The Wraparound Fidelity Index Short Form (WFI-EZ) is a useful instrument, with some important limitations, according to a Georgia Health Policy Center study recently published in Evaluation & the Health Professions.
High Fidelity Wraparound is an intensive, individualized care planning process that uses a team-based approach to integrate youth into the community to minimize the need for intensive, institutional services.
Evidence shows Wraparound is a cost saving behavioral health intervention for youth with severe emotional disturbances and is widely adopted across the United States, including as a reimbursable service by Medicaid in some states. With growing adoption, there is a need to monitor fidelity to the Wraparound process.
Several measurement instruments have been created and tested, including the WFI-EZ, which has been used to monitor model fidelity for practice improvement and for clinical trials and comparative effectiveness research.
The present study sought to understand the measurement characteristics of the WFI-EZ using 1,027 responses from two care management entities in Georgia.
Key results show
- The internal consistency of WFI-EZ was very good.
- Negatively worded items did not appear to function as well as positively worded items.
- Ceiling effects were seen, with overall response patterns showing that most individuals positively endorsed the items.
- WFI-EZ scores performed well at predicting perceptions of needs being met and home life improving, but not for institutional placements or emergency room visits for mental health issues
“Evaluators and those implementing Wraparound may wish to use the instrument at the item level to target specific conversations and gather input for process improvements,” explains lead author Brandon Attell, a senior research associate at GHPC. For example, the instrument may be effective in direct training and supervision of facilitators, but further research is needed to understand if the total score, sub-domain scores, or recently established thresholds should be used to determine overall fidelity for an entire program or site.”
Study coauthors include Ashley C. Singleton (formerly at GHPC), Susan A. McLaren, and Giselle Moses. Read the full study here.