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Book Forum: Child and Adolescent Psychiatry   |    
Early Intervention With High-Risk Children: Freeing Prisoners of Circumstance
Am J Psychiatry 1999;156:657-657.
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edited by Arthur B. Zelman. Northvale, N.J. Jason Aronson, 1996, 360 pp., $45.00.

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In the scope of my practice of rural general psychiatry, I have often been called on to perform evaluations of and treatment to children in crisis. Because this is my area of least experience, this book was much-anticipated before it was read and proved useful in application.

In eight comprehensive sections, Arthur Zelman addresses the major types of issues that face practitioners who work with high-risk children. The categorizations are interesting: the first six sections are divided by situations in which children might find themselves (i.e., in disrupted, symbiotic/psychotic, or neglectful families; homeless; bereaved; in foster placement), and the last two sections focus on 1) ways in which individual practitioners can help institutions to assist multiply stressed children and 2) specific effective, research-tested methods of intervention.

Originating at the Center for Preventive Psychiatry in New York State, the work described in this tome is both scholarly and pragmatic. The preface gives an overview of the history of the Center for Preventive Psychiatry, its philosophies, milieus, and graduates. Many of the contributors to this volume have been or continue to be associated with the Center for Preventive Psychiatry.

The 17 chapters here are introduced by clear definitions of prevention and theories of early intervention (long-term, intensive, multifaceted, flexible). Statistics concerning numbers and percentages and prevalences of children who have been abused or improperly or erratically reared or who manifest innate prerisk disabilities are also well handled.

The approach and coverage vary from one chapter to the next, but the edited writing is consistent throughout. Several entries emphasize certain real-life programs too heavily and do not abstract sufficiently for an unrelated clinician to benefit. Other chapters read too academically, with an imbalance between idealized suggestions and reports of concrete applications. Finally, in some areas, an excess of case note material overshadows therapeutic conclusions.

The most helpful sorts of recommendations that can meaningfully be extracted from this reference involve commonsense comments about how to manage disruptive children on a therapeutic unit (chapter 11), relevant frameworks for ongoing psychodynamic (chapter 12) and group (chapter 15) therapies for high-risk children, and cognitive changes in stressed children (chapters 16 and 17).

This book is dense but readable, factual and anecdotal, and best suited for advanced practitioners in the field of children’s mental health.




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