Organization of Services

In Brazil during the 1990s, psychosomatic medicine or consultation-liaison services were available in 86% of 63 general hospitals offering adult psychiatric services (Martins and Botega 1998). Although an estimated two-thirds of patients admitted under pe-diatric services would benefit from psychiatric consultation, only 11% of the pediatric resources request such consultations (Reckziegel et al. 1999). Few medical centers that treat children and adolescents have a psychiatric consultation department. The most comprehensive services are offered in the university medical centers. When available, consultation is usually provided by child psychiatrists or psychologists, not using a multidisciplinary model of care. However, alternate systems of service do exist. For example, the child and adolescent psychiatry division at Hospital de ClĂ­nicas de Porto Alegre

(HCPA) provides a more integrated model, offering multidisciplinary care that covers the child, family, community, and hospital staff. The multidisci-plinary consultation-liaison team includes part-time psychiatrists and residents, pediatric neurologists, nurses, psychologists, social workers, occupational therapists, and educators, including teachers. Outpatients are primarily assessed and treated by the child psychiatrists and residents in training. The child and adolescent psychiatry division, which provides consultation-liaison services for HCPA's center for primary care, was established in 2005 with the objective of advising teams on the diagnosis and treatment of pediatric mental health issues within the context of outpatient primary care. At HCPA child psychiatrists are on duty to provide consultation-liaison services for hospitalized and emergency pediatric patients as needed.

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