Exploring Attrition, Fidelity, and Effectiveness of Wraparound Services Among Low-Income Youth of Different Racial Backgrounds

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Introduction: Wraparound services (i.e., community-based collaborative care) for children with severe mental health needs have been reported as effective. Yet, no attention has been given to aggregating treatment results across racially and economically diverse groups of youth. While controlling for socioeconomic status (i.e., free/reduced lunch status) this study explored potential racial disparities in response to wraparound services. Method: Data from a diverse statewide sample (N = 1,006) of low-income youth (ages 6–18 years) identified as having a serious emotional disturbance were analyzed for differences in wraparound attrition, fidelity, and effectiveness. Results: African American youth receiving free/reduced lunch failed to complete wraparound services at significantly higher rates when compared to Caucasian youth. For those who met treatment goals (i.e., completed services), mean intervention fidelity scores showed services to be implemented similarly across youth. Furthermore, wraparound services resulted in improvements in mental health functioning, though racial background and attrition status impacted exit scores. Discussion: Collaborative community-based mental health services improve youth outcomes and physicians and school personnel should strive to be part of these teams. Further research is needed to more closely examine the challenges of helping youth to meet the goals associated with their wraparound services. Relatively higher service attrition rates in low-income African American youth warrants further investigation.

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