Journal of Pediatric Psychology 29(3) pp. 241-242, 2004
Journal of Pediatric Psychology vol. 29 no. 3 © Society of Pediatric Psychology 2004; all rights reserved
Book Review
Promoting Children's Health: Integrating School, Family, and Community, The Guilford Press (2003). Thomas Power, George DuPaul, Edward Shapiro, & Anne Kazak, 2003.
Psychology Manager and Director of Training
Children's Hospitals and Clinics
Minneapolis/St. Paul, MN
Pediatric, child clinical, and school psychologists will benefit from Promoting Children's Health, a 2003 publication by leaders in the field who have developed a practical text that is clearly based upon a comprehensive review of theoretical models and research data. The work is likely to be embraced by a wide array of specialty psychologists. Further, Promoting Children's Health has the potential to unify distinctly specialized practice areas. In fact, this book will be in demand not only by practitioners in the field, but also by academic faculty who might add this to reading lists for training graduate students.
The authors set out to achieve a lofty goal: to have their book serve as a useful guide for professionals from a wide range of disciplines with the premise that professionals must work to integrate systems of care to manage successfully and prevent health care concerns. By the end of the text, their goal is achieved; the authors are successful in challenging a paradigm shift in the field and help to achieve a working knowledge of a new "language," as well as practical applications of their model. The authors offer theoretical models as well as provide specific guidelines for both developing and evaluating programs of care. Their models and guidelines are both grounded in evidence-based strategies and a consistently strong linkage of science and practice.
The authors establish the basis of their model in chapter 1, suggesting integrated systems of care, broadening their concepts to include various levels of care in subsequent chapters, and, throughout, tying each together with four major themes: contextual background information, development of intervention strategies, development of prevention strategies, and planning for the future. The authors are consistently able to take basic scientific principles and extend our knowledge base in such a way that one understands and yet is challenged with new information. The reader is never merely left with the idea that "I have heard this before." For example, in chapter 3, while discussing intervention models, the authors present extensive background on common assessment models but then extend basic scientific knowledge by adding the less common ecological assessment paradigm that is consistent with their systems approach. All system levels are incorporated in this model, including individual and idiosyncratic characteristics, family, school, community, and public policy influences; all are tied together systematically to achieve an integrated model of care to promote children's health.
The book is timely given that during the past year, the American Psychological Association amended its mission statement through a change in bylaws to include health as a primary mission: "to advance psychology as a science and a profession, and as a means of promoting health and human welfare." This text will provide much needed information to assist the broadening of knowledge and skills of practicing psychologists who want to extend their services to health care. In this day and age, in which medical advances have meant that disease is often chronic and long-term, families take on much more of the day-to-day management of a family member's health problems. Children are now provided much of their medical care at home, in short stay units, or day treatment facilities. Managed care often denies extended admissions with the goal of expert home care services. Subsequently, children return to school much sooner than in previous years, but attendance is complicated by occasional absences and complex daily management of medical regimens required of school staff. As noted by the authors, "children with health conditions present a real challenge to the community" and they suggest the possibility of multifaceted care provided by a team including the individual child, family members, medical team, school staff, and friends. No single person can achieve what is possible by the full care team.
In chapter 4, "Integrating Children with Health Problems into School," Power et al. describe the impact of the Individuals with Disabilities Education Act of 1997, which mandates that children with acute or chronic medical conditions are eligible for specialized services to address their individual educational needs (particularly if their academic performance is impacted by their medical condition). Consistent with the Rehabilitation Act of 1973, children with health concerns benefit from involvement in the least restrictive educational setting possible to address their needs. Although this has often been an idealized goal, the authors are able to offer recommendations that help make this more practical and feasible.
Throughout the book, the authors use case examples that offer a clear illustration of their intentions. The practitioner side of me related to each example as similar to many issues I have faced day to day in working with chronically ill children and their families. Yet the cases were presented in such a way that I had a clear grasp of what more could be done, including the next logical step in their recommended progression; a way to take care one step further. That theme, one step further, characterizes the book by offering psychologists (whether school, clinical, or community based) additional steps to take in order to provide the most effective service that is responsive to the values of the family and needs of the individual child. The authors' use of evidence-based practices enhances the clinical material and supports the clinician when he or she considers challenging the traditional system of care.
Throughout the book, the authors seem to be challenging practitioners to ask themselves two questions: (1) Am I providing this systems level of care? and (2) What more can I do to promote a public health approach to my delivery of health care services? The challenge facing psychology in general, and each of us specifically, is how to truly develop the systems model advocated by these authors within our daily practice and research endeavors. Based on our traditional training, it is much easier to understand how to accomplish this for an individual child, yet it is not so clear how to go beyond individual cases and truly establish the more complex, integrated systems-oriented approach to care. This is our challenge, but Promoting Children's Health is a step in the right direction to begin to do this.
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