A controlled prospective study of child abuse and neglect, failure to thrive, accidents and poisonings included 303 inpatients and 257 outpatients. Analysis of maternal interview and clinical data demonstrated significant differences between cases and controls in summative indices of environmental stress, including housing, employment, and access to essential services.The associations with a postulated common causal underpinning of these illnesses argue for a broadened, ecologic conceptualization of etiology and a wider range of preventive approaches. A family advocacy Pediatric Social lilnessChild abuse and neglect, accidents, poisonings, and failure to thrive are known to have familial, child developmental, and environmental antecedents. [1][2][3] We have yet, however, to develop a rational base of practice for these disorders.The child and the environment may be forgotten in child abuse and neglect case management, because the diagnostic labels "abuse" and "neglect" focus attention on hurtful acts and their perpetrators. Clinical approaches to accidents, poisonings, and failure to thrive derive from implicit conceptual models of chance or idiopathic occurrence in the names of these "social illnesses". They focus clinical attention on the child's symptom, which may be treated while the familial and environmental antecedents and concomitants of the symptom are ignored.In order to develop a more nearly adequate illness classification scheme for this group of disorders, we designed a A maternal interview explored past and present events, realities, and stresses which seemed to bear on the capacity of the child's nurturing context to support his growth and protect him from harm. The central hypothesis was that these "social illnesses" are related, and that their common etiologic underpinning includes important elements of stress in the family before, during, and after the birth of the child.Ofparticular interest was the impact on a family's protective capacity of stresses originating in the present life context. The interview focused strongly on such issues as access to essential services, including housing, health, and child care, and we were particularly concerned to identify social isolation of families.4 We were not surprised to find a high prevalence of these problems in the families of children bearing the diagnosis of child abuse.Because of the large number of families whom we set out to interview, we perceived an ethical dilemma: could we possibly ignore the problems which we would identify? Did we have a responsibility, having identified such issues, to offer help to the families of children in both the case and comparison groups? We concluded that there was no getting away from this responsibility, and so, when interviews for the ENVIRONMENTAL CORRELATES OF PEDIATRIC SOCIAL ILLNESSDetailed results of the interview study are reported elsewhere.5 In general the data support the basic hypothesis that differential levels of hypothesized stresses and personal and social strengths contribute to the ...

The present study aimed to identify the needs and describe the use of twenty mental health services in a population of chronic schizophrenic patients living in two regions in Quebec (Estrie and Centre-Sud). An attempt was also made to determine the principal reasons for which some services were not being used when they were identified as clinically required. The population considered was composed of the patients (N = 88) who had been discharged from the psychiatric care units of five general hospitals over a period of five months in 1982, and for whom the attending psychiatrist could confirm with certainty a diagnosis of chronic schizophrenia in accordance with the criteria of DSM-III. Medical files of these patients were reviewed, and the patients and psychiatrists themselves were interviewed separately regarding the patients' needs and use of twenty mental health services over the period from the seventh to the twelfth month after discharge from hospital. Results of the study show that services which were most often identified as clinically required were: 1) taking of neuroleptics, 2) organization of leisure activities, 3) case management, and 4) individual supportive therapy. At the same time, results indicate a poor fit between needs and use for most of rehabilitation and psychosocial services. The main reasons for non-use of services which were identified as clinically required are also presented. The implications of these results for the organization of mental health services for persons suffering from chronic schizophrenia are discussed, especially the importance of case management services.