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Book Review   |    
Handbook of Child and Adolescent Outpatient, Day Treatment, and Community Psychiatry
Thrassos S. Calligas, M.D.
Psychiatric Services 1999; doi:
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edited by Harinder S. Ghuman, M.D., and Richard M. Sarles, M.D.; Philadelphia, Brunner/Mazel, 1998, 393 pages, $69.95

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This book is a thorough, encyclopedic, and up-to-date reference that, as the editors state in their preface, is intended as a guide to the delivery of contemporary ambulatory psychiatric care for children, adolescents, and their families—one that is useful both to experienced practitioners and to trainees in the mental health disciplines. The editors and the 30 contributors have succeeded in reaching the goal. The book is a very useful, practical, informative, and authoritative reference and resource.

The handbook is divided into six parts, reviewing clinical, administrative, and training issues in ambulatory services; assessment of children and adolescents; common disorders of childhood and adolescence; therapeutic interventions; day treatment; and other community-based programs. The 30 chapters address a variety of related topics from organizational and staffing issues in child and adolescent services to thoughtful summaries of assessments, common disorders, and interventions. Seven chapters totaling about 70 pages are devoted to day treatment and other community day programs.

The most useful chapters are the ones discussing administrative and systems issues involved in operating outpatient clinics and other programs that provide less intensive care than hospitals. This book is one of the few resources that actually address recommendations for staffing patterns (a ratio of one full-time child psychiatrist for a hundred patients in a community mental health center is recommended) and that outline clinical responsibilities for the various disciplines. It also discusses recruiting, staff development, team leadership, and the role of the psychiatrist. I found the chapters on school-based services, therapeutic milieu in a day hospital, and home- and community-based care to be particularly valuable as guidelines to expectations, goal setting, and administration.

I found the case examples especially useful, particularly the ones outlining interventions through consultation to a system. Another strength of the book is its attention to issues related to insurance, health maintenance organizations, and financial constraints. This pragmatic focus is acknowledged early in the book and informs much of the discussion that follows. However, I would have liked a more thorough presentation of insurance and utilization review issues; an effort to document standards in our textbooks will help balance insurance-based criteria for utilization.

The sections on common disorders and on therapeutics, including psychopharmacology, are somewhat cursory, but they are up to date, with excellent lists of references. Those two sections are the ones that most overlap with other textbook-like resources.

Overall, I found the Handbook of Child and Adolescent Outpatient, Day Treatment, and Community Psychiatry a valuable, informative, and refreshing guide to which I have turned many times in the course of my daily work in a hospital and partial hospital setting. I would highly recommend it, especially to mental health professionals working in clinics or partial hospitals.

Dr. Calligas is affiliated with the McLean-Franciscan child and adolescent mental health programs at Franciscan Children's Hospital in Boston.

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