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The author discusses the treatment needs of the young, self-destructive, unstable borderline client. A practice approach reformulated on the basis of recent research findings on borderline developmental history and course of illness is presented. This approach employs strategies derived from trauma recovery and brief treatment to address self-destructveness and high rates of attrition in this clinic population as well as the demands of managed mental health care for briefer, more effective treatment. Pragmatic goals and structured, focused interventions for initial contacts or the early stage of treatment are outlined and illustrated.

This chapter examines the mandate for cultural competence and the advances in theory, organizational strategies, and practice techniques that are now available to guide agencies and clinicians in making progress toward making culturally competent services in community-based systems of care a reality. Advances in culturally informed organizational and practice theories have moved the mental health field closer to its professed goal of serving appropriately, and effectively, individuals from diverse cultural backgrounds. However, there has been insufficient research that tests the effectiveness of culturally informed intervention strategies and techniques. There is also a need for epidemiological studies of the risk factors associated with minority status, differences in clinical presentation, cross-ethnicity prevalence rates, and differences in the use of mental health services, in order to develop more effective prevention and early-intervention programs.

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