Book reviews

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Clinical Judgement

R. Schalock & R. Luckasson. Washington, DC: American Association on Mental Retardation. 2005. 113 pp. US $19.95/Aus $27.95. ISBN 0‐940898‐89‐6

This book asserts clinical judgement to be one of four practitioner competencies essential for best practice, the others being the ability of the clinician to (a) incorporate professional standards into everyday work; (b) measure work practices against professional ethics; and (c) base actions on research‐based knowledge. The authors identify six areas of research and eight areas of contemporary policy that emphasise the importance to practitioners of being able to exercise sound clinical judgement. The authors debunk the common misconception that clinical judgement is essentially an “educated guess”, or a process to be used as a substitute for thorough assessment. Quite the contrary, the authors argue that good clinical judgement will be characterised by its scientific rigour; that it will be systematic, formally constituted, and transparent to the extent that it can be tested. Furthermore, for those exercising clinical judgement, they emphasise the importance of a comprehensive knowledge base, specialist expertise and practical experience.

The book's 9 chapters are presented in three major sections. Although at times repetitive in content, the material is presented in a way that enables the reader to consider the issues and proposed strategies in ever‐increasing degrees of complexity. The first section, Context and framework, establishes the importance of the clinician's ability to make good, scientifically rigorous and defensible clinical judgements. Reference is made to both scientific and political developments in recent years that have made the exercise of good clinical judgement of increasing importance. A decision‐making framework, consisting of 6 strategies, is outlined. This section concludes with a discussion of the importance of accurately formulating “the question” to be considered, understanding the context of the question and where it might be leading, and appreciating the resources required to comprehensively answer it. The second section, Clinical judgement strategies, presents in detail 6 strategies to assist with making good clinical judgements. Each strategy is illustrated by an extended case study. The third section, entitled Putting it all together, contains a set of “clinical judgement guidelines” summarising material covered in the text.

Clinical Judgement comprehensively addresses a complex issue that is faced on a daily basis by most practitioners. It proposes practical strategies, constituted within a scientific framework, and provides essential information for students undertaking courses in “professional practice” and “assessment techniques”. It should also be informative for seasoned practitioners working in educational, clinical or forensic settings, those providing supervision and mentorship to other practitioners, and those responsible for the evaluation of best practice in the provision of professional services.

Keith R. McVilly

RMIT University, Melbourne, Australia

Deinstitutionalization and People with Intellectual Disabilities: In and Out of Institutions

Kelley Johnson & Rannveig Traustadottir (Eds.). London: Jessica Kingsley Publishers. 2005. 293 pp. $45.95. ISBN 1843101017

This book examines deinstitutionalisation primarily from the perspective of people with intellectual disability. The book is divided into four parts. Each part includes a number of chapters that examine deinstitutionalisation from various perspectives: personal descriptions from people with intellectual disability; commentary by academics and practitioners; and views of family members of people with intellectual disability. The editors have brought together international contributors providing reflections on deinstitutionalisation from western countries as geographically diverse as New Zealand and Iceland.

The personal nature of many of the chapters in this book, the inclusion of a brief plain English summary at the beginning of each chapter, and an average chapter length of 8 pages, make this book more accessible to people with intellectual disability and their families than many other texts on this subject. Additionally, the book will be useful for students, practitioners, academics, and policy‐makers, as it provides a balance of personal and theoretical perspectives on deinstitutionalisation. The book fails, however, to make clear that today only a small proportion of people with intellectual disability are institutionalised and hence experience deinstitutionalisation. This in no way negates the experiences of those whose stories are told; however, it is an important contextual reminder.

Notwithstanding this point, this is an important book as it provides an excellent example of the use of a life history approach to collect and retell the often untold personal experiences of people with intellectual disability. The stories are powerful reminders that policy decisions have far‐reaching, long‐term, personal consequences for people with intellectual disability and their families. Having personal accounts juxtaposed with the critical perspectives of researchers and practitioners challenges the reader to refrain from self‐congratulatory assumptions regarding the benefits of deinstitutionalisation, and to reflect instead on whether the closure of traditional modes of institutional care have really resulted in community acceptance and participation for people with intellectual disability.

Angela Dew

Faculty of Health Sciences, University of Sydney, Australia