Use of the wraparound philosophy in program implementation is widespread across the country, though evidence of linkages between adherence to this philosophy and client outcomes is limited. In Erie County, NY, this philosophy is delivered through care coordination services by care coordinators. This is a study of the effect of adherence to wraparound philosophical elements and components of care coordinator practices on client outcomes ( n = 252). It was found that shorter times of initial care coordination phase completion were associated with higher ratings of wraparound fidelity by caregivers and greater decreases in youth impairment. Higher ratings of adherence to wraparound fidelity by caregivers were found to be associated with a family's objectives being met at discharge. Findings from this study highlight the need to consider both care coordinator practice and adherence to fidelity when attempting to understand the effect of wraparound services on youth.