Disparities in mental health outcomes for youth are often found between rural and urban areas. As part of an overarching question about under what circumstances and for whom, the wraparound process is beneficial (Suter & Bruns, 2009), this study specifically examined whether high fidelity to the wraparound model helped bridge the gap between outcomes in urban and rural areas for youth with complex behavioral health challenges. Youth participating in Indiana’s Community Alternatives to Psychiatric Residential Treatment Facilities Medicaid demonstration grant between 2008 and 2011 (n = 811) resided in urban (n = 615) or rural (n = 196) communities. Logistic regression examined treatment and contextual predictors of improvement in the mental health functioning of youth. High fidelity to the wraparound model and higher levels of initial behavioral health symptoms predicted improvement in mental health outcomes, with a small, but significant effect size (R2 = .129). Geography, demographic characteristics, initial risk behaviors, nor functional needs were significant predictors of change. Effectively implementing the wraparound process is a feasible strategy to reduce disparities in behavioral health outcomes for youth with complex needs in rural communities.

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