Early Intervention With High-Risk Children: Freeing Prisoners of Circumstance

Arthur Zelman has put together accounts of preventive interventions that are successful with high-risk children, based on work originated at the Center for Preventive Psychiatry in New York. Zelman has served as medical director of the center since 1979. He has consulted to a day school, maintained a private practice, and published extensively in the field of preventive psychiatry.

Prevention is often associated with medicine and medical models. Zelman challenges the medical definition of prevention, stating in his introduction that the book "is intended as a corrective to the seductiveness of the medical model as it relates to the idea of prevention and early intervention in the area of mental health and `illness.'"

Zelman does a nice job of setting the stage for the importance of prevention services to high-risk children, outlining risk factors and types of interventions. He then introduces us to five types of early intervention: therapeutic nurseries, nonmilieu multimodality approaches, different types of individual child psychotherapy, group psychotherapy, and tripartite psychotherapy. Contributors address the specific needs of children of disrupted families, foster children, homeless children, children bereaved of a parent, children of symbiotic and psychotic parents, and children of neglect. Chapters are also devoted to helping institutions assist high-risk children and to follow-up studies of interventions for multiply stressed children.

This book blends theory with practice, presenting case examples that illustrate interventions and their effectiveness. The interventions, based on object relations and psychoanalytic theory, are individualized, comprehensive, and generally long term. The examples bring to light the intense needs of high-risk children and their families and provide inspiration to individuals working with such children by demonstrating effective outcomes.

The book will be most useful to clinicians working with high-risk children in settings that are able to provide long-term care. Services researchers specializing in children's services will also find the book useful. While the information presented satisfies the standards of research expected by most clinicians, social scientists with a more quantitative bent may not find it rigorous enough. This discrepancy illustrates a fundamental paradox: research done by clinicians is not seen as rigorous enough, while research done by researchers without clinical experience is not seen as grounded in reality.

Although long-term care is vanishing from the landscape largely due to managed care, some individuals need long-term care. However, many clinicians work in settings where long-term care is just a memory. Ironically, a marriage between clinical practice and research holds the greatest promise for influencing policy about long-term interventions in a managed care environment.

Ms. Mikeska is assistant administrator of children's mental health services in the division of behavioral health of the New Hampshire Department of Health and Human Services in Concord.