Researchers with the Wraparound Evaluation and Research Team (WERT) led by Eric Bruns, PhD, have published a new article in the Journal of Medical Internet Research presenting results from the first-ever randomized study of the impact of an electronic health record (EHR) on provider, service, and client outcomes in children’s mental health. EHRs are widely proposed as a mechanism for improving health care quality, but rigorous research on the impact of EHR systems on behavioral health service delivery is scant, especially for children and adolescents.
The new research focused on implementation of an EHR specific to Wraparound, a research-based care coordination process for children or youth who are experiencing serious mental health or behavioral challenges. Care coordinators (or facilitators) typically lead the Wraparound process, which brings together an team unique to the youth and family to collectively develop and oversee implementation of an individualized plan of care that includes formal evidence-based services and informal and community supports. A recent review of peer-reviewed research found that young people with complex needs assigned to a Wraparound team tend to experience better mental health and better functioning in their homes, schools and communities compared to those who do not receive wraparound care coordination. Wraparound also minimizes the time young people spend in out-of-home facilities like residential treatment centers or psychiatric hospitals and thus results in significant cost savings to public systems.
Findings showed that EHR-assigned facilitators from both sites demonstrated a robust use of the system. Facilitators in the EHR group reported spending significantly more time reviewing client progress and less time sending reminders to youth/families, indicating increased efficiencies. However, there was little evidence of any impact (positive or negative) on overall service quality, fidelity, or client satisfaction. The study was funded by the National Institute of Mental Health and represented a collaboration among the NWI, UW Wraparound Evaluation and Research Team (WERT), and software developer FidelityEHR.
WERT seeks to improve the lives of children and their families through research on the implementation and outcomes of the Wraparound process. Through development, refinement, and dissemination of the Wraparound Fidelity Assessment System, the team aims to assist implementation of the Wraparound process, evaluate effectiveness, identify the need for technical assistance and training, and promote communication within the service delivery and research and evaluation fields.
