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Book Reviews   |    
Service Delivery for Vulnerable Populations: New Directions in Behavioral Health

edited by Steven A. Estrine,, Robert T. Hettenbach,, Heidi Arthur, and Maria Messina; New York, Springer Publishing Company, 2011, 352 pages, $65 softcover

Reviewed by Stephanie Le Melle, M.D., M.S.
Psychiatric Services 2013; doi: 10.1176/appi.ps.640201
View Author and Article Information

Dr. Le Melle is codirector of public psychiatry education in the Department of Psychiatry, Columbia University, and New York State Psychiatric Institute, New York City.

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The title of this book does not quite capture its emphasis. A more descriptive title might be Vulnerable Populations: A Review of Special Needs and Innovative Programs. That said, the book gives a concise overview of vulnerable populations, their unique needs, and the systems of care and some treatment modalities that have been developed to try to address these needs.

The book is organized into nine sections of two to four chapters each. The first seven sections introduce specific vulnerable populations with a brief overview of their needs and a literature review. Each section ends with a description of the evidence-based and best practices for the treatment of the specific population. The populations covered include adults with severe mental illness and other disabilities, children, underrepresented sexual orientation groups, refugees, the elderly population, veterans, and people with criminal justice involvement. For each population emphasis is placed on trauma-informed care, reduction of stigma, cultural competence, and a systems approach to care.

The last two sections of the book focus more on systems of care and service delivery. One section deals with service delivery in the criminal justice system and critical aspects of program evaluation. The other section covers emerging issues in service delivery, including use of the Internet and electronic social networking as tools to provide care, the importance of health care literacy, the mental health care consumer movement, and the future of managed health care.

The two chapters on refugees are particularly interesting. A three-phase model of the trauma of the refugee experience is presented, covering premigration, migration, and resettlement. The second of the two chapters highlights several emerging approaches to treatment, including self-care and healing, traditional healing, storytelling, and psychosocial approaches. The chapter on jail diversion is comprehensive; it’s a must-read for any clinician working with a high-risk population. The chapter first reviews many of the factors that have contributed to the increase of persons with mental illness in the criminal justice system. It then outlines each step of the process of incarceration and the points of diversion. The chapter on program evaluation is an excellent introduction to the considerations needed in program design. The chapter on the impact of the consumer movement highlights several key individuals who have had a tremendous influence on the field and have promoted the concept and practice of recovery principles.

This book is a quick read and provides a good brief overview for any clinician working with vulnerable populations. It also provides key references and a good foundation for more in-depth exploration of the topics.

The reviewer reports no competing interests.

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