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This book, which proposes a developmental view of short-term inpatient treatment for severely disturbed children, is much needed in our field. It is particularly relevant, emotionally engaging, and a pleasure to read because the writers who are the actual participants and leaders in the milieu program, discuss their own experiences with a variety of children. The principles of milieu therapy are beautifully described and its application to a diverse ethnic population of sick children is clearly delineated. I congratulate Leon Hoffman and his co-workers for bringing to the field of child psychiatry a timely and helpful work. Irving N. Berlin, M. D. Professor of Psychiatry and Pediatrics Director, Division of Child and Adolescent Psychiatry, and Director, Children's Psychiatric Center, University of New Mexico School of Medicine, Albuquerque, New Mexico PREFACE Children who require hospital or residential treatment need an environment that provides a structure to their daily activities. Much of the literature on milieu treatment is inadequate because of a lack of integration between the various theoretical frames of reference and their practical application. Berlin has stressed the importance of a develop mental frame of reference in the organization of a hospital child psychiatry unit. * The Mount Sinai Medical Center is a large urban institution located on the fringes of a New York City ghetto.
Before the 1940s, children in the United States with severe emotional difficulties would have had few options for care. The first option was usually a child guidance clinic within the community, but they might also have been placed in a state mental hospital or asylum, an institution for the so-called feebleminded, or a training school for delinquent children. Starting in the 1930s, however, more specialized institutions began to open all over the country. Staff members at these residential treatment centers shared a commitment to helping children who could not be managed at home. They adopted an integrated approach to treatment, employing talk therapy, schooling, and other activities in the context of a therapeutic environment. Emotionally Disturbed is the first work to examine not only the history of residential treatment but also the history of seriously mentally ill children in the United States. As residential treatment centers emerged as new spaces with a fresh therapeutic perspective, a new kind of person became visible—the emotionally disturbed child. Residential treatment centers and the people who worked there built physical and conceptual structures that identified a population of children who were alike in distinctive ways. Emotional disturbance became a diagnosis, a policy problem, and a statement about the troubled state of postwar society. But in the late twentieth century, Americans went from pouring private and public funds into the care of troubled children to abandoning them almost completely. Charting the decline of residential treatment centers in favor of domestic care–based models in the 1980s and 1990s, this history is a must-read for those wishing to understand how our current child mental health system came to be.
What happens when an educated, motivated family gives their best and its not enough? A Toxic Child is the story of Katie, an emotionally disturbed child, and the family who loves her. Written from the unique perspective of both her family and Katie herselfexplaining the behavior of a severely troubled child from her own perspectivethis book is both brutally honest and heartwarming. Katie was truly a toxic child, and as her story unfolds, it seems almost impossible that she survived both the mental and physical problems that plagued her. Other families struggling with these issues will be able to relate to Katies story and find insight and hope in reading about this familys journey. The emotionally disturbed child lives in another world that we would never be able to understand if we had not been exposed to it for 35 years. This book is written to clarify and help explain this world, her father shares. Katie dramatically affected our family and the other three children. She created chaos and pain for much of our lives. But this is not just a story of despair. Instead, it is a story of how knowledge, understanding, and love finally resulted in a happier and more successful outcome.
There is mounting interest in services to strengthen families and, if possible, to keep them together, preventing unnecessary and costly out-of-home placements. Unfortunately, although these programs are proliferating throughout the country, many are developing without the benefit of existing historical, conceptual, and scholarly data, information needed to make sound fiscal policy and programmatic decisions. This book fills this critical void, with a systematic examination of home-based services for abused, neglected, delinquent, and emotionally disturbed children and their families. With the most authoritative research on the topic to date, this book will be of interest to practitioners, policymakers, and child advocates.
The aim of this book is to provide illustrations of ways in which psychoanalytic ideas can be adapted and used in a wide variety of community settings - including social services, schools and hospitals - to help children and families who are emotionally disturbed or who have been physically or sexually abused. It is a book for professionals who are interested in using psychoanalytic ideas in their own work settings, and assumes no previous knowledge of these ideas on the part of the reader. It provides basic principles, many practical examples, further reading, and information about where to get support and consultation.
Originally published by Sage Publications in 1979, the authors observed life at a residential treatment center for emotionally disturbed children and reported on staffings, activities, and individual treatment sessions. This important book points out the great need for improvement in the quality of care and services given to these special children and their families
The life span of day treatment for children in the United States is relatively short, covering a period of about 50 years. Although the first 20 years saw little growth in the number of centers operating around the country, the concept of day treatment was recognized by the Joint Commission on Mental Illness and Health in 1961 as the most significant treatment innovation of this century. Enthusiasm for this treatment modality gained impetus from growing dissatisfaction among many mental health care providers who had no choice but to place children in a highly restrictive hospital environment. Day treat ment did not carry the stigma associated with inpatient placement. The children could now remain with their own families and within their own communities. The parents could be actively included in their child's treatment. This new modality avoided the short- and long-term negative effects of institutionalization, and there was a fa vorable cost discrepancy between day and inpatient mental health services. In more recent years, there has been growing evidence of the efficacy of day treatment as an intensive therapeutic environment for children and their parents. Despite these advantages, day treatment has continued to be underutilized in favor of inpatient treatment by both the psychiatric community and third-party payers. Only recently is it being acknowledged by some insurers as a therapeutically sound and financially advantageous alternative to inpatient services. Conse quently, it is showing signs of intense growth nationally.