Book excerpt: In the past few years, there has been a major shift in the mental health care of child and adolescents from inpatient care to non-hospital community ambulatory settings. Economic pressures have primarily driven this change in service delivery. Insurance companies and managed care organizations have not only restricted access to hospitalization and limited length of stays but additionally have sharply reduced reimbursements for treatments. State and federal policies for inpatient treatment and reimbursement have followed similar trends. As a result, mental health planners have attempted to develop programs to deal with this trend of restricted inpatient care shifting treatment of children and adolescents to home and community settings. Some of these new programs are well planned and others are hastily planned and implemented. The pitfall to this community approach is that there is a population of chronically disturbed children and adolescents, and highly stressed parents often lacking adequate personal and family resource who may not respond to these new less restrictive, less costly community approaches which potentially may lead to an unsafe and dangerous situation for the child, adolescent, family and the community. With this in mind, the purpose of this book is to provide comprehensive and up-to-date information regarding child and adolescent outpatient, day treatment and community psychiatry. The emphasis of this book is to provide practical knowledge through clinical case illustrations and to explain various strategies in a detailed fashion.