Child and adolescent psychiatry in general children's hospitals. A survey of chairs of psychiatry

Models and patterns of service in child and youth consultation-liaison services

OBJECTIVE

The aim was to examine referral pathways to child and youth consultation-liaison (C-L) services to identify patterns associated with demographic characteristics of patients, referral sources, the presenting problem and models of service.

METHOD

A case record review with a cross-sectional design. Data were extracted from the records of all patients referred to the C-L service for a 3 month period.

RESULTS

Adolescents were more likely to access mental health services through informal liaison services. Medical specialty areas that were inclusive of nursing and allied health, in both the request for service and initial response to the request, had higher frequencies of referral. There was no difference between the disciplines of medicine and social work in the frequency of referrals. However, medicine, social work and nursing differed in the number of staff who initiated the request for consultation, and the types of problems that were presented as reasons for referral.

CONCLUSIONS

Inclusive multidisciplinary models may facilitate the development of service relationships in paediatric hospital settings, due to the stability of staffing arrangements. The wider participation of allied health and nursing staff within paediatric hospitals may extend opportunities for the identification of mental health problems and enhance timely management of referrals.

Redevelopment of a consultation-liaison service at a tertiary paediatric hospital

OBJECTIVE

This paper aims to describe the way a multidisciplinary team set out to redevelop a consultation-liaison (C-L) service at a tertiary paediatric hospital.

METHOD

The activities and processes in which the team members engaged were documented within a continuous quality improvement cycle. These activities included literature review, analysis of referral patterns, consultation with extant services, survey of referral sources and consultation with other tertiary paediatric services.

RESULTS

The outcomes of these initiatives were integrated into a re-formulated multidisciplinary team model dedicated to providing C-L services to the paediatric hospital. Significant challenges identified in the initial process were ongoing issues with caseload management and clarification of boundary demarcations.

CONCLUSION

There has been a gradual acceptance of the new C-L service by medical staff. The structure has resulted in a focused and coordinated C-L team that has contributed to innovations in the C-L process within the hospital.

Child and adolescent psychiatry. Exploring the option to be a manager in an academic medical center

Traditionally, few child psychiatrists have opted for careers as senior managers in academic medical centers, preferring to emphasize their clinical role and hoping their clinical work will be valued and reimbursed despite economic pressures. Yet the career of a hospital-wide manager in an academic medical center provides opportunities to promote an individual's career, the mission of the whole organization, and child psychiatry itself. Drawing on some of the issues discussed in the general literature on the clinician-executive, this article outlines the basic qualities and skills required to be a successful child psychiatrist executive and delineates the essential steps and potential pitfalls in building such a career. This delineation looks at the developmental stage of both the psychiatrist and the organization involved. The authors emphasize the importance of child psychiatrists assuming active roles within academic medical centers to protect and enhance the field of child psychiatry.