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Book Forum: Mental Health Services   |    
School-Based Mental Health Services: Creating Comprehensive and Culturally Specific Programs
ISRAEL KATZ, M.D.; ALBERT C. GAW, M.D.
Am J Psychiatry 2005;162:830-a-831. doi:10.1176/appi.ajp.162.4.830-a
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By Bonnie Kaul Nastasi, Ph.D., Rachel Bernstein Moore, Psy.D., and Kristen M. Varjasm, Psy.D. Washington, D.C., American Psychological Association, 2004, 232 pp., $49.95.

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This book describes the authors’ approach to the creation, implementation, and evaluation of mental health services in schools among diverse cultures. It begins by pointing out that 20% of children and adolescents in the United States have symptoms of a diagnosable mental disorder and that childhood neuropsychiatric disorders will rise proportionately by more than 50% internationally by the year 2020 to become one of the five most common causes of childhood morbidity, mortality, and disability in the world. The authors describe the pivotal role that schools can have in many different cultures and how the integration of mental health services in schools can provide the starting point toward the prevention and treatment of mental health problems in children and adolescents.

The book presents the participatory culture-specific intervention model, describes its foundations, and introduces it with illustrations of the authors’ work in the field; it also describes detailed procedures for implementing the model and discusses future directions in research along with questions raised by the model. The participatory culture-specific intervention model is an interdisciplinary model based on applied anthropology and school psychology. The authors emphasize the participatory nature of the model throughout the book and the importance of engaging the stakeholders (children, families, teachers, school staff, the larger community, etc.) as partners in the process. They also stress the importance of the application of ethnographic research methods and an ecological perspective as part of the model.

The authors illustrate the participatory culture-specific intervention model with their work from the Sri Lanka Mental Health Project, where they developed school-based mental health services in the urban community of Kandy. It was particularly interesting to read about the struggles and rewards of the project taking shape over the years and the interdisciplinary nature of it, with the participation of sociologists, government officials, psychiatrists, anthropologists, and other specialists from both Sri Lanka and the United States.

The first six of the 11 phases of the participatory culture-specific intervention model are devoted to research and include developing the model, building up relationships with the community, and working with the cultural brokers. The following five phases deal with issues of intervention and include steps such as the implementation of the program, evaluation of the program, and continuation and extension of the program. There is also a partnership component that is central to the model and that encompasses all the other phases. The book describes each of the phases in detail with numerous examples from their own work along with that of others in the field of school psychology. The authors stress the critical role of the cultural broker in forming partnerships with the stakeholders and how the broker serves as an expert and interpreter of the culture and a liaison between the researchers and the community.

This book is very thorough and convincingly demonstrates the usefulness of the participatory culture-specific intervention model. It is written clearly and contains numerous examples, appendixes, and references. The book is primarily intended for school psychologists, but psychiatrists and other mental health professionals working in the school system and in the implementation of school-based mental health services will also find it rewarding and thought-provoking.

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