Combining System Support Mapping, System Dynamics and Health Behavior Theory to Create a Framework for Implementation of a Youth-Driven Wraparound Intervention for Transition-Aged Youth

Background: Transition-age youth are an especially vulnerable population as they navigate the changing landscape of supportive resources, including health care, available to them as young adults, compared to the provisions and supports when they were considered children by the state. Wraparound services have been a centerpiece of traditional management and treatment for these youth. Bruns et al., 2010). An adaptation (and high-fidelity version of wraparound), RENEW (Eber, Malloy, Rose, & Flamini 2013) is a youth-driven community-based intervention implemented by North Carolina Families United and similar agencies, and has been shown efficacious in aiding transition-age youth in developing sustainable natural social supports, securing housing, maintaining or improving health, and obtaining secure employment in the areas of the youths’ choice (Malloy, Sundar, Hagner, Pierias & Viet, 2010). RENEW seeks to empower youth by making them drivers of their care plan, supported by a RENEW mentor. When youth leave school and foster care systems as they age out, funding and structure for RENEW support often vanishes. Further, RENEW involves strong participation with the community and requires connection to various community services. Thus, as NC Families United seeks to expand RENEW’s implementation across the state and scale out into settings other than its traditional setting, schools, priority is being given to understanding the structural barriers and facilitators to implementation. Methods: In order to construct a more complete picture of the barriers and facilitators of RENEW methods and youth success, a systems-thinking assessment known as system support mapping will be conducted with eight RENEW participants to understand the youths’ self-identified objectives in transitioning to adulthood, as well as the requisite factors and support systems they require to achieve their most important objectives such as improvement in relationships in the form of natural support and community inclusion, graduation from school, prevention of mental ill health exacerbation, and securing supportive housing and employment.  They will be asked what most supported them in meeting these objectives, and to reflect on what 3 things, if changed, would have most improved their success. Combining this systems science approach and health behavior theory, a model is then presented that shows the “active ingredients” of the RENEW model in supporting transition-age youth. This model is then generalized to provide a community assessment framework that could be used to evaluate the training, infrastructure, or other needs an organization would need to address to be able to implement RENEW successfully to support local youth. Discussion: This project will identify prevention and management strategies for transition aged youth, as well as uncover threshold effects to help articulate the pathways through which RENEW is most effective. Developing a framework for the requisite system characteristics for implementing RENEW can promote successful implementation of this efficacious program, preventing the exacerbation of health concerns for transition-aged youth.