Is High Fidelity Wraparound (HFW) Evidence-Based? What is the Research?

The HFW process has been implemented widely across the United States and internationally for several reasons, including its documented success in promoting shifts from residential treatment and inpatient options to community-based care (and associated cost savings); its alignment with the value base for systems of care; and its resonance with families and family advocates. HFW has been included in the Surgeon General’s reports on both Children’s Mental Health and Youth Violence, mandated for use in several federal grant programs, and presented by leading researchers as a mechanism for improving the uptake of evidence-based practices.

Continued expansion of the HFW research base has provided additional support for continued investment in HFW. To date, results of eight to ten (depending on criteria used) controlled (experimental and quasi-experimental) studies have been published in the peer-reviewed literature. A meta-analysis of seven of these studies has recently been published showing consistent and significant outcomes in favor of the HFW group compared to control groups across a wide range of outcomes domains, including residential placement, mental health outcomes, school success, and juvenile justice recidivism.1 The overall effect size found in this meta-analysis was found to be between .33 - .40, about the same as was found in a recent meta-analysis of children’s mental health evidence-based treatments.

Thus, though HFW has typically been described as a “promising” intervention, there has been consistent documentation of the model’s ability to impact residential placement and other outcomes for youth with complex needs. The research base for HFW continues to expand and, as a result, HFW is likely to be more consistently referenced as an “evidence-based” model in the years to come.

The Resource Guide to Wraparound includes a section on Theory and Research that presents articles on the Theory of Change for HFW, the wraparound evidence base, and the nature of wraparound implementation in the United States. In addition, there are many dozens of relevant journal articles and book chapters on the HFW process, which are detailed in the wraparound bibliography, which is maintained and continuously updated by the NWI.

1. Suter, J.C. & Bruns, E.J. (2009). Effects of Wraparound from a Meta-Analysis of Controlled Studies. Clinical Child and Family Psychology Review, 12, 336-351.