Organization of Services

In Germany, most pediatric psychosomatic medicine services are provided in pediatric hospitals, commonly staffed by a psychologist, and less frequently by a child or adolescent psychiatrist, with support from social workers, educational specialists, and teachers. Cooperation between disciplines is dependent on personal relationships between providers and a shared philosophy of patient care. A majority of pediatric hospitals run specialized medical-psychiatric units, which have longer lengths of stay than pediatric medical and surgical units. Typical problems addressed in these units include internalizing disorders, such as somatization and conversion disorders. By contrast, children with externalizing and psychotic disorders are more likely to be treated in a child psychiatric hospital. For inpatient psychiatric care, which may include medical-psychiatric units for psychosomatic disorders, legally prescribed standards dictate the nature of services that must be provided, include detailed task descriptions for each member of the multidisciplinary team, and indicate precise staff-to-patient ratios.

Outpatient treatment is provided by interdisciplinary teams in social psychiatry practices run by child and adolescent psychiatrists, or in psychiatric outpatient departments associated with a child and adolescent psychiatric hospital (Institutsambulanz). Services are reimbursed using time-based rates, although in university hospitals, lower and often inadequate reimbursement is provided using a flat rate for prescribed services. Data from German studies suggest a lack of coordination and integration of services, and often parallel systems of care (Ullrich 2004).

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