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Book Forum: Clinical Practice   |    
Handbook of Child and Adolescent Systems of Care: The New Community Psychiatry
ALAN E. KAZDIN, Ph.D.
Am J Psychiatry 2003;160:2071-2071. doi:10.1176/appi.ajp.160.11.2071
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New Haven, Conn.

Edited by Andres J. Pumariega and Nancy C. Winters. San Francisco, Jossey-Bass, 2003, 547 pp., $80.00.

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This book is the product of the Work Group on Community-Based Systems of Care of the American Academy of Child and Adolescent Psychiatry (AACAP). The group has made enormous contributions to the care of children, adolescents, and families; critical issues that govern care; and the professional and national agenda on service delivery. Since its inception in 1994, the group has published pivotal works on managed care; treatment outcomes; training in child and adolescent psychiatry; care of infants, toddlers, and preschool-age children; measurement of child and adolescent needs for services; juvenile justice and mental health; issues of confidentiality; and more. The vision of AACAP in forming this group, the seriousness with which the group has taken its charge, and its products to guide policy, training, and clinical care are truly remarkable.

This handbook is the most recent product of the work group. The focus on systems of care refers to ways in which children and adolescents with social, emotional, and behavioral problems can be served. The systems involve a broad range of community-based services; involvement of the family; flexible and individualized care; interagency and service communication, coordination, and planning; cultural competence and sensitivity of the providers; accountability (e.g., program evaluation and outcome); and prevention and early identification.

The book includes 21 chapters organized into four sections: Conceptual Foundations of Systems of Care, Integrating Clinical Modalities Into Systems of Care, Working Across Populations and Settings, and Administration and Evaluation of Systems of Care. The first section includes contributions on the history of community care, a conceptual framework for providing care for children and families, family advocacy, collaborations needed across disciplines and agencies, and cultural competence required to provide care. The second section discusses pharmacotherapy, evidence-based community interventions, and case management. The third section covers different systems of care (e.g., juvenile justice and school-based services), special populations (e.g., youth with comorbid disorders, foster children in child welfare), and the collaboration required of community systems with primary care. The final section discusses systems of care in relation to federal, state, and local government, managed care, legal mandates, outcome evaluation to improve quality, and training of child psychiatrists and other mental health professionals for systems of care.

This book provides a model as well as a mandate for organizing the delivery of services and for evaluating their outcomes to ensure they are achieving the intended effects. The implications are broad in the integration of training, service delivery, policy, and legislation but also concrete in the description of the ways services can be organized, delivered, and evaluated. We have needed guidance on providing clinically sensitive, cost-effective, evidence-based, and comprehensive services. This book charts the course very well. It is also pivotal for training because it conveys the many roles, opportunities, and needs of child psychiatry and related disciplines and the range of possibilities for having an impact on different facets of service delivery.

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