Group sessions for adolescents and for parents awaiting therapy in a child guidance clinic.

Abstract

#{149}A psychiatric outpatient clinic’s ability to deliver services is complicated by seasonal fluctuations in the availability of staff time and in the flow of patients. The outpatient clinic of Kings County (N.Y.) Medical Center’s division of child and adolescent psychiatry is probably typical of most large municipal hospital clinics that serve primarily ghetto children from minority ethnic groups. A large percentage of the patients, especially the adolescents, are referred by the schools. Thus, between June and October intakes are low because there are no school referrals. By mid-October, however, school personnel begin to identify children with problems and refer them to the clinic; the result is a large number of new intakes from November through May. There are also fluctuations in staff time. The clinic is a unit of a large teaching division. Trainees begin their tour of duty on July 1, providing many available therapy hours precisely when the census is low. By December or January, when large numhers of children are referred for treatment, most of those hours already have been filled. Because of that mismatched schedule, either children were placed on long waiting lists, from which more than 50 per cent would eventually drop off, or valuable therapy hours went unused. To cope with this recurring yearly pattern, two “holding” groups were organized, one for adolescents and one for their parents. Once most therapy hours are filled, usually sometime in January, all new cases in need of therapy are given a choice between seeking treatment elsewhere (we offer help in finding a suitable resource) or participating in the clinic’s holding groups. If clients choose to