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Book Reviews   |    
The Handbook of Child and Adolescent Systems of Care: The New Community Psychiatry
Reviewed by Peter Metz, M.D.; Manisha Punwani, M.D.
Psychiatric Services 2004; doi: 10.1176/appi.ps.55.6.723
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edited by Andres J. Pumariega and Nancy C. Winters; San Francisco, Jossey-Bass, 2003, 547 pages, $80 softcover

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In D. W. Winnicott's words, "In order to use the mutual experience one must have in one's bones a theory of the emotional development of the child and the relationship of the child to the environmental factors." Understanding systems of care is crucial in providing care to children with complex emotional and behavioral needs and their families. Such children and families are often shortchanged by a fragmented, uncoordinated, and hierarchical system in which youths and families are blamed or "fall through the cracks" of a system whose goal it is to provide needed support and treatment.

The Handbook of Child and Adolescent Systems of Care: The New Community Psychiatry, edited by Andres J. Pumariega and Nancy C. Winters, is a groundbreaking and comprehensive book that helps the reader understand in detail the changes that have influenced the practice of child psychiatry within a system-of-care framework over the past two decades. The book highlights the importance of incorporating the values and principles of community-based systems of care in working with youths with serious emotional disturbances and their families. Community-based systems of care offer new perspectives on the use of existing resources, emphasizing principles of coordination of care within community-based services, parent-professional collaboration, cultural competence, and individual strengths-based treatment planning that is child centered and family focused.

The Handbook of Child and Adolescent Systems of Care is the result of dedicated and persistent effort by the contributors, who have been members of the work group on community-based systems of care of the American Academy of Child and Adolescent Psychiatry (AACAP). The work group has been active since 1994 and has been a strong advocate within the AACAP for systems of care as a framework for work with youths with serious emotional disturbances and their families.

The book is divided into four parts. It also has a separate section for tables and figures, which makes for easy reading. Part 1—"Conceptual Foundations of Systems of Care"—discusses the history and the values and principles of community child mental health, systems of care, family advocacy, cultural competence, and collaboration across disciplines and among agencies. Part 2—"Integrating Clinical Modalities Into Systems of Care"—highlights the role of pharmacotherapy in the system of care, evidence-based community-based interventions, and care coordination (case management). Part 3—"Working Across Populations and Settings"—clearly describes the conceptual framework for early-childhood systems of care. Other chapters describe the roles of the juvenile justice system, school-based mental health services, comorbidity issues, foster children in the welfare system, and risks, goals, and outcomes of collaboration with primary care. Part 4—"Administration and Evaluation of Systems of Care"—is an analysis of the relationship between legal systems, managed care, and federal and local governments to systems of care. This part ends with a very informative guide to training child and adolescent psychiatrists and child mental health professionals about systems of care.

The Handbook of Child and Adolescent Systems of Care makes the reader aware of the importance of integrating interagency supports in a context of parent-professional collaboration and cultural competence at the community level and the level of the individual family. The book is well written and easy to read, avoiding technical jargon. It is highly valuable reading for all professionals who work with youths who have serious emotional disturbances, both within the mental health field and in the larger arena of child-serving agencies and organizations, including primary pediatric care, schools, child protective services, and the juvenile justice system. The book is also recommended for parents and family members of youths with serious emotional disturbances as an aid to providing information to these essential partners in the overall effort to allow youths with psychiatric disorders to stay in their homes and local communities.

The authors are affiliated with the department of psychiatry at the University of Massachusetts Medical School in Worcester.

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