Structure of US Pediatric Psychosomatic Medicine Services

Psychiatric consultation for physically ill children and adolescents is provided by a number of professional disciplines, often with different service models. Traditional pediatric psychosomatic medicine services, more commonly referred to as pediatric consultation-liaison services, are generally located in large academic medical centers or pediatric hospitals (Campo et al. 2000). Such services are usually housed administratively within a department of psychiatry under the directorship of a child and adolescent psychiatrist. Services are often multidis-ciplinary in nature, with representation from child and adolescent psychiatry as well as pediatric psychology. These services commonly have a strong teaching role with trainees from both disciplines.

Recent data on the composition and staffing of such services are limited, although Shaw et al. (2006) reported that results from a national survey indicated that pediatric programs have a relatively low staff-to-patient ratio compared with comparable adult services. The ratio of pediatric attending consultation-liaison staff to number of hospital beds is also significantly lower than that recommended by Fink and Oken (1976) for adult services. Campo et al. (2000) reported that psychiatry consultation services are in deficit in the vast majority of children's hospitals, and 43% of the U.S. pe-diatric psychosomatic programs reported inadequate staff to meet clinical need (Shaw et al. 2006).

Consultation to pediatricians is also commonly provided by pediatric psychologists, who may be hired by a hospital or a pediatric department (Campo et al. 2000). Pediatric psychologists may consult to a single program, providing both inpatient and outpatient services, and may or may not be affiliated administratively with an academic department of psychology or psychiatry. National data on the location and composition of these services is limited, although the volume of service provided in these arrangements is likely greater than that provided by the traditional hospital-based pe-diatric psychosomatic medicine services. Social work clinicians are also an important group who provide mental health services, including triage and assessment of physically ill children. Lack of integration of such services may result in duplication of effort and confusion related to the referral of patients for mental health consultation. Models of outpatient psychosomatic medicine services vary widely, depending on the roles of and the nature of relationships between pediatric and mental health care providers (Dolinar 1993).

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