Review of A Guide to Psychiatric Services in Schools: Understanding Roles,Treatment,and Collaboration,by Shawna S. Brent

Although teachers, especially special educators, and child psychiatrists both work with youth who have psychiatric disorders, they speak different technical languages, operate in different worlds of experience, and generally do not work side by side or collaborate sufficiently. Given this ongoing background, Shawna Brent, a child psychiatrist who works extensively in schools, has observed that educators wish to know more about psychiatric diagnoses and available treatments. Therefore, she has written a timely book, primarily directed at educators, which communicates in detail how child psychiatrists work and think, pulling back the curtain to answer basic questions.

She first describes the process of psychiatric evaluation, formulation, and treatment planning, emphasizing the multiple possible factors that child psychiatrists survey and consider. Such a background can help educators to better understand how exactly child psychiatrists evaluate children and their families, and can subsequently bring to life final reports by child psychiatrists that educators may read. Next, Brent discusses the various consultation roles that child psychiatrists can perform in schools, so that educators can be clear what they can ask for and expect from consultants. An overview of psychopharmacology is then provided, which can be well understood by teachers looking for a readable overview. An accompanying CD provides more detailed information (such as side effects) about the most-used medications, if readers wish to have that level of knowledge.

The majority of the book then provides overviews of the major child and adolescent Diagnostic and Statistical Manual of Mental Disorders (DSM) disorders, again in digestible detail for educators. Each section features succinct summaries about characteristics, epidemiology, and course, followed by treatment approaches (both medication and non-medication) and some educational implications. The book concludes with an assessment of and treatment approaches to (mainly pharmacological) common serious target symptoms such as physical aggression, descriptions of acute evaluation for the most frequent mental health crises (such as suicidal symptoms), and principles for starting psychotropic medication with children.

Throughout the book, clinical cases (some complex), which teachers will recognize, are used liberally, and educators can look over the shoulder of Dr. Brent as she thinks through the cases as a child psychiatrist. A CD also accompanies the book, providing more in-depth information, which the reader may desire on a variety of topics beyond medication. On a related subject, references cited throughout the book appear up to date and not overly technical for an educational audience.

The strength of the book is how well it conveys the thinking and working style of child psychiatrists for educators to absorb in a reader-friendly manner. I have not encountered such a book before. As the two disciplines rarely train or even work together, this book provides invaluable insight for educators about child psychiatrists, whom they too often know only through written reports and communications about medication.

Although the book will help readers understand better how child psychiatrists assess and treat their student patients, suggestions for how teachers can intervene in the classroom are limited and often general. This criticism is not so much of the author as of the two fields: education (especially special education) and child psychiatry. Neither field has contributed much to its sister field on how to most effectively intervene with problematic students in school, beyond, possibly, attention-deficit/hyperactivity disorder (ADHD) and disruptive behavior disorders. For example, educators primarily approach the behavioral and emotional problems of children by using functional behavioral assessment (FBA) and subsequent behavioral intervention plans (BIP). Psychiatric diagnoses may be listed as a setting factor, but are underutilized for understanding the student and subsequent treatment planning. Psychiatric diagnoses and accompanying medication or other mental health services are rarely part of the methodology in special educational research. On a related subject, it has been my experience that practicing child psychiatrists, unfortunately, do not commonly gather information from teachers (e.g., through checklists) beyond the treatment of ADHD. This absence reflects child psychiatric research that rarely gathers teacher information when studying child psychiatric disorders. For example, the recent multimodality studies of treatment for depression in youth used almost no information from teachers for diagnosis or measuring treatment response (Mattison et al. 2007).

Therefore, the two fields have, to this point, rarely conducted collaborative research, and too often work independently, both doing their best with the treatments they have available to help such children, but not working together to fully understand the students and what treatment combinations may be the most effective in school. They are not full collaborators, even though their mutual technologies could increasingly work well together.

As child psychiatrists begin to work more in schools, for example, in school mental health clinics, and thereby have contact with educators, this book will serve as an ice breaker for educators to understand our field better. A fitting companion book has recently been written by an experienced consultant team consisting of a behavioral therapist and a child psychiatrist: The Behavior Code: A Practical Guide to Understanding and Teaching the Most Challenging Students (Minahan and Rappaport 2012). This book in part provides extensive practical treatment and explanatory information for teachers on four common problems shown by students in school: Anxiety, oppositional behavior, being withdrawn, and sexualized behaviors.

From the educators' perspective, the principle textbook written for educators by educators on psychopathology is Characteristics of Emotional and Behavioral Disorders of Children and Youth (Kauffman and Landrum 2009). This book to some degree can help child psychiatrists understand how educators think about problematic students. The recent text Cognitive-Behavioral Interventions for Emotional and Behavioral Disorders (Mayer et al. 2009) describes various evidence-based cognitive behavioral therapy CBT approaches that educators might find useful in the classroom to complement their behavioral techniques, making it, therefore, an important resource for child psychiatrists to be aware of.

A next helpful step would be for a special educator who works with child psychiatrists to communicate in an extended chapter about what questions special educators have, and what would be the most useful information that they need from child psychiatrists. Researchers in both fields would also benefit from such dialogue, to foster collaboration.

Consequently, more useful books to help educators and child psychiatrists work together more effectively are beginning to appear. In addition to working more often in real time with educators, child psychiatrists can recommend Brent's book to their educator colleagues, and also, ideally, to trainers of educators to promote understanding and better use of our field.