The Handbook of Child and Adolescent Systems of Care: The New Community Psychiatry - Hardcover

Hardcover

ISBN 10: 0787962392 ISBN 13: 9780787962395

Verlag: Jossey-Bass Inc.,U.S., 2003

Inhaltsangabe

The Handbook of Child and Adolescent Systems of Care is a groundbreaking volume that presents the latest thinking in the field of child and adolescent psychiatry written by a stellar panel of child and adolescent psychiatrists. The Handbook shows that the best way to help at-risk children is not in isolated doctor and patient treatment rooms but with community-based systems of care (SOC) that incorporate an interagency integration of services based on a client-centered and family empowering orientation. This important resource offers psychiatrists, psychologists, social workers, counselors, pediatricians, nurses, educators, lawyers and judges, politicians, child advocates, parents, and families a guide to this dynamic new theory and practice. Comprehensive in scope, The Handbook of Child and Adolescent Systems of Care includes vital information on a wide variety of topics including

• Developmental and cognitive psychology in systems of care (SOCs)
• Social sciences, neurobiology, and prevention in SOC
• The best way to use psychopharmacology
• Family- and community-based interventions
• Culturally diverse populations
• Youth in juvenile justice and child welfare, school-based services
• Partnerships among parents, consumers, and clinicians

Über diesen Titel

Über die Autorin bzw. den Autor

Andres J. Pumariega is professor and director of Child and Adolescent Psychiatry at the James H. Quillen College of Medicine, East Tennessee State University. He is founding former cochair of the Work Group on Systems of Care of the American Academy of Child and Adolescent Psychiatry (AACAP) and the author or coauthor of more than ninety scientific articles, chapters, and monographs on a wide variety of topics including child mental health and cultural competence. He is the coeditor (with Hubert B. Vance) of Clinical Assessment of Child and Adolescent Behavior (John Wiley & Sons, 2001).

Nancy C. Winters is assistant professor of Child and Adolescent Psychiatry and Pediatrics, and director of the Child and Adolescent Psychiatry Residency Program, at the Oregon Health and Science University. She is the current cochair of the Work Group on Systems of Care of the AACAP.

Von der hinteren Coverseite

More than twenty years ago, the mental health professional began using the medical model to address the needs of children and teenagers. This traditional method centers on diagnosis, focused treatment, and the use of medical facilities and residential programs. Continuing to use this model puts many of our children with serious emotional disorders at risk of falling through the cracks and being lost to their communities.

The Handbook of Child and Adolescent Systems of Care is a groundbreaking volume that presents the latest thinking in the field of child and adolescent psychiatry written by a stellar panel of child and adolescent psychiatrists. The Handbook shows that the best way to help at-risk children is not in isolated doctor and patient treatment rooms but with community-based systems of care (SOC) that incorporate an interagency integration of services based on a client-centered and family empowering orientation. This important resource offers psychiatrists, psychologists, social workers, counselors, pediatricians, nurses, educators, lawyers and judges, politicians, child advocates, parents, and families a guide to this dynamic new theory and practice. Comprehensive in scope, The Handbook of Child and Adolescent Systems of Care includes vital information on a wide variety of topics including

• Developmental and cognitive psychology in systems of care (SOCs)
• Social sciences, neurobiology, and prevention in SOC
• The best way to use psychopharmacology
• Family- and community-based interventions
• Culturally diverse populations
• Youth in juvenile justice and child welfare, school-based services
• Partnerships among parents, consumers, and clinicians

The Handbook of Child and Adolescent Systems of Care affirms that pills and pathologizing won't help our children survive and flourish. What is needed is a concentrated, integrated community effort which incorporates mental health treatment and potential problem prevention within educational and social services while strengthening and utilizing the power of the family and the community at large.

The Handbook of Child and Adolescent Systems of Care is a groundbreaking volume that presents the latest thinking in the field of child and adolescent psychiatry written by a stellar panel of child and adolescent psychiatrists. The Handbook shows that the best way to help at-risk children is not in isolated doctor and patient treatment rooms but with community-based systems of care (SOC) that incorporate an interagency integration of services based on a client-centered and family empowering orientation. This important resource offers psychiatrists, psychologists, social workers, counselors, pediatricians, nurses, educators, lawyers and judges, politicians, child advocates, parents, and families a guide to this dynamic new theory and practice. Comprehensive in scope, The Handbook of Child and Adolescent Systems of Care includes vital information on a wide variety of topics including

• Developmental and cognitive psychology in systems of care (SOCs)
• Social sciences, neurobiology, and prevention in SOC
• The best way to use psychopharmacology
• Family- and community-based interventions
• Culturally diverse populations
• Youth in juvenile justice and child welfare, school-based services
• Partnerships among parents, consumers, and clinicians

The Handbook of Child and Adolescent Systems of Care affirms that pills and pathologizing won't help our children survive and flourish. What is needed is a concentrated, integrated community effort which incorporates mental health treatment and potential problem prevention within educational and social services while strengthening and utilizing the power of the family and the community at large.

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The Handbook of Child and Adolescent Systems of Care

The New Community Psychiatry

Jossey-Bass

Copyright © 2003 Andres J. Pumariega and Nancy C. Winters
All right reserved.
ISBN: 978-0-7879-6239-5

Chapter One

A History of Community Child Mental Health

Ira S. Lourie

It is difficult to conceive of the history of community child mental health as separate from the history of child mental health itself. A large segment of the field of child mental health has always focused on the delivery of service in the community for the population of children in need regardless of their social status or standing. In fact, the earliest child mental health services were aimed at a population of homeless and wayward youth, following from an advocacy movement that grew out of the industrial revolution at the end of the nineteenth century and the spate of immigration at the beginning of the twentieth century in the United States. The child guidance movement grew out of these early beginnings and focused on serving the entire population. As a result, by the time the formal community mental health movement began in the United States in the early 1960s, the concepts of treating the mental health needs of children and adolescents in the context of their communities were already being practiced by child guidance centers and had become the accepted practice of the field.

Over the more recent history of the child mental health movement, several underserved populations have emerged around which the need for specialized community mental health services has been recognized: the alienated adolescents of 1960s and 1970s and children and adolescents with severe emotional disturbances as recognized in the 1980s. This chapter traces the four major community mental health movements for children that have occurred over the past hundred years: child guidance, the community mental health center program, the alternative youth services movement, and now the system of care concept for children and adolescents with serious emotional disturbances and their families.

CHILD GUIDANCE

The history of child mental health began as a progressive movement toward social welfare in the late nineteenth century described as the "child savers" (Jones, 1999). This group of advocates aimed at rescuing wayward children from the destructive forces of poverty. This movement then expanded to ameliorating the effects of those same forces, along with mental retardation, as the causes of juvenile delinquency. Beginning in the 1880s, problematic behavior in children, most often manifesting as delinquency, was seen as the product of moral and mental defects, compounded by the lack of appropriate resources. While one might find these concepts simplistic and antiquated by today's standards, we should be reminded that poverty and racism remain overwhelming social problems that leave their mark on the development and mental health of children growing up in their shadows.

Jones (1999) describes the forces that moved child mental health to a more professional child guidance during the first thirty years of the twentieth century. The first child mental health services began as child guidance clinics that functioned much like court clinics today. The first child mental health service agency, which was in Chicago, still bears its original name, the Institute for Juvenile Research, and another of the still existing early such programs, the Judge Baker Child Guidance Center, was named for the judge who was instrumental in its inception.

Child guidance was aimed at guiding youth in the right direction. Jones (1999) describes a Judge Baker Foundation document from 1915, Strengthening the Twig, which presents the concept of taking a young organism and helping it grow in the proper straight direction. A general professional acceptance of this premise is reflected in the fact that the primary professional organization for child mental health professionals from 1930 through the 1970s was the American Orthopsychiatric Association, in which the term orthopsychiatric is derived from the Greek root of the word ortho, meaning to straighten.

The first major advancement in our understanding and treatment of children and adolescents with problematic behavior that grew from child guidance was the shift from punishment to correction: we should fix troubled children, not further harm them. This community-focused concept was built on the premise that if children and adolescents misbehaved, it was not necessarily their own fault. Rather, society was to blame because it deprived youth of the resources necessary to meeting their needs. The accepted position that most delinquents came from the lower economic sectors of society was used as support for this supposition. At the same time, early thoughts on individual and family development were emerging, building on the earlier understanding that development was affected by economics and organicity (primarily retardation).

In the 1920s and 1930s, child guidance expanded from a primarily delinquency-based movement to one aimed more at the middle and upper classes. Jones (1999) calls this the "popularization of child guidance," which was driven by both the desire for mental health professionals to have their gospel more generally accepted and a youth movement of the 1920s unlike any before it. A broad audience for child guidance followed from a growing understanding that problematic youth behavior was found in all classes. Jones's theory is that the public became fascinated by the Leopold and Loeb trial of two upper-class youth convicted of a senseless murder, which led not only to a focus on upper-class problems but also served as a lesson in the relationship between developmental issues and youth behavior. What followed was a conceptualization of delinquency prevention, which led to a better understanding of how the deviations from the normal developmental course could lead to poor behavior. A movement followed from this to teach parents how to avoid these problems by using better methods in rearing their children.

Most of the early growth in the field of child mental health that Jones described consisted of a new understanding of children and their development and was exemplified by the focus on individual development, the role of the family in that development, and the effects of societal forces that children and families had to deal with. Unfortunately, it was during this era late in the first half of the twentieth century that child guidance accepted an increasing role as a private practice-like setting for middle- and upper-class populations. Although most child guidance clinics continued to provide publicly supported and charitable services to those who could not afford them, the field of child mental health as a whole slipped from being a primarily community mental health service to a private practice model.

COMMUNITY MENTAL HEALTH CENTER PROGRAM

A major shift in mental health policy in the United States occurred in the early 1960s with the advent of the Federal Community Mental Health Center program. In adult psychiatry, the public system had no community mental health alternative equal to the child guidance centers, and most communities did not have access to those centers. Public psychiatry consisted for the most part as state hospitals serving mainly a population with chronic psychotic disorders. For children, there were child guidance centers and some residential treatment, funded primarily as child welfare and juvenile justice institutions. The advent of phenothiazine treatment of psychotic symptoms in the 1950s had begun to create a population of adults with serious and persistent mental health problems who had been deinstituionalized and were living in communities.

Federal Community Mental Health Center Act

The U.S. Congress responded by the passage of the Mental Retardation Facilities and Community Mental Health Center Construction Act of 1963 (P.L. 88-164) to begin to meet the needs of this population. The purpose of the mental health portion of that legislation was to create a nationwide network of community-based mental health clinics that could serve this deinstitutionalized population, among others. The program was aimed at the development of community mental health centers (CMHCs) in every community in the country (the plan was to have one center for each catchment area of about 135,000 people). These centers were to provide five essential services: inpatient (short term), outpatient therapy, emergency services, crisis stabilization, and consultation and education.

Although children and adolescents were not excluded from the use of these services, their needs were not specifically addressed. Under the earliest iterations of the CMHC program, there was no requirement that services specifically aimed at children and adolescents be offered by the centers. As a result, the plight of children was left up to each center; unfortunately, only about half of the centers had any children's services at all (Ad Hoc Committee, 1971). Two major forces tended to inhibit the development of community mental health services for children and adolescents. The first of these was the predominance of adult focus within the field of mental health itself. This tendency, which still exists, causes the community mental health leadership not even to think about specialized services for children and adolescents. Some of this is related to their unfamiliarity with the differences in the needs of the populations. In addition, the needs of the adult population are so great that they alone could easily use up all the existing funds available and still require more.

The second factor is the high cost of children's services. CMHCs were most often created with money from the federal CMHC program, which offered startup staffing grants and which decreased over the period of eight years (there were also some funds available specifically for the building of new centers). As the federal funds decreased, they were made up with state funds and other public and private reimbursement sources. For adults, this process worked fairly well. As the federal monies dried up, the state was able to replace them with state mental health funds (which had been primarily aimed at this population of serious and persistently mental ill adults in the first place) and with newly developed federal funding streams such as supplemental security income, Medicaid, and Medicare, all of which the adult mentally ill population had easy access to. Children and adolescents had less access to these sources of funding.

Children's services require a greater degree of indirect services that are not reimbursable by most public or private insurance programs: informal case management tasks, consultation with schools and other programs for children and adolescents, and internal teaming time by the group of professionals at the mental health program who work with one family. During the time that a CMHC was receiving federal funding, many of these nonreimbursable child-oriented services were covered under the rubric of consultation and education services. But as soon as the federal monies were gone, state resources rarely were used to fill in, and the services dried up. When this happened, the cost of children's services became too high for the CMHCs to afford. Centers that had started children's services under the federal CMHC program dropped them when the federal monies went away, and other centers never even started them.

Compounding these problems was the fact that the state departments of mental health, which had the responsibility for continuing the CMHC program after the federal government's eight-year commitment was over, often did not have a child mental health capacity or expertise to support children's services. In 1982, Knitzer found that twenty-one states did not have a full-time person assigned to children's mental health services at the state level or a specific children's mental health allocation in their state mental health budgets. With such a lack of interest and support for children's services, it is no wonder that not many such services grew within the early days of the CMHC movement.

Part F of the Community Mental Health Center Act

The failure of adequate child and adolescent community mental health services to develop led child advocates to push for the development of a special child and adolescent program under the CMHC Act. In 1972, Congress passed an amendment to that act that provided for a special children's program, Part F. Part F was one of the most exciting advances in children's mental health services since the emergence of the child guidance centers some sixty years earlier. Under this program, around four hundred CMHCs developed and supported children's services, about a third of the total number of CMHCs (Lourie, 1992). Many of these children's programs were exciting and innovative and led the way to defining the delivery of mental health services to children, adolescents, and their families during that era. This program was deemed a success, and in 1974, the CMHC program was changed so as to require children's services in every federally funded CMHC. Unfortunately, the same CMHC act amendment of that year also added six other required services, raising the number from five to twelve but without increased funds to provide for these new services. As a result, each of the seven new services was insufficiently funded to be properly implemented, and status quo was the general rule. In addition, there were no longer special monies available to start new children's services as there had been under Part F. However, CMHCs that had received Part F grants did continue to receive these special children's funds for the full eight years of their original Part F grant.

Joint Commission on the Mental Health of Children

Around the same time that the Community Mental Health Center Program was started, there was another major step in community child mental health: the Joint Commission on the Mental Health of Children. Congress established this national study of the needs of children and adolescents with emotional problems in 1965. In Crisis in Child Mental Health (1970), the Joint Commission laid the framework for a child advocacy approach to children's services. This child advocacy reflected the full range of children's needs-welfare, corrections, education, health, and mental health-and was to be based on the principles of child guidance. This advocacy was felt to be needed at the national, state, local, and individual levels. Congress made two attempts to enact legislation implementing the recommendations of the Joint Commission, but both failed. This major setback for the field of child mental health reflected the waning of the federal government's commitment to child mental health from its earliest support of child guidance.

The 1970s saw few advances in community child mental health, and there was minimal impact from the Joint Commission in spite of the major advances in providing mental health services in general during that period through the national CMHC program, which was flourishing at its height nationwide, covering over half of the communities in the country with community mental health centers supported by federal monies. Unfortunately, this movement had little impact on child mental health because most of these community mental health centers offered few services for children and adolescents.

ALTERNATIVE YOUTH SERVICES MOVEMENT

One area in which there was a great deal of growth and change in the 1970s was the field of youth services. Like the founding child savers of the child guidance movement, a group of individuals became concerned about the spirit of alienation of the late 1960s and early 1970s between the youth culture and the adult culture (not unlike the forces of the 1920s that helped drive child guidance). Adolescents in the 1970s were less likely than prior generations to participate in the traditional child guidance approach. Not only were these youth rebelling against their parents as had generations before; they also rebelled against adult authority in general, including the professional authority embedded in child mental health. Child mental health as a field responded to these alienated youth with the popularization of family therapy, which sought to treat the problems of youth as the result of a family system gone wrong rather than focusing on the alienation itself. Family therapists viewed the problems of youth as being the result of dysfunctional dynamics that developed among various family members, including the youth.

(Continues...)

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Details zur Ausgabe

• Verlag: Jossey-Bass Inc.,U.S.
• Erscheinungsdatum: 2003
• Sprache: Englisch
• ISBN 10: 0787962392
• ISBN 13: 9780787962395
• Einband: Tapa dura
• Anzahl der Seiten: 576
• Herausgeber: Pumariega Andres J., Winters Nancy C.
• Kontakt zum Hersteller: Nicht verfügbar
• Verantwortliche Person: Nicht verfügbar