Behavior Problems in Preschool Children: Clinical and Developmental Issues

The Child and Adolescent Service System Program (CASSP) was initiated in 1984 to encourage the establishment of comprehensive, coordinated, and culturally competent mental health services for emotionally disturbed children and adolescents. Since the introduction of CASSP principles and theory, mental health professionals and administrators have attempted to implement them into local systems of care with government and private financial support. The Handbook of Child and Adolescent Systems of Care serves as an impressive road map for the implementation of CASSP principles and the establishment of systems of care for child and adolescent mental health. The Handbook grew out of the work of the American Academy of Child and Adolescent Psychiatry’s Workgroup on Community-Based Systems of Care. It is divided into four sections devoted to the history and concepts underlying CASSP and systems of care, integration of clinical services, issues related to specific child and adolescent populations, and the administration and evaluation of systems of care. The initial section consists of five chapters and establishes the broad principles of CASSP and systems of care that reappear in most of the succeeding chapters as they relate to specific topics, such as pharmacotherapy, juvenile justice, or managed care. Each chapter serves as a comprehensive review of its subject and easily stands alone, and there is little overlap in the authorship of other chapters, so that the reader may concentrate on a specific chapter without significant contextual loss. The chapters that focus on integration, establishment, and collaboration of services come to life with descriptions of real-world examples of the successes and problems encountered in delivering mental health services in various settings and systems of care. Although federal grants remain in place, the authors point out that some of the successful programs have been dramatically reorganized as funding sources have declined or been altered. This funding problem is likely to worsen as federal and state budget deficits rise, and historically most states have not prioritized the funding of public mental health care. Many of these systems of care that were established after years of intensive work, and in some cases court orders and consent decrees, may be endangered as government finances worsen, and managed care is imposed on the delivery of publicly funded mental health care. These problems may disrupt the future development of comprehensive systems of care for young people. The specificity of each chapter allows the reader to focus on a narrow subject as it relates to the broader concept, but it also leads to a significant amount of redundancy when the book is read as a whole. This is especially evident when each chapter reviews similar history and core principles that appear in a majority of the other chapters, albeit slightly altered to fit each chapter’s specific area. Although the specific examples of newly established systems of care are encouraging, they do raise the unanswered question of whether similar systems would be successful if they were applied to broader populations. Unfortunately, success in a narrow, welldefined population does not always translate into success with large, more diverse populations. A discussion of these potential pitfalls and future options would have been informative. The Handbook of Child and Adolescent Systems of Care is clearly a welcome and much-needed guide to the principles of CASSP and the development of systems of care. It is a well-researched reference for those who are interested in the history and continuation of comprehensive systems of care for children and adolescents. Its review of the history and theory underlying systems of care is enlightening, and the authors’ examples of successful systems and their collaborations serve as a reminder that if mental health systems improve, children and families will benefit. If implemented and supported by mental health professionals and policymakers, the principles discussed throughout this book could have a profound effect on the future mental health care received by disadvantaged children and adolescents.