Wraparound Services in Philadelphia Schools: An Analysis of Wraparound Agencies' Monitoring Practices of Therapeutic Staff Support Treatment Integrity

Abstract

Therapeutic Staff Support, commonly known as TSS, provide one-on-one direct care (in home, school, and community settings) to children diagnosed with a severe emotional or behavioral disorder. In this dissertation I explore wraparound agencies practices of monitoring Therapeutic Staff Support treatment integrity. Using a qualitative design, 26 participants from three wraparound agencies were selected for this study. Data collection included interviews and documents (treatment plans, progress notes, and psychologist recommendations). Two primary research questions guided my inquiry into wraparound agencies monitoring practices of TSS: How do wraparound agencies monitor TSS treatment delivery? Does monitoring incorporate strategies for targeting TSS misutilization? Two secondary questions were: What are some potential threats to TSS treatment integrity? How do TSS address threats that directly affect students in schools? Findings suggest wraparound agencies use myriad methods to monitor TSS treatment adherence and accountability mechanisms adequately address TSS job performance. Similarly, I find agencies shape treatment document designs (plans and progress notes) to facilitate their use. Findings also point to five categories of issues which serve as potential threats to effective TSS treatment administration. I also find TSS misutilization was not a factor although there was no method of monitoring it. TSS did, however, find themselves performing multifaceted roles (often in response to threats directly affecting their students) which extended beyond their required roles of treatment agent and data collector; eight roles emerged. Ultimately, findings suggest documentation review and BSC observations are the most common approaches to monitoring TSS treatment integrity. Themes for threats (consistent with those found in other treatment literature) and themes used for TSS typology can be explored in future studies.