Trends and Shifting Ecologies: Part II
Andres J. Pumariega, MD, Nancy C. Winters, MD
Children and adolescents are embedded in the ecologic context of their families, schools, neighborhoods, and other social systems (such as child welfare and juvenile justice) responsible for their care. Contextual factors are particularly relevant to child and adolescent mental health emergencies. Generally, a child's parents or other responsible adults decide when the child's emotional or behavioral problems are beyond their control and require emergency services. The timing of the acute presentation is as likely to result from impairment in the adults' functioning (or capacity to contain the child's behavior) as from a worsening of the child's psychopathology.
Community-based systems of care offer some promising ecologically based approaches to child psychiatric emergencies. More community-based effectiveness research is needed on child and adolescent mental health crisis services. To meet the needs of real-world children with serious emotional disorders and their families, however, research should include integration of multiple evidence-based modalities (such as psychopharmacology, behavioral, and cognitive approaches) and the effectiveness of single modalities. Funding priorities in mental health systems also should shift significantly to support community-based crisis services over more restrictive approaches that have a less solid evidence base.
This article may be read in its entirety in the journal of Child Adolesc Psychiatric Clin N Am 12 (2003) pages 779-793.
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