edited by Anita Lightburn and Phoebe Sessions; New York, Oxford University Press, 2005, 584 pages, $65
Dr. Adams is assistant professor of psychiatry with the Division of Community Psychiatry, University of Maryland, Baltimore.
Calling the Handbook of Community-Based Clinical Practice a handbook is a stretch, given its 542 pages of text and references. Its four sections provide an introduction to community-based practices, essential elements of community-based practice, challenges for leaders in the community, and examples of programs that have been implemented. The last section is further subdivided into chapters on early intervention, school-based practice, services for children and families, and services for adults.
This volume has a different author for nearly every chapter, and this format is both a weakness and a strength. Some writers are more capable than others; one author created a single sentence that included 67 semicolons. This stream of consciousness was tedious. Relief came when a more skilled writer took over the writing of the chapter, and the clarity of the prose increased greatly. Negative editorial comments aimed at parents and individualism that appear in another chapter are not necessary in order to make the intended points.
The handbook's strengths are many. It gives a broad view of community practices from the level of the in-the-field therapist to that of a policy maker. Its candor regarding the many difficulties of creating and sustaining community programs is going to be useful to those who currently run programs and those who are considering starting community-based programs.
Despite the multiple authors, several important themes recur. Reducing isolation of patients and families is repeatedly underscored as an essential activity of a community-based service. Several chapters reinforce the idea that the approach to the people we treat must emphasize the discovery and development of the strengths of the individual in crisis. Vital emphasis is placed on helping people get on with their lives, reminding them that they had lives before the crisis or illness, and encouraging them to return to those lives or some reasonable approximation. In short, treatment is a part of their life and is not their entire life.
Much of what alleviates the crisis has little to do with medication and the medical model and a lot to do with psychosocial interventions, and this point is well made. For physician readers, it may take time to get used to reading material that comes from a strengths-based approach instead of a pathology-based, symptom-focused approach. Another useful theme is that treatment must occur where the patient is, not where it is convenient for those providing the treatment, and this is eloquently described in a well-written chapter called "Recovery Guides."
The handbook is at least two books: one is for the person who will pick and choose chapters based on his or her current needs. It's another book for a person who wants an overview of community practices over the past 30 years and how they have evolved. This book is a challenge to read from cover to cover, but it reveals a bounty of information when read that way. For people who are looking for a comprehensive text from which to teach important tenets of community care, this is your book.