A Review of Crisis Intervention with Adolescents: A Guide for Parents and Professionals

The major premise by the author is that parental empowerment and “voice” is now mandatory for quality mental health care of children. Our health/mental health system has an extreme imbalance between professional and parental oversight and decision-making responsibility for quality care.  Medical model mental health services impose a doctor-patient structure with a conspicuous lack of give-and-take, implicit expectations for patient compliance, and few opportunities for parents to acquire the knowledge necessary to participate in informed decisions concerning their children. Providers frequently impose their own values and usurp parental decisions on the basis of their training, professional experience, and status.  A legacy of impersonal service delivery style and severe time constraints often interferes with discussion of collaborative issues.  Lack of routine power-sharing between parents and practitioners vitiates the ethical imperative of beneficence or practice in the best interest of the client in favor of paternalism invoking the priority of the provider’s assumed knowledge.  Information can increase parental power to recognize symptoms, ask the right questions in search of a dialogue, and to become aware of a full array of potential treatment options. Above all else, developing this power can level the playing field with professionals and foster feelings of being a good and responsible parent in a quest for the best available service resources for children in crisis. 

A relatively new recovery vision in the United States also emphasizes optimism, hope, and the possibility of augmented responsibility and authority by consumers.  This differential balance of power, distinct from treatment of symptoms per se, augments the recovery process. Both parents and their children can benefit from self-directed coping, a process in which meaning accrues by self-conscious tracking of progress and connectedness to their important human relationships and valued activities.  A recovery-oriented vision is part of an emerging human science that cannot be satisfactorily implemented by single-factor interventions (e.g., cognitive-behavioral; pharmacological) for the multiple, interrelated risks of childhood and adolescence.

Interventions in this new science increasingly rely on prevention models to relate risk factors to subsequent child and adolescent difficulties. StepOne provides awareness of these multiple risks for individual children/adolescents.  Preventive interventions for these risks are available in existing primary health care and school settings largely independent of mental health services.  Parents have an immediate and continuing involvement in these preventive interventions.

Comprehensive mental health screening has become a primary avenue of inquiry; mandatory screening is in process of acceptance on a state-by-state basis. Conner’s low cost, on-line, immediately available feedback from StepOne provides parental control of privacy and yields flexible, customized screening or advanced child-focused specific and individualized informative reports for parents suggesting feasible treatment options and outcomes.    

Conner’s book is consistent with intimations of a new human science for child/adolescent mental health care contained in three seminal American Psychologist articles (Huang et al., 2005; Tolan & Dodge, 2005; Weiss, Sandler, Durlak, & Anton, 2005).  These papers identify children’s mental health as a primary mental health obligation including comprehensive assessment, linking prevention and treatment, and articulating values in standards of care. These articles are resources for all mental health practitioners because they examine the assets, liabilities, and current scientific status of our attempts to provide services for children. Conner provides a similar resource for parents that is readable, coherent, practical, and a professionally responsible independent and parallel rendition of the contents of these papers.

Finally, Conner’s book and these articles complement my understanding of an emerging human science (see Dana, 2006, March; in press).  This science is premised on a judgment-based approach to individual uniqueness and cultural differences within a democratized mental health establishment embracing professionals and consumers. Comprehensive assessment and complementary treatment/healing resources are integrated and coextensive. A research-informed practice provides a basis for training professionals described as local clinical scientists. The Internet provides opportunities for communication, information, research, and screening as well as a potential for delivery of other mental health services.

A human science in a multicultural society is obligated to provide equitable access to services and subsequent opportunities for specific culturally sensitive services as needed or requested. This latter desideratum, recognized explicitly in the cited American Psychologist articles, has not yet occurred in available mental health services in the United States or in Conner’s StepOne and crisis intervention book. In California, however, mandated cultural competency training in public mental health settings represents a Multicultural Assessment-Intervention Process model for embedding culture in services and service delivery as part-and-parcel of the new human science (see Chapter 1, Costantino, Dana, & Malgady, 2006).  

References

Costantino, G., Dana, R. H., & Malgady, R. (2006). Tell-Me-A-Story assessment of children in multicultural societies. Mahwah, NJ: Lawrence Erlbaum Associates.

Dana, R. H. (in press). Refugee assessment practices and cultural competency training. In J. P. Wilson & C. Tang (Eds.), The cross-cultural assessment of psychological trauma and posttraumatic stress disorder. New York: Springer-Verlag.

Dana, R. H. (2006, March). An international, interdisciplinary, culturally-relevant science of human assessment: Ingredients, perspectives, and prospects. In S. Strack (Chair), The pioneers of personality science discuss lessons learned and ideas for the future. Symposium conducted at the midwinter meeting of the Society for Personality Assessment, San Diego, CA. 

Huang, L., Stroiul, B., Friedman, R., Mrazek, P., Friesen, B., Pires, S., & Mayberg, S. (2005). Transforming mental health care for children and their families. American Psychologist, 60, 615-627.

Tolan, P. H., & Dodge, K. A. (2005). Children’s mental health as a primary care and concern: A system for comprehensive support and service. American Psychologist, 60, 601-614.

Weisz, J. R., Sandler, I. N., Durlak, J. A., & Anton, B. S. (2005). Promoting and protecting youth mental health through evidence-based prevention and treatment. American Psychologist, 60, 628-648.

Mentor Research Institute is a non-profit educational and research organization with a focus on mental health for youth and families including homelessness, effective intervention, public and professional education.

Contact Kevin Rea: 541 390-9848
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