A Mobile Text Approach to Measurement and Feedback for Wraparound Care Coordination

Abstract Fifteen million children and adolescents in the U.S. experience a diagnosable mental health (MH) disorder, with approximately half (6 to 8 million) considered to experience a serious emotional disorder (SED). Integrated, multi-modal community systems to coordinate multiple helpers and provision of multiple interventions have been identified to address the complex and multifaceted problems faced by youth with SED. One such model, the Wraparound service model (WSM), has been cited in multiple major reviews of effective community treatments, and is listed in the Surgeon General’s Reports on youth mental health and violence. As is the case for other evidence-based practices, the degree to which data are consistently measured and used to inform care—i.e., “measurement-based care” or MBC—accounts for a large proportion of variance in outcomes for Wraparound. The goal of this SBIR project is to complete development and testing of the Short Message Assisted Responsive Treatment for Wraparound (SMART-Wrap) application to overcome the current barriers to measuring and using data in everyday service settings. SMART-Wrap will facilitate MBC with an SMS system and thus inform and improve both service and clinical outcomes. In Phase II, we will accomplish three specific aims. First, we will continue the Delphi process with WSM expert advisors to finalize SMART- Wrap’s SMS assessment bank and will test bank items with families enrolled in WSM. Second, we will finalize care team features by fully developing the Care Team Dashboard and conducting a user test with WSM care team professionals to assess usability, feasibility, and value. Lastly, we will conduct a controlled efficacy study with 24 care teams from three large WSM provider organizations serving families of youth with SED. Care teams will be randomized to deliver SMART-Wrap or “Services-as-Usual” to families over a 4-month period to assess WSM fidelity, use of MBC strategies, and service and clinical outcomes. Phase II quantitative and qualitative data will be used to ready the system for commercialization. The proposed SMART-Wrap product will harness the simplicity and accessibility benefits of SMS to significantly improve engagement in Wraparound services and shift current Wraparound practice toward MBC. The result will be a rigorously tested new mobile Routine Outcome Monitoring (ROM) solution to help improve service and clinical outcomes for the over six million youth in the U.S. with SED.