Taking John
A. Talbott,
Editor M.D.
Editotial Board: Carl C. Bell, M.D. Magda Campbell, M.D. Maryjane R. England, M.D. Robert 0. Friedel, M.D. Jeiftey L Geller, M.D., MPH. Stuart L. Keill, M.D. Steven M. Mirin, M.D. Jose M. Santiago, M.D. James H. Shore, M.D. Miles F. Shore, M.D. George M. Simpson, M.D. Leonard I. Stein, M.D. Gail M. Barton, M.D., exofficio Interdisciplinary Advisory Board: Suzanne Dworak-Peck, A.C.S.W. Susan B. Fine, M.A., O.T.R. Laurie M. Flynn Mary E.Johnson, M.A.LS. Sheldon Silk, MS. Gai R. VandenBos, Ph.D. Eleanor M. White, Ph.D., RN.
130 Garth
Road,
Suite
Book Review Martin S. Kesselman, 501, ScarscWe,N.Y.
Editor: M.D. 10583
Contributing Editors: Ian Alaer, M.D., AsdiovisudOterview Paul S. Appelbaum, M.D., LaW&Psyhimy Lsona L Bachiach, Ph.D., The Chronic Patient Gene D. Cohen, M.D., Ph.D., Practical Geriatrics Wendy Davis, MEd., DSM-lVin Progress Richard Frances, M.D., Akohol& Drug Abuse James Randolph Hillard, M.D., Eu,nayPshiat,y Samuel W. Perry III, M.D., Treatment Planning Carl Salzman, M.D., Psychophat,nacology Steven S. Sharfstein, M.D., Economic GrandRounds Kathleen Kannenberg, M.A., O.T.R., James M. Karis, D.S.W., Sandsa1lley, R.N.,ItN., Gary R. VandenBos, Ph.D., Interdthplinary Update Editorial Consultants: LeonaL. Bachrach, Ph.D. John 0. Lipkin, M.D. Theodore W. Lorei, M.S.W. Sally Webster,
Cover Art Consultant: Ph.D., New York City
Editorial Staff: 202-682-6070 Teddye Clayton, Managing ,ditor Betty Cochran, Assistant Managing Editor Joanne Wagner, SeniorAssistant Editor Constance Grant Gartner, Assistant Editor Nancy C. Van Gorden, Production Editor Joyce S. Ailstock, Administration Assistant Carolyn Rice, Suretaiy Advertising Production, Circulation: Nancy Frey, D#{241}wtor,Periodicals Services LauraAbedi, Adonrtising Production Manager Beth Prester Circulation Dirertor Jacqueline Coleman Young, Fulfillment Manager Elizabeth Flynn, Promotion Manager Advertising Sales: RaymondJ. Purkis,Diswtor 908-964-3100 2444 Morris Avenue, Union, N.J. 07083 Nonpharmaceu:ical and Classified Michael Roy 202-682-6124 1400K Street, N.W., Washington, D.C. 20005
Ronald
Hospital
American Psychiatric Association: Jospeh T. English, M.D., President John S. Mdntyre, M.D., President-Elsa A. Shellow, M.D., Speaker, APA Assembly Melvin Sabshin, M.D., Medical Director
and
Community
Psychiatry
Must
Research
Issue Guide
Services
for Children
and
Adolescents
As we move into the 21st century, recognition by policymakers and business leaders ofthe need for a competent, healthy work force has made children’s needs the centerpiece of national health care policy reform. The current systems approach to child mental health issues may serve as a model for reform, but development ofservices requires a commitment to a vigorous services research agenda. Today’s national movement to serve children with serious mental illness includes a dynamic and vocal parents’ coalition and a defined program agenda. Its landmarks will be familiar to many. In 1982 the Children’s Defense Fund surveyed the country and found that only one-third of children with serious mental disturbance received mental health services, and too often the services were inappropriate. The National Institute of Mental Health responded by creating the Child and Adolescent Service System Program, which has engaged every state in planning to build interagency coordination in serving seriously emotionally disturbed children. In 1988 the Robert WoodJohnson Foundation initiated the Mental Health Services Program for Youth, through which eight states, in partnership with identified communities, are assembling multiagency systems of care. The movement recognizes that seriously emotionally disturbed children need more than mental health services provided in traditional clinic or hospital settings; services of the major public entitlement programseducation, child welfare, health, mental health, and juvenile justice-must be decategorized and integrated. Families-partners and allies in treatment-must be preserved, and the nurture of the family circle is the normal and optimal treatment milieu. Once flexible services encircle an individual child in a “full-court press,” a system ofcare has been created. And a system ofcare that intervenes early and sustains and supports the child and family throughout the developmental years will prevent, to a significant degree, the lifetime of dysftinction and dependency to which seriously and persistently mentally ill persons are usually condemned. These ideals and the program innovations launched to meet them recognize the need for health care delivery for children and adolescents to be coherently organized. But these ideals must be tested, and program development must be guided by a vigorous research program. The Institute ofMedicine has called for a services research agenda in the context ofa comprehensive basic research program on mental illness in children and adolescents. NIMH has proposed one; it needs critical review, adequate resources, and action!-MARYJANE ENGLAND, M.D.,president, Washington Business Group on Health, andprogram director, Robert Wood Johnson Foundation’s Mental Health Services Programfor Youth
Hospital published
facilities
and
Community
monthly
and
by
agencies
with
research advance
and professional the standards ofall
1992
American
concerned
keeping
October
the
Psychiatry, the
association’s
VoL 43
established
in 1950
Psychiatric
Association
with
by Daniel for
Blain, staff
the care of mentally disabled to improve care and treatment, education in mental health and related mental health services and facilities. objectives
No.
10
M.D.,
members
is of
persons, in to promote fields, and to
961
A. Talbott,
Editor M.D.
Editotial Board: Carl C. Bell, M.D. Magda Campbell, M.D. Maryjane R. England, M.D. Robert 0. Friedel, M.D. Jeiftey L Geller, M.D., MPH. Stuart L. Keill, M.D. Steven M. Mirin, M.D. Jose M. Santiago, M.D. James H. Shore, M.D. Miles F. Shore, M.D. George M. Simpson, M.D. Leonard I. Stein, M.D. Gail M. Barton, M.D., exofficio Interdisciplinary Advisory Board: Suzanne Dworak-Peck, A.C.S.W. Susan B. Fine, M.A., O.T.R. Laurie M. Flynn Mary E.Johnson, M.A.LS. Sheldon Silk, MS. Gai R. VandenBos, Ph.D. Eleanor M. White, Ph.D., RN.
130 Garth
Road,
Suite
Book Review Martin S. Kesselman, 501, ScarscWe,N.Y.
Editor: M.D. 10583
Contributing Editors: Ian Alaer, M.D., AsdiovisudOterview Paul S. Appelbaum, M.D., LaW&Psyhimy Lsona L Bachiach, Ph.D., The Chronic Patient Gene D. Cohen, M.D., Ph.D., Practical Geriatrics Wendy Davis, MEd., DSM-lVin Progress Richard Frances, M.D., Akohol& Drug Abuse James Randolph Hillard, M.D., Eu,nayPshiat,y Samuel W. Perry III, M.D., Treatment Planning Carl Salzman, M.D., Psychophat,nacology Steven S. Sharfstein, M.D., Economic GrandRounds Kathleen Kannenberg, M.A., O.T.R., James M. Karis, D.S.W., Sandsa1lley, R.N.,ItN., Gary R. VandenBos, Ph.D., Interdthplinary Update Editorial Consultants: LeonaL. Bachrach, Ph.D. John 0. Lipkin, M.D. Theodore W. Lorei, M.S.W. Sally Webster,
Cover Art Consultant: Ph.D., New York City
Editorial Staff: 202-682-6070 Teddye Clayton, Managing ,ditor Betty Cochran, Assistant Managing Editor Joanne Wagner, SeniorAssistant Editor Constance Grant Gartner, Assistant Editor Nancy C. Van Gorden, Production Editor Joyce S. Ailstock, Administration Assistant Carolyn Rice, Suretaiy Advertising Production, Circulation: Nancy Frey, D#{241}wtor,Periodicals Services LauraAbedi, Adonrtising Production Manager Beth Prester Circulation Dirertor Jacqueline Coleman Young, Fulfillment Manager Elizabeth Flynn, Promotion Manager Advertising Sales: RaymondJ. Purkis,Diswtor 908-964-3100 2444 Morris Avenue, Union, N.J. 07083 Nonpharmaceu:ical and Classified Michael Roy 202-682-6124 1400K Street, N.W., Washington, D.C. 20005
Ronald
Hospital
American Psychiatric Association: Jospeh T. English, M.D., President John S. Mdntyre, M.D., President-Elsa A. Shellow, M.D., Speaker, APA Assembly Melvin Sabshin, M.D., Medical Director
and
Community
Psychiatry
Must
Research
Issue Guide
Services
for Children
and
Adolescents
As we move into the 21st century, recognition by policymakers and business leaders ofthe need for a competent, healthy work force has made children’s needs the centerpiece of national health care policy reform. The current systems approach to child mental health issues may serve as a model for reform, but development ofservices requires a commitment to a vigorous services research agenda. Today’s national movement to serve children with serious mental illness includes a dynamic and vocal parents’ coalition and a defined program agenda. Its landmarks will be familiar to many. In 1982 the Children’s Defense Fund surveyed the country and found that only one-third of children with serious mental disturbance received mental health services, and too often the services were inappropriate. The National Institute of Mental Health responded by creating the Child and Adolescent Service System Program, which has engaged every state in planning to build interagency coordination in serving seriously emotionally disturbed children. In 1988 the Robert WoodJohnson Foundation initiated the Mental Health Services Program for Youth, through which eight states, in partnership with identified communities, are assembling multiagency systems of care. The movement recognizes that seriously emotionally disturbed children need more than mental health services provided in traditional clinic or hospital settings; services of the major public entitlement programseducation, child welfare, health, mental health, and juvenile justice-must be decategorized and integrated. Families-partners and allies in treatment-must be preserved, and the nurture of the family circle is the normal and optimal treatment milieu. Once flexible services encircle an individual child in a “full-court press,” a system ofcare has been created. And a system ofcare that intervenes early and sustains and supports the child and family throughout the developmental years will prevent, to a significant degree, the lifetime of dysftinction and dependency to which seriously and persistently mentally ill persons are usually condemned. These ideals and the program innovations launched to meet them recognize the need for health care delivery for children and adolescents to be coherently organized. But these ideals must be tested, and program development must be guided by a vigorous research program. The Institute ofMedicine has called for a services research agenda in the context ofa comprehensive basic research program on mental illness in children and adolescents. NIMH has proposed one; it needs critical review, adequate resources, and action!-MARYJANE ENGLAND, M.D.,president, Washington Business Group on Health, andprogram director, Robert Wood Johnson Foundation’s Mental Health Services Programfor Youth
Hospital published
facilities
and
Community
monthly
and
by
agencies
with
research advance
and professional the standards ofall
1992
American
concerned
keeping
October
the
Psychiatry, the
association’s
VoL 43
established
in 1950
Psychiatric
Association
with
by Daniel for
Blain, staff
the care of mentally disabled to improve care and treatment, education in mental health and related mental health services and facilities. objectives
No.
10
M.D.,
members
is of
persons, in to promote fields, and to
961
