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Innovative Approaches for Difficult-to-Treat Populations

Edited by Scott Henggeler, Ph.D., and Alberto B. Santos, M.D.

  • ISBN 978-0-88048-680-4
  • Item #8680

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Innovative Approaches for Difficult-to-Treat Populations makes recommendations for developing and disseminating innovative mental health services. It is geared toward clinicians, administrators, and policy-makers struggling to develop both clinically effective and cost-effective mental health and substance abuse services, and it focuses on services for individuals who use the highest proportion of mental health resources and for whom traditional services have not been effective. These target populations include youth with serious behavioral and emotional disturbances and adults with severe and persistent mental illnesses.

The innovative approaches reviewed include diverse treatment methods for differing clinical populations. These varied approaches have several common elements:

  • Social-ecological theory frameworks
  • An emphasis on delivering flexible, comprehensive, pragmatic, and goal-oriented interventions in persons' natural environments
  • Increased accountability on the part of service providers
  • The transition from centralized to community-based care is discussed, and normalizing a patient's daily routine as an important factor in the success of state-of-the-art community support programs is emphasized

Innovative Approaches for Difficult-to-Treat Populations offers mental health professionals and students a firsthand look at the future direction of clinical services. Policy issues necessary to developing and disseminating progressive treatments are addressed, including the downsizing of state psychiatric hospitals, strategies for reforming state mental hospital systems, and ethical issues in research on child and adolescent mental disorders.


  • Services for Children, Adolescents, and Their Families.

    Ecological trajectories in child mental health. Family preservation services for families with children who have mental health problems. Community- and neighborhood-based services for youth. Effective community-based treatments for serious juvenile offenders. Approaches to intervention with chronically neglecting families. Interventions for adolescents who abuse substances. The east Baltimore mental health partnership. Vocational initiatives for transition-age youths with severe mental illness.

    Approaches for Severely Ill Adult Populations.

    From the hospital to the community: the great American paradigm shift. Treating substance abuse in patients with severe mental illness. Family psychoeducation: basic concepts and innovative applications. Rural assertive community treatment: taking mental health services on the road. Adult foster care: the forgotten alternative? Mobile psychiatric emergency medical services. Optimal psychiatric inpatient care: from comprehensive to efficient treatment. Innovative services for elderly populations. Enhancing vocational outcomes for persons with psychiatric disabilities: a new paradigm.

    Policy Issues.

    Why don't the knuckleheads use common sense? Downsizing state psychiatric hospitals. Medicaid financing. Statewide program dissemination in Michigan. Strategies for reforming state mental health systems. An EPA for children: empowerment, prevention, and advocacy at work. Ethical issues in research on child and adolescent mental disorders: implications for a science of scientific ethics. Behavioral therapy research: a conceptualization of a process. Index.

About the Authors

Scott W. Henggeler, Ph.D., works in the Department of Psychiatry and Behavioral Sciences and Director of the Family Services Research Center at the Medical University of South Carolina, Charleston, South Carolina.

Alberto B. Santos, M.D., is currently the Director of the Division of Public Psychiatry and the Director of Psychiatry Residency Training in the Department of Psychiatry and Behavioral Sciences at the Medical University of South Carolina, Charleston, South Carolina.

I have little doubt that a reader with different interests would recommend alternative chapters. That is the strength of this volume. The editors have successfully compiled a tremendous amount of information on diverse programs for difficult-to-treat patients. It is an excellent text that should provide assistance for almost anybody attempting to develop an effective mental health program.—The Journal of Nervous and Mental Disease

If out of all of the confusion and disorder there may still emerge a system of care that is human and efficient, Innovative Approaches for Difficult-to-Treat Populations can serve as a marker in mapping the direction such a system will take.—Readings: A Journal of Reviews and Commentary in Mental Health

This intriguing and important book challenges our comfortable images of traditional treatment, neatly packaged in 50-minute sessions in the therapist's office. The interventions described here take place in the real-world settings where the clients live their lives and confront their stressors—at home with their families, in shopping malls, and sometimes on the street, in police cars, and even in jail. The treatments are practical and action-oriented, they focus on some of the most challenging conditions mental health workers confront—substance abuse, juvenile delinquency, child neglect, severe mental illness, and others—and there is a refreshing emphasis on empirical assessment of outcomes. The book offers both inspiration and instruction to mental health professionals seeking new approaches to old problems.—John R. Weisz, Ph.D., Professor of Psychology, Department of Psychology, University of California, Los Angeles

This book presents a timely colloquium among leaders in mental health service delivery systems. It begins to shape new roles for senior clinicians, and it will serve as a benchmark for best practice throughout this decade of reform of American health care.—Mary Jane England, M.D., Past President, American Psychiatric Association, President, Washington Business Group on Health, Washington, D.C.

A major challenge in the treatment arena today is to provide useful clinical interventions that are economically feasible. This is especially true for populations of patients that are difficult to treat. This excellent book, edited by Henggeler and Santos, brings together, in one volume, chapters written by leading clinical researchers working with difficult-to-treat problems and presents cutting-edge information needed to provide appropriate clinical services.—Leonard I. Stein, M.D., Director of Research and Education, Mental Health Center of Dane County, Inc., Madison, Wisconsin

This book is a comprehensive compendium of innovations in system change and service delivery. It should be useful to those involved in service evaluation, program development, system change, and training of the next generation of clinicians. The book's ecological framework is most useful for understanding the state of the art treatment of difficult populations and of anticipating future directions.—David A. Brent, M.D., Chief, Division of Child & Adolescent Psychiatry, Western Psychiatric Institute & Clinic, Prof of Psychiatry, Pediatrics & Epidemiology, Univ of Pittsburgh School of Medicine

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