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Shirley, a 33-year-old African-American mother of seven children, became involved with agency clinicians in 1988, after all the children had been removed from her care multiple times by the state's child protective agency. Shirley, who had become a mother at 16, was about to lose them permanently. More than a decade later, in 2003, Shirley remains involved with the Guidance Center, Inc., a community agency serving the comprehensive developmental, mental health, and family support needs of children and families in Somerville and Cambridge, Massachusetts. Today, Shirley is a psychologically stronger woman who has developed more effective parenting skills. The Guidance Center's community-based clinical practice model evolved in response to the needs of parents like Shirley. The model and practice were crafted through the creative mix of visionary leadership and active, experienced, flexible staff, who worked with Shirley and other courageous families and children needing mental health intervention. This chapter uses Shirley's story throughout to put the Guidance Center's model and the development of its integrated service continuum into a historical context. It also illustrates how a combination of descriptive clinical research, knowledge of best practice, and dynamic advocacy can be used to secure resources, facilitate change, and ultimately create a comprehensive continuum of care for troubled children and families.

This chapter argues that continued use of inherited models of case management limits the progress that otherwise could be made in actualizing this shift from a deficit- and institution-based framework to a recovery and community integration paradigm. This paradigm calls for new models of community-based practice that move beyond the management of cases and beyond merely semantic changes that introduce new terms for old practices. One such model that appears to be emerging in the field is that of tour guide, community guide, or, “recovery guide.” Prior to introducing this model, the chapter first reviews existing models of case management that have underlain the last 40 years of community-based practice. It then outlines the principles of care that ground a recovery-oriented alternative; describes the key components of the recovery guide model; and considers some of the broader implications of this model for community-based practice.

Critical Incident Stress De-briefing (CISD) has emerged as an intervention in response to disasters. It is a structured group process for survivors and victims of disasters and other trauma-inducing events. De-briefings are usually considered part of a larger system of crisis responses to “critical incidents” known as Critical Incident Stress Management (CISM), which include more immediate responses known as “defusings,” briefings for management, and individual crisis intervention. CISD and CISM are community-based interventions and often rely on a peer or volunteer model of responders and facilitators. This chapter focuses on debriefings, the most widely used crisis intervention service in response to disasters. It describes what de-briefings are, summarizes research about their effectiveness, and considers how they are an essential component of a community-based system of clinical care.

This chapter argues that immigrants' need for mental health services can most effectively be met by community-based services that respect and integrate aspects of their culture of origin. The chapter includes three sections. First, unique characteristics of adolescent immigrants and their special needs are reviewed and illustrated. The second section reviews hallmarks of community-based practice, discusses and illustrates principles generated from successful community-based mental health services for adolescent immigrants, and argues why such services are better equipped than traditional services to meet their needs. The focus is on what proved helpful and how it can be done. Finally, the third section presents one example of a community-based mental health service.

This chapter presents a case study for practitioners in intensive community-based family work. The story of the Vega family helps describe the roots, program development, and strategic clinical techniques of a service designed to maintain children who have experienced or are at risk of hospitalization or residential care. The aim is twofold. First, as program developers, the authors describe the roots of their model and how it can be constructed, supported, and implemented clinically. Second, as clinicians they seek to move beyond basic principles to describe some of the approaches they have refined over years of working with severely challenged families. These include ecological assessment, the art of intensive case management and metasystemic family work, contingency planning for urgent intervention, and assisting families in making transitions in care. With the Vegas' help, the chapter also illustrates how this work can be carried out through grassroots work by a relatively small community-based agency.

This chapter describes integrated family center practice that offers protection, nurturance, and avenues for development for parents and their children. The focus is the integrated family center (or family resource center) as a community-based single-site system of care, which arguably has an important role in the development of safe communities and new visions for children's services. As an alternative to existing child welfare services, they address fragmentation, defensive practice, and the disconnection from community that are serious problems in protective services. As stable community-based programs, integrated family centers provide a therapeutic milieu with a complex array of services to meet child welfare's primary goal: child well-being and family support. These integrated centers have the advantage of being a community, a place to belong to that grows with the family.

This chapter describes the Visiting Nurse Service of New York's Mobile Community Support Service's (MCSS), the creation of a caring community for emotionally distressed youth based on recognizing that we are one; we are family. The MCSS is a component of Families Reaching in Ever New Directions, Inc. (FRIENDS, Inc.). The chapter briefly reviews the theoretical changes leading to the current emphasis on community-based, family-driven care; describes key components of the tri-level intervention model of care; illustrates use of the model and discusses outcomes, including difficulties as well as successes; and reviews lessons learned.

This chapter describes the Neighborhood Place, an innovative prevention program with two primary goals: to engage children from marginalized, disenfranchised families in constructive activities outside of the school day, and to give them a voice for the expression of their thoughts and emotions. By engaging these children in positive activities, routines, and structures in a stigma-free environment, problems, should they emerge, could be addressed on-site without the customary referral to a “clinic.” Additionally, children would learn pro-social skills and have an opportunity to channel their talents and energies in ways that are socially acceptable and appropriate. The chapter comprises four components: background, literature review, program description, and summary. Specifics of the program are addressed so that it can be adapted or replicated in various environments.

The Yale Child Study Center, through its Program for HIV-Affected Children and Families, has developed a community-based approach to the mental health care of children and families beset by HIV/AIDS. This chapter explores the unique opportunities inherent in providing mental health care to HIV-infected and HIV-affected children using non-traditional techniques. The chapter begins by briefly providing a history of HIV-affected children on a national level, followed by a detailed discussion of the Program for HIV-Affected Children and Families, including the issues faced by these children and their families. Two case vignettes illustrate the need and challenges of home-based work with HIV-affected children.

The Child Development-Community Policing program (CDCP) is an innovative collaboration between police and child mental health professionals that aims to co-ordinate clinical approaches to intervention for children exposed to or involved in violence with police activities that contain the external sources of danger in the child's world. This chapter describes the theory and practice of CDCP and the impact of this unusual interdisciplinary partnership on the delivery of policing, mental health, and other social services for children and families exposed to violence and trauma.

The family has long been recognized as the most effective, long-term institution for raising children. Adequately functioning families socialize children, transmit intergenerational values and beliefs, and provide a place of refuge from the challenges of the outside world. In cases where parental functioning is impaired and the family environment is chaotic, taking the child out of home for treatment either in traditional outpatient care or by temporarily removing him or her to a different, unfamiliar setting may fail to address the underlying systemic issues that affect the child's sense of self and ability to function autonomously. This chapter describes some of the characteristics of families for whom the home may be a preferred treatment site, reviews some of the literature on home-based preventive and intervention programs for high-risk children, and provides specific case examples drawn from both a family preservation program and a psychiatric service for children and adolescents with severe emotional disturbances, which are delivered in the child and family's home.

School settings offer a wealth of opportunities for social workers to learn, practice, and enhance their social work knowledge and skills. Clinical practice in schools has generally focused on providing services to individual students related to behavioral, social, and academic issues, often involving collaboration with parents, caregivers, and teaching staff. Clinical social work practice may also involve group sessions with students around behavioral and social interaction issues. Working with site-based decision-making teams, taking an active role in leadership activities, or engaging in school reform are areas that generally have not been attended to by social workers. This chapter looks at the role of social work in the context of school leadership and systemic reform through the involvement of one school reform program. Recommendations are offered to support those desiring to work in this manner.

This chapter presents the work of Partners for Success (PfS), a collaborative project between Smith College School for Social Work (SSW) and an urban public school system of a mid-size city in the Northeast. In a context of widespread experimentation in locating mental health services in the public schools, this program succeeded in achieving the goals of providing multi-systemic mental health services consistent with system-of-care principles, while preparing social work interns for clinical and leadership roles in school-based mental health services. The chapter describes the impetus for the project, the initial negotiations between the two partners, the agreed-upon goals, the initial stages of entry and engagement, a lengthy period of stability and expansion, the clinical model that evolved over time, evaluative studies of the degree of satisfaction experienced by different stakeholders, and the process of adjustment to recent financial crisis in the schools, with reduction in the scope of the program, coupled with integration into the structure of the school system. The story is supplemented by integrating discussions of important issues from the literature about school-based mental health practice, as well as with case examples.

Over the course of several years, a protocol for psychoeducational intervention has been implemented, evaluated, and continually refined. The protocol aims to increase adolescents' awareness of the impact of trauma on their functioning, thereby setting the stage for helping them cope more effectively with stress; all in the service of diminishing the likelihood of re-enactment and risk-taking behaviors. This chapter describes the current status of the protocol, its evolution through the process of evaluation, and its potential for wider applications in the community. First, it presents the latest version of the protocol. Second, it traces the course of its evaluation, from a quantitative to a qualitative approach, the latter developed to better validate clinical impressions. Third, it presents a framework to conceptualize the role of this intervention in violence prevention. Finally, some of the implications for future community applications are discussed.

This chapter discusses the Family of Friends program. Family of Friends is an innovative program model designed to be implemented in day care centers and other preschool programs to create nurturing and supportive communities among participating families in order to ameliorate factors associated with child abuse and neglect. Its focus is based on the primary prevention concept of building the capacity of parents to cope with the factors in their lives that present risks to adequate parenting.

This chapter describes the first community mental health center opened in Gjakova, Kosovo in 2001, following 10 years of conflict in the region from 1989 to 1999. The design and training for the services at the Gjakova Center for Mental Health grew out of an ongoing collaboration between U.S. and Kosovar mental health professionals, known as the Kosovar Family Professional Education Collaboration (KFPEC). Since 1999, the work of the KFPEC has supported the development of a family-focused community mental health system in Kosova, the center in Gjakova being the first of seven planned community mental health centers.

This chapter reviews the work of a community mental health team in an urban public elementary school. It provides examples of the work with administrators, teachers, parents, and students. In recounting the work of the team over 4 years, the reader is only provided with an early interim report. A great deal remains to be done. Over the next 5 to 10 years, with the principal's help, the team hopes to extend these concepts to build a school-wide culture involving everyone: students, teachers, administrators, and parents.

This chapter presents the work of the Open Dialogue (OD) approach to mental health intervention in psychiatric crises developed by a team of clinicians and researchers in Finland. In Open Dialogue, the first treatment meeting occurs within 24 hours after contact and includes as many significant people as possible from the patient's social network. The aim is to generate dialogue and put words to the experiences embodied in the patient's psychotic symptoms. Psychosis is a way of responding to stressful life situations, and in therapy, generating dialogue becomes the primary aim. All issues are analyzed and addressed with everyone present. Treatment is adapted to the specific and varying needs of patients and takes place at home, if possible. Psychological continuity and trust are emphasized by constructing integrated teams that include both inpatient and outpatient staff, all of whom focus on generating dialogue with the family and patients instead of trying to rapidly remove psychotic symptoms. Treatment is based on generating dialogue; a case is analyzed to illustrate this principle.