The culture of mental health care is being reshaped through community-based innovations, both across the United States and internationally, that are enabling healing and recovery in community. This chapter presents where the evolving traditions of community-based clinical practice have been most influential. As the practice examples in this volume are previewed, the values and perspectives of community work come to life. The chapter shows that mental health care is being transformed through clinicians' recognition that working with the resourcefulness and meaning of community is more than simply working in community.

This research report highlights selected findings that describe the characteristics of excellent, innovative programs for high-risk children and adolescents in Massachusetts. The conclusions reported are based on interviews with administrators and providers at nine sites. A research consortium composed of policy makers, administrators, clinicians, and academic researchers recommended the site selections. The study describes a spectrum of innovative practices used to help youngsters in severe crises. Innovative practice was shaped by a common vision of doing treatment within family and community contexts, and coordinating overall care at all levels of the family's social and professional networks. Topics addressed include an examination of the core values directing these programs, the four distinct subtypes of design, therapeutic approaches, management, and evaluation. Obstacles to innovation are considered in light of current policy and practice limitations. The discussion concludes with a summary of the challenges and future directions for policy makers, funding agencies, program directors, and clinicians committed to addressing the current crisis in mental health care for children and youth.

This essay is based on a pilot study that examined the effects of managed care on the treatment of children and families, with special attention to community mental health. We embarked on the pilot study to test the accuracy and generalizability of our impression that family therapy and other systemic practices have been marginalized in ordinary clinics and agencies, and to understand the reasons why. We interviewed managed care providers, researchers, family therapy trainers, and clinicians in the Northeast. Our findings led to seven themes that support our impression that, even though there is a consensus about the need for coordinated family-based services, there is a disconnection between state policies, contractual requirements and what is actually occurring at the implementation level. This study suggests that our knowledge of human systems may be in danger of being disqualified and lost, with damaging consequences for the care of children. Yet, as systemic thinkers and practitioners, it is our belief that ethical and effective treatment need not be at odds with care that is cost-efficient. The direction of our future research will be to study whether the involvement of all stakeholders at all levels of planning and training leads to systemic family-based practices that consistently save costs and provide high-quality care.

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Creative and responsive community-based clinical practice has emerged through a host of initiatives and programs that are now recognized as important means for meeting mental health needs. There is increasing evidence that these alternative approaches are an important addition to traditional practice and that they have a special role in meeting the needs of those whom traditional services have failed to help. This chapter tries to orient the reader to the field of community-based clinical practice and its increasing significance. It focuses on addressing what community-based clinical practice is, why it is re-emerging now, what traditions it is building upon and expanding, and what significant ideas are fueling its development.