Innovative Approaches for Difficult-to-Treat Populations makes recommendations for developing and disseminating innovative mental health services. It is geared toward clinicians, administrators, and policy-makers struggling to develop both clinically effective and cost-effective mental health and substance abuse services, and it focuses on services for individuals who use the highest proportion of mental health resources and for whom traditional services have not been effective. These target populations include youth with serious behavioral and emotional disturbances and adults with severe and persistent mental illnesses. The innovative approaches reviewed include diverse treatment methods for differing clinical populations. These varied approaches have several common elements: * Social-ecological theory frameworks* An emphasis on delivering flexible, comprehensive, pragmatic, and goal-oriented interventions in persons' natural environments* Increased accountability on the part of service providers* The transition from centralized to community-based care is discussed, and normalizing a patient's daily routine as an important factor in the success of state-of-the-art community support programs is emphasized Innovative Approaches for Difficult-to-Treat Populations offers mental health professionals and students a firsthand look at the future direction of clinical services. Policy issues necessary to developing and disseminating progressive treatments are addressed, including the downsizing of state psychiatric hospitals, strategies for reforming state mental hospital systems, and ethical issues in research on child and adolescent mental disorders.

This is an open access title available under the terms of a CC BY-NC 4.0 International licence. It is free to read at Oxford Scholarship Online and offered as a free PDF download from OUP and selected open access locations. Before new interventions are released into disease control programmes, it is essential that they are carefully evaluated in field trials'. These may be complex and expensive undertakings, requiring the follow-up of hundreds, or thousands, of individuals, often for long periods. Descriptions of the detailed procedures and methods used in the trials that have been conducted have rarely been published. A consequence of this, individuals planning such trials have few guidelines available and little access to knowledge accumulated previously, other than their own. In this manual, practical issues in trial design and conduct are discussed fully and in sufficient detail, that Field Trials of Health Interventions may be used as a toolbox' by field investigators. It has been compiled by an international group of over 30 authors with direct experience in the design, conduct, and analysis of field trials in low and middle income countries and is based on their accumulated knowledge and experience. Available as an open access book via Oxford Medicine Online, this new edition is a comprehensive revision, incorporating the new developments that have taken place in recent years with respect to trials, including seven new chapters on subjects ranging from trial governance, and preliminary studies to pilot testing.

Clinical trials are used to elucidate the most appropriate preventive, diagnostic, or treatment options for individuals with a given medical condition. Perhaps the most essential feature of a clinical trial is that it aims to use results based on a limited sample of research participants to see if the intervention is safe and effective or if it is comparable to a comparison treatment. Sample size is a crucial component of any clinical trial. A trial with a small number of research participants is more prone to variability and carries a considerable risk of failing to demonstrate the effectiveness of a given intervention when one really is present. This may occur in phase I (safety and pharmacologic profiles), II (pilot efficacy evaluation), and III (extensive assessment of safety and efficacy) trials. Although phase I and II studies may have smaller sample sizes, they usually have adequate statistical power, which is the committee's definition of a "large" trial. Sometimes a trial with eight participants may have adequate statistical power, statistical power being the probability of rejecting the null hypothesis when the hypothesis is false. Small Clinical Trials assesses the current methodologies and the appropriate situations for the conduct of clinical trials with small sample sizes. This report assesses the published literature on various strategies such as (1) meta-analysis to combine disparate information from several studies including Bayesian techniques as in the confidence profile method and (2) other alternatives such as assessing therapeutic results in a single treated population (e.g., astronauts) by sequentially measuring whether the intervention is falling above or below a preestablished probability outcome range and meeting predesigned specifications as opposed to incremental improvement.

Mental health care for people experiencing schizophrenia has changed dramatically over the last twenty years. This book draws on the expertise of a group of experienced clinical practitioners to provide an up-to-date understanding of this condition, and a practical guide to implementing evidence-based psychosocial interventions for people with schizophrenia. Written in a clear and accessible format, this book -covers the historical, social and political perspectives which give meaning to the current position of mental health care -includes up-to-date interventions framed within the context of peoples lives -describes how these interventions translate into specialist areas of practice Using a variety of clinical examples, this text provides a clear overview of schizophrenia, and serves as a comprehensive, practical guide to the understanding, treatment and management of this mental condition.

Community mental health care has evolved as a discipline over the past 50 years, and within the past 20 years, there have been major developments across the world. The Oxford Textbook of Community Mental Health is the most comprehensive and authoritative review published in the field, written by an international and interdisciplinary team.

An exceptional opportunity is being missed. A chance to alleviate suffering and to achieve health care cost reductions for society is available, but is being ignored. There is an explosion of new knowledge about the emotional and intellectual development of children, and the causes and treatment of psychiatric disorders of children and adolescents. Research from diverse disciplines such as the developmental neurosciences, psychoanalysis, psychopharmacology, developmental psychology, and genetics propels us forward,. However, the effects of this new knowledge reach children and adolscents slowly, or not at all. The long history of neglect of the mental health of children and adolescents is now exaggurated by sudden, disruptive economic and political influences on mental health services for children and adolescents in most countries. Prevention and treatment of emotional and intellectual problems in childhood and adolescence have vastly improved, but utilization of these advantages lags behind. This disappointing incongruity stimulates a need to document our knowledge about these services and systems and to make it more broadly available. This is the primary aim of this new volume by a team of distinguished contributors. It reviews the causes and prevalences of psychiatric disorders in children and adolescents, the problem of health care financing for these services, the underutilization of these services, our current understanding of the outcomes of treatment, and the new models for both treatment and prevention. The book also provides a survey of current mental health services and sytems for children and adolescents in countries across the world. Information drawn from these multiple perspectives is has been used by a group of international experts to develop the Venice Declaration, providing specific guidelines for families, clinicians, administrators, and policy-makers who are concerned with the development of children and adolescents, and are committed to a more efficient economic approach to mental health services.

This new edition looks at the many recent changes in the arena of Human Sevices Organizations.