on the wraparound process who provided structured and semistructured feedback.


RESULTS
Overall, respondents expressed a high level of agreement with the proposed set of activities. For 23 of the 31 activities presented, there was unanimous or near-unanimous agreement (that is, one dissenter) that the activity was an essential component of the wraparound process. For 20 of the 31 activities, there was unanimous agreement that the description was phrased acceptably. A final model was created on the basis of feedback from reviewers.


CONCLUSIONS
Results indicate that using the experience of a wide base of stakeholders to operationalize a complex model such as wraparound is feasible and holds many potential benefits, including building consensus in the field, improving service quality, and accelerating the incorporation of evaluation results into real-world practice.
Walker
Janet S
JS
Portland State University, Regional Research Institute, P.O. Box 751, Portland, OR 97201, USA. janetw@pdx.edu
Bruns
Eric J
EJ
D000293:Adolescent; D000296:Adolescent Psychiatry; D002648:Child; D002665:Child Psychiatry; D003156:Community Mental Health Services / Q000458:organization & administration*; D019317:Evidence-Based Medicine / Q000379:methods*; D005104:Expert Testimony; D006293:Health Promotion; D006801:Humans; D001523:Mental Disorders / Q000628:therapy*; D010818:Practice Patterns, Physicians'; D011361:Professional Competence; D016730:Program Development; D011795:Surveys and Questionnaires; D014481:United States