One program that I have heard coming up in the social services sector over the past few years is a suite of interventions called “wraparound services.”
The basic concept of "wraparound services" is to provide seemingly unrelated services to someone who needs help with a specific issue. For example, providing employment and housing assistance to someone who seeks out behavioral health services.
Wraparound services can be a range of different services including case management, counseling, crisis management, education, family support, psychiatric care, health care, legal services, recreational therapy, long-term care, group therapy, and transportation.
When I first heard about “wraparound services,” I was admittedly skeptical about the approach. The kind of wide-eyed excitement they aroused in people I heard talking about them smacked of a snake-oil intervention. All in all, they felt like a firehose approach to social problems: if we throw enough interventions at someone, something is going to stick and we are going to help them improve their lot in life.
I also was skeptical because I hadn’t heard of any evaluation of these interventions. It seems like a lot of the faith in the “wraparound approach” was built on faith in the current social services system. The idea is that we have the right programs in place to help people, we just need to get the right people connected with the right programs and they will see improvement. I hadn’t seen any evidence that this is indeed the problem with our social system and I was skeptical of that logic model.
I needed to see more evidence.
A working paper published by the National Bureau of Economic Research this month finally gives some credence to the claims of wraparound programs. Researchers from the Rochester Institute of Technology and the University of Notre Dame conducted a randomized controlled trial of a wraparound program.
Participants were randomly assigned to intensive wraparound services provided flexibly and intensively over a number of years. Participants designed their own goals and then were supported by these programs.
The topline finding of the researchers was that participants in the program were employed at rates ten percentage points higher than control group members after a year of receiving services and that the effects persisted past the conclusion of the program. The researchers did not find evidence that wraparound services helped participants achieve other goals besides employment, though, even when participants had identified non-employment goals as their primary goals.
What does this tell us about the program? The first thing I take away from this study is that wraparound programs are effective on one dimension. A ten percentage-point increase in labor force participation rate is a big deal. For context, if the state of Delaware, which is 39th in the country in labor force participation rate, had a 10 percentage point increase in labor force participation, it would tie North Dakota for the highest labor force participation rate in the country.
The second thing I take from this is that the impact of wraparound programs is limited. This is not a panacea of a program that is able to solve every aspect of social life for those who are struggling. It will help them improve their chances of employment, though.
This finding does lead to a clear question: why wraparound at all at this point? If wraparound programs are just a good jobs program, why provide all the other services? Why don’t we cut our costs by funding all these superfluous programs and focus on what is actually helping people?
One of the findings from the researchers helps explain a problem with this approach. In their research, they found some evidence that participation in the wraparound program increased hopefulness and agency among participants. The researchers hypothesize that it is the hopefulness and agency that caused the increase in employment. So some of the wraparound services, in particular counseling, might be what is driving the employment effect.
I am happy to see there is some evidence that wraparound services are working. I also think these programs need to be evaluated and ineffective pieces of them need to be trimmed back. The goal of social services is to make sure that people get the support they need to thrive, and resources spent on programs that don’t do that are resources that are withheld from programs that do. More research will help us further cut through the noise of a program like this.