Child Guidance Clinics

The National Committee for Mental Hygiene marshaled the child guidance clinic movement, which spanned the decades of the 1920s to 1940s. Child guidance clinics were established for the psychiatric study, treatment, and prevention of juvenile delinquency, other social ills, and conduct and personality disorders in 3- to 17-year-old non-mentally retarded children. The child guidance clinic approach to children's mental health represented a shift from traditional treatment models of the era, which were largely individual psychoanalytically oriented play therapy sessions conducted by a psychiatrist or psychologist, toward more innovative modes of intervention. Child guidance clinics' comprehensive, community-based approach to children's mental health service was carried out by multidisci-plinary teams of psychologists, psychiatrists, psychiatric social workers, speech therapists, and psychiatric occupational therapists. In the 1940s the mental health focus shifted from the child guidance clinic movement to World War Il-related mental health issues.

The next large impact on children's mental health services was the Community Mental Health Centers (CMHCs) Act of 1963. Like child guidance clinics, CMHCs sought to address both the treatment and prevention of mental illness within communities. However, unlike child guidance clinics, CMHCs were not solely child focused, rather, they addressed mental health issues across development, from prenatal health to coordination of services for the elderly at individual, family, and community levels. CMHCs were responsible for a comprehensive menu of services including outpatient treatment, primary and secondary prevention efforts, 24-hour crisis response, and community mental health education. CMHCs fulfilled their community education responsibility through consultation with schools in the area of early child risk evaluation.

Partly in response to changes in insurance reimbursement systems such as health maintenance organizations, mental health services for children have continued to evolve. Currently they include varied theoretical orientations and treatment approaches. Current work with chil dren emphasizes child-centered, family-focused, community-based efforts in the planning and implementation of treatment. Mental health services strive to be both culturally competent and responsive to the cultural, racial, and ethnic differences within varied service populations. Services available to children within the mental health system include inpatient and outpatient psychiatric and psychological treatment facilities, partial programs, mobile therapy, crisis teams, foster care, juvenile justice, education, social welfare, primary health care, emergency shelter, and home-based interventions. In addition, wraparound services that meet a child's mental and physical health needs across his or her varied environments have been added to the children's mental health service menu. Case managers, whose job it is to coordinate children's mental health services within this complex system, have emerged to ensure that services are not fragmented and work in an interactive therapeutic manner to meet children's mental health needs. Undoubtedly, the mental health service system will continue to evolve in an effort to meet children's ever-changing physical, emotional, social, and educational needs.

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