Canadian Wraparound: Measuring Implementation Fidelity for Youth in Care

For youth in the care of child welfare, the need for a greater emphasis on service integration and youth-centred approaches is widely agreed. This case study examined an implementation of the Wraparound approach, which focuses on coordinated service delivery and youth-centered care, as delivered by an intervention team at a Canadian urban community health centre with 12 youths in care. Wraparound is a philosophy of care and a process that facilitates the provision of integrated support for individuals with complex needs. The high-fidelity implementation of this approach has been identified as critical to improvements in life outcomes. The Wraparound Fidelity Index Short Version (WFI-EZ), which measures adherence to the guiding principles and primary activities of Wraparound, was administered with team members, facilitators, caregivers, and a youth. The Team Observation Measure (TOM-2), which measures facilitation skills and team work as observed during Wraparound meetings, was administered with a sample of four Wraparound teams. Overall fidelity scores at this site, though below average, are encouraging considering the complex profiles and multi-system needs of the youths. Intensive training and ongoing coaching of Wraparound facilitators contributed to high ratings, while success was limited by narrow definitions of family and by system-level constraints such as high turnover among social workers. Future research should explore the value of peer support for youth and caregivers, training for all team members in the Wraparound approach, and adapting the fidelity assessment tools to better account for family, community, and system-level constraints.