This article is part of the MiiWrap Institute’s series, Closing the Sustainability Gap: Building Human Services That Create Change Beyond Services. [Start with Part 1] | Part 2: Engagement Is Not the First Step of Change → (forthcoming)
Human services organizations are asked to solve difficult problems under difficult conditions. Leaders are expected to respond to crises, improve outcomes, coordinate fragmented systems, meet contractual requirements, manage limited resources, support a workforce under pressure, and demonstrate that the services they provide make a difference.
Most organizations take that responsibility seriously. They track whether people engage with services. They monitor whether plans are completed, referrals are made, crises decrease, goals are met, placements are avoided, or people remain safely in their homes and communities. These measures matter. They tell us important things about what happens while services are in place.
But they do not tell us everything we need to know about whether those services create lasting change. To understand the full impact of our work, we have to ask the next question: What remains when services end?
When formal intervention steps back, what has changed in a person’s life that can continue without the same level of professional involvement? Has the person developed greater confidence in navigating challenges? Do they have stronger relationships and sources of support? Can they identify and pursue their own goals? Have they developed skills, strategies, or problem-solving capacity they can draw on when the next challenge arrives? Do they know how to find and use resources? Is there a network of people and relationships that can continue to support progress?
These questions are not arguments against services. They are questions about what services are ultimately for. The goal of human services cannot simply be to help people function while services are present. For many of the people and families we serve, the more consequential test is what happens after formal intervention ends: when the professional team steps away, funding follows another priority, a program reaches its planned conclusion, or a person simply moves forward with their life.
The question is not only whether we helped someone while we were there. It is whether our work helped create the conditions for progress to continue after we are gone. That is the sustainability gap this series will explore.
Human services often have to work within relatively short windows of time. A program may be funded for six months. A case may be open for a year. A crisis intervention may last several weeks. A treatment episode may have a defined beginning and end. That makes it natural to measure what happens during that period. But the fact that an outcome occurs while services are active does not necessarily tell us whether change will persist.
For the purposes of this series, we use the following definition: Sustainable change is change that can be maintained, adapted, and built upon beyond the period of active formal intervention.
That definition matters because sustainable change is not the same thing as independence from services. Some people will appropriately need formal support for long periods of their lives. A person with a significant disability may need ongoing assistance. Someone experiencing chronic mental health challenges may benefit from continuing treatment. A family may need intermittent support as circumstances change. The goal should not be to make people stop needing help simply so an agency can claim success. The more important question is this:
When greater capability is possible, are our services helping people develop it?
A person can need support and still become more capable. They can rely on others while becoming more confident in making decisions. They can use formal services while also strengthening natural relationships. They can receive assistance while becoming better able to identify what they need, advocate for themselves, solve problems, and navigate the systems around them.
In other words, sustainability does not require that people need no one. It requires that progress does not depend entirely on the continued presence of the intervention that produced it.
This is not simply a philosophical concern. It is also a measurement problem. Implementation researchers have long argued that different kinds of outcomes need to be distinguished. Proctor and colleagues, for example, distinguish among implementation outcomes, service outcomes, and client outcomes rather than treating them as interchangeable. Their framework includes implementation outcomes such as adoption, feasibility, fidelity, cost, penetration, and sustainability alongside outcomes that describe the quality and effectiveness of services and the well-being of clients.
That distinction is useful for human services leaders because it reminds us that there is a difference between:
These questions are related, but they are not the same question. An organization can have excellent attendance rates, high staff compliance with procedures, completed service plans, and strong satisfaction scores while still having limited evidence that the changes it produces persist after formal services recede. That does not mean the organization is failing. It means the organization may be measuring only part of the story.
This becomes particularly important when organizations see the same people returning to services. It is tempting to interpret repeated service use as evidence that a person has failed to make progress. That interpretation is often both unfair and inaccurate. People’s circumstances change. New crises occur. Systems can create barriers that individuals cannot overcome alone. Some conditions require ongoing support.
But repeated service involvement can also be a signal worth examining. If a person repeatedly enters the same service system with similar challenges, leaders should be willing to ask: What are we learning from this pattern?
These are leadership questions, not questions that should be placed solely on frontline practitioners.
Human services organizations do not operate in a vacuum. What practitioners can accomplish is shaped by caseloads, funding structures, documentation requirements, supervision, organizational culture, leadership, workforce development, available resources, relationships with other systems, and the expectations built into contracts and policies.
Implementation science has made this point particularly clearly. Damschroder and colleagues’ Consolidated Framework for Implementation Research was developed in part because interventions that demonstrate promise in research settings do not automatically produce the same results when implemented in different real-world contexts. Their framework identifies factors across the intervention itself, the outer setting, the organization, the individuals involved, and the implementation process.
Aarons and colleagues similarly emphasize the role of leadership and organizational climate in creating conditions that support implementation and sustainment. This has an important implication for leaders:
If we want different outcomes for the people we serve, we may need to design different conditions for the people providing the service.
It is not enough to tell practitioners that they should promote self-determination, build natural supports, strengthen motivation, or help people develop lasting capabilities. The organization has to make that work possible.
The evidence from Wraparound provides a useful example. Wraparound is not simply a set of services. It is a structured, individualized process intended to coordinate supports around children and families with complex needs. Research on Wraparound has produced a mixed but meaningful evidence base, with findings varying across studies and settings.
A 2021 systematic review and meta-analysis found positive effects favoring Wraparound across several outcome domains, including residential outcomes, school functioning, mental health symptoms, and functioning. Importantly, the review also found larger effects in conditions with higher Wraparound fidelity, while noting methodological weaknesses and the fact that fidelity measurement was absent from many studies.
That finding illustrates a larger principle. An intervention is not just what is written in the manual. It is what actually happens in practice, in a particular organization, with particular people, under particular conditions. This is one reason the question of sustainability cannot be separated from the question of implementation.
If the quality of practice varies substantially from one setting to another, then outcomes will vary too. And if an organization cannot sustain the practices that matter, improvements achieved during an initial implementation may erode over time.
The implementation literature increasingly treats sustainability as something that must itself be understood and measured rather than assumed.
All of this brings us back to the question at the center of this series: What should remain when services end? The answer cannot simply be that the person received good services.
Good services matter. Effective interventions matter. Access matters. Coordination matters. Crisis reduction matters. But when lasting change is possible, the ultimate value of those interventions should include what they leave behind.
Those outcomes are harder to measure than whether a referral was completed. They are also much closer to the reason most people entered human services in the first place.
At the MiiWrap Institute, we believe this question should sit much closer to the center of how human services define effectiveness.
Services should not only help people through the problem that brought them to us. When sustainable change is possible, they should help people become more capable of navigating what comes next.
This is one of the central ideas underlying the MiiWrap Practice Model. MiiWrap begins with a premise that is simple to state but consequential in practice: meaningful and sustainable change cannot be delivered to people. Practitioners can provide resources, expertise, structure, relationships, and support. But ownership, motivation, confidence, agency, and the ability to act ultimately have to develop within the person.
That raises a deeper question than whether practitioners have completed the right tasks. What is happening in the relationship between the practitioner and the person that makes change more or less likely?
This is where MiiWrap’s integration of Wraparound and Motivational Interviewing becomes important. MiiWrap retains the individualized, team-supported structure of Wraparound while placing greater emphasis on the relational and motivational processes through which people develop direction, ownership, and capacity for change.
The Institute’s early outcome research is encouraging. Across MiiWrap implementations, emerging data suggest that outcomes can be stronger under particular implementation conditions and in particular contexts. Some of this work has not yet been published, so we are careful to distinguish emerging findings from established peer-reviewed evidence. But the early results are promising enough to warrant continued investigation.
That investigation is part of the Institute’s role. We are interested not only in whether MiiWrap works, but in why it works, under what conditions it works best, what organizations need to implement it well, and what remains true after formal services step back.
Those questions require more than a training curriculum. They require research, fidelity measurement, implementation support, practitioner development, organizational learning, and a community willing to examine what is happening in practice and learn from it. That is the work we are building the MiiWrap Institute to do.
There is one final connection that will become increasingly important throughout this series. If we believe that sustainable change requires people to develop capabilities rather than simply receive services, then practitioners need to practice differently. And if we expect practitioners to practice differently, we cannot reasonably expect a training event to accomplish that transformation by itself.
The same principle applies at every level of the system.
That means the path toward sustainable outcomes cannot stop at “we trained our staff.” It has to include the infrastructure that makes good practice possible, observable, coachable, measurable, and sustainable.
That is where this series is headed next.
In Part 2, we will examine one of the most consequential assumptions embedded in human services: that engagement is something we achieve before the real work begins.
What if that assumption is backwards? What if engagement is not simply the doorway to change? What if engagement is part of the mechanism through which change happens?
Continue to Part 2: Engagement Is Not the First Step of Change. It Is the Mechanism of Change. → (Forthcoming)
Research & Further Reading
Aarons, G. A., Ehrhart, M. G., Farahnak, L. R., & Sklar, M. (2014). Aligning leadership across systems and organizations to develop a strategic climate for evidence-based practice implementation. Annual Review of Public Health, 35, 255–274.
Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4, 50.
Olson, J. R., Benjamin, P. H., Azman, A. A., Kellogg, M. A., Pullmann, M. D., Suter, J. C., & Bruns, E. J. (2021). Systematic review and meta-analysis: Effectiveness of Wraparound care coordination for children and adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 60(11), 1353–1366.
Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A., Griffey, R., & Hensley, M. (2011). Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health and Mental Health Services Research, 38, 65–76.
This article is part of the MiiWrap Institute’s series, Closing the Sustainability Gap: Building Human Services That Create Change Beyond Services. [Start with Part 1]...
Every helping system has clients whose circumstances seem to challenge everything the system was designed to do. It might be a family living with chronic...
We often celebrate participation as evidence that change is happening. A person attended the meetings. They contributed to the plan. They agreed with the goals....
An organization spends months preparing for a new evidence-informed practice, kicking off a flurry of activity. Staff attend training, supervisors receive coaching, and new forms...
Most organizations that provide intensive services recognize the importance of developing their workforce. They invest in training. Many invest in coaching, reflective supervision, or communities...
Understanding a practice model is not the same thing as being able to use it when it matters most. Every year, organizations invest enormous amounts...
Implementation does not remain stable over time. It is either strengthening through reinforcement or gradually weakening through drift. One of the most persistent assumptions in...
The more responsibility the system carries for change, the less space remains for the person to develop ownership of it. Most practitioners do not wake...
“The written plan and the lived plan often begin separating long before anyone formally recognizes it.” One of the challenges in human services is that...
