Creating Competence from Chaos

Children with emotional and behavioral disorders are often adrift in our society, lacking adequate mental health care or caught between several child-serving systems, such as child welfare, juvenile justice, and the schools.

In Pennsylvania, a commitment has been made, on a statewide basis, to serve these children and strengthen their vulnerable families through a home-based approach grounded in ecosystemic thinking and practice. This book tells the story of Pennsylvania's evolving treatment program, providing a model for other professionals who believe that a family's needs are best met through individually tailored, family-centered, community-based, culturally competent, and outcome-oriented services.

This is a complete, comprehensive guide, covering everything from planning and development of home-based services through supervision and training of home-based practitioners and evaluation of treatment outcomes. Particular attention is given to the clinical challenges faced by home-based therapists working with families where children are depressed and perhaps suicidal, oppositional and defiant, out-of-control and aggressive, or hyperactive/impulsive. These families commonly have multiple problems, complex histories, and a negative view of outside "helpers."

Delivered in the family's home and involving parents as partners, the services described here work to improve child and family functioning through family therapy, creation of collaborative links between appropriate community and family resources, and provision of family support funds for concrete services such as transportation, respite care, and emergencies. Home-based treatment serves both children at risk for out-of-home placement due to a diagnosis of severe mental illness or behavioral disorders and children being discharged from inpatient hospitals and psychiatric residential placements.

The authors, active at every level of program conceptualization and implementation, share their wealth of experience with readers. Their advice and case studies move from the big picture to the small details of where to sit in a family's home, what to say, and how to think about a problematic situation. Several appendices of forms used for assessment, evaluation, and training add to the book's practical value. Theoretically sound and fully practical, this guide to home-based services will encourage all professionals serving children to involve their families and communities-and to meet them where they live.

Martha Morrison Dore, Ph.D., is associate professor at Columbia University School of Social Work in New York. She was formerly Director of Social Work Research at the Philadelphia Child Guidance Center and adjunct assistant professor of social work in psychiatry at the University of Pennsylvania.

Marion Lindblad-Goldberg, Ph.D., is clinical associate professor of psychology, department of psychiatry at the University of Pennsylvania School of Medicine in Philadelphia. She is also Director of the Family Therapy Training Center, Philadelphia Child Guidance Center of the Children's Hospital of Philadelphia.

Lenora Stern is Chief, Division of Research and Program Development, State Office of Mental Health and Substance Abuse Services, Harrisburg, Pennsylvania.