Communicating Findings to the Medical Team and Family

Communication problems with mental health consultations are often the root of dissatisfaction for pediat-ric nurses and doctors, and the consultant must make every effort to communicate promptly and clearly, and to present an action plan. The mental health consultant should present a biopsychosocial formulation that clearly specifies both what needs to be done about the problem and why, remaining mindful of the frustration engendered in physicians by patients with emotional and behavioral presentations (DeMaso and Beasley 1998). This frustration comes in part because in the familiar medical model framework, psychosocial factors have little role in patient care.

This dialogue usually occurs in a team meeting. Four types of team meetings are common in the pe-diatric setting (see Table 3-6): 1) the traditional medical team meeting, which focuses on gathering medical information to make a medical diagnosis and gen

Table 3-6. Types of team meetings in the pediatric setting

Meeting type

Participants

Target areas

Goals

Traditional medical

Physicians, nurses, and medical/surgical consultants

Gathering medical information used to make a diagnosis, determine prognosis, and/or formulate a treatment plan

Develop a medical treatment plan

Psychosocial

Physicians, nurses, medical/ surgical consultants, social worker, and mental health clinician

Gathering psychosocial information used to make a diagnosis and/or formulate a treatment plan

Develop a psychosocial plan

Family conference

Primary physician, nurse, staff crucial to treatment plan, and patient/family

Giving medical and/or psychosocial information, answering questions, listening to family concerns, and making decisions around interventions

Develop a cohesive, fully informed family care plan

Staff centered

Physicians, nurses, medical/ surgical consultants, social worker, mental health clinician, clergy, ethicist, and/or lawyer

Focusing on questions regarding the treatment of a specific patient

Address ethical issues

Source. Adapted from Williams and DeMaso 2000.

erate the treatment plan, and generally convenes without the family; 2) the psychosocial team meeting, which focuses predominantly on psychosocial issues, such as treatment adherence or child abuse, and has the goal of reviewing psychosocial issues and formulating a treatment plan that addresses coping and emotional adjustment; 3) the family conference, which provides medical and psychosocial information to the family and works toward a consensus with the family about the treatment plan; and 4) the staff-centered meeting, which often addresses ethical issues or differences in approach that may arise in the context of the child's treatment (Williams and DeMaso 2000). The role of the psychiatric consultant in these meetings may involve providing advice to the medical team, advocating for the child or family, providing psychosocial support for team members, or educating the team about the child's developmental and mental health needs.

After the mental health consultant and pediatrician discuss the problem and reach consensus, there should be an "informing conference" that includes at least the physician, patient, and family (DeMaso and Beasley 1998; DeMaso and Meyer 1996). Depending on the context and the pediatrician, the mental health consultant may or may not attend this meeting. In a supportive and nonjudgmental manner, the pediatrician (and at times the mental health consultant) should present the patient and family with both the medical and psychosocial findings.

In the final step, the consultant, together with the patient, family, and referring physician, develop and implement an integrated medical and psychiatric treatment program that is based on the agreed-upon biopsychosocial formulation. The key components of most plans fall into five categories, which are summarized in Table 3-7 (Shaw and DeMaso 2006).

Table 3-?. Treatment recommendations

Category of recommendation Examples

Clarification of diagnosis Further review of medical records. Discussion with outside providers.

Additional laboratory tests or diagnostic procedures. Additional subspecialty consultation. Neuropsychological testing.

Management by psychiatry team Psychopharmacology interventions: Specific doses and timing of doses.

Highlight potential drug interactions. Highlight common side effects. Individual psychotherapy. Family therapy.

Behavior modification programs: Specific instructions on how to set limits or de-emphasize attention being paid to problematic behaviors. Clarification of roles of staff members and parents in implementation of the program. Outline specific approaches to behavior management. Medical hypnosis.

Legal issues Referrals to child protective services or police department. Ascertain the need to obtain and document informed consent for specific treatments. Provide assistance with steps necessary for involuntary psychiatric hospitalization and transfer.

Involvement of other services Child-life/recreation therapy for therapeutic play and recreation. Social work for assistance with resources. Chaplaincy for spiritual and religious support. Occupational therapy for activities of daily living including feeding issues. Physical therapy for rehabilitation and biofeedback. Speech and language for evaluation and assistance with communication needs.

Outpatient recommendations Referral for outpatient mental health follow-up: Specify model, frequency, duration, and potential location of therapy. Specify the need for substance abuse treatment if relevant. Outline specific approaches to behavior management. Referral to school for testing or school-based resources.

Source. Adapted from Shaw RJ, DeMaso DR: "The Pediatric Consultation Psychiatry Assessment," in Clinical Manual of Pediatric Psychosomatic Medicine: Mental Health Consultation with Physically Ill Children and Adolescents. Washington,

DC, American Psychiatric Publishing, 2006, pp. 43-45. Copyright 2006, American Psychiatric Publishing. Used with permission.

Using Hypnosis To Achieve Mental Mastery

Using Hypnosis To Achieve Mental Mastery

Hypnosis is a capital instrument for relaxation and alleviating stress. It helps calm down both the brain and body, giving a useful rest. All the same it can be rather costly to hire a clinical hypnotherapist, and we might not always want one around when we would like to destress.

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