Child Psychiatry Consultation Research Articles

The impact of life events on child and adolescent psychiatry consultations

Purpose: Children are exposed to many adverse life events, and this may cause psychiatric disorders. In this study, we aimed to investigate the effects of two different life events, the COVID-19 pandemic and the earthquake, on the consultations requested. Materials and Methods: 1268 consultations requested from the child and adolescent psychiatry department between March 2019 and March 2023 were reviewed from hospital records. The specified period was divided into four distinct parts with one-year intervals: pre-pandemic, the first year of the pandemic, the second year of the pandemic, and post-pandemic. The age, gender, diagnoses of the cases, the department requesting consultation and the reason for consultation were recorded. Results: There were statistically significant differences between periods in terms of departments requested consultation, consultation reasons, and diagnoses. Compared to previous periods, a decrease was found in pediatric emergency and general pediatric clinic consultations in the post-pandemic period. In contrast, an increase was seen in nephrology and intensive care unit department consultations because of earthquakes. In the first year of the pandemic, more consultations were requested from the hematology & oncology department compared to other years. While the rate of consultations requested for suicide attempts decreased in the post-pandemic period, consultations for psychiatric assessment increased. Conclusion: Consultation-liaison psychiatry, which is at the center of interdisciplinary interaction, maintains its importance in the prevention and early diagnosis of psychological symptoms that can develop due to both organic events and the effect of trauma itself after the life events.

Closing the gap in access to child mental health care: provider feedback from the Wisconsin Child Psychiatry Consultation Program

BackgroundMental illnesses are common among children and negatively impact wellbeing during childhood as well as later in life. However, many children with these conditions are not able to access needed mental health care. The Wisconsin Child Psychiatry Consultation Program (WI CPCP) was created to reduce gaps in access to care by providing primary care providers with referral resources, access to behavioral health consultations, and training on mental health topics.ObjectivesThe purpose of this study was 1) to assess the effectiveness of the WI CPCP in Milwaukee County, providing specific insights into provider’s ability to care for child mental health, and 2) identify challenges Milwaukee PCPs faced in providing mental health care to child patients and contextualize these challenges in a conceptual framework of access to health care.MethodsA cross-sectional mixed-methods secondary data analysis was conducted using data collected from online baseline and nine-month follow-up surveys completed by providers participating in the program practicing in Milwaukee County from 2014 to 2022. Provider confidence and skill in providing mental health care was analyzed quantitatively using Two-sample Wilcoxon rank-sum (Mann–Whitney) tests (baseline vs. follow-up survey responses) and descriptive statistics (follow-up survey only). Provider challenges to providing mental health care were analyzed qualitatively using a thematic analysis research approach.ResultsResults from quantitative analyses showed that provider confidence and skill in treating childhood anxiety and depression improved from baseline to follow-up. Results from qualitative analyses were categorized by factors within and beyond the scope of WI CPCP. Within the scope of WI CPCP, providers reported a lack of knowledge of referral options and a lack of training in mental health care as well as a lack of knowledge in assessing and treating mental disorders. Still, many barriers to mental healthcare access persist that are beyond the scope of WI CPCP, such as long wait times and a lack of insurance coverage.ConclusionsThis study supports the effectiveness of the program to improve access to care for children. However, there is a need for additional solutions such as better reimbursement for mental health professionals and expanded insurance coverage.

Comparison of Outpatient and Inpatient Consultations Requested from Child and Adolescent Psychiatry

Objective: This study aims to examine the sociodemographic and clinical characteristics of child and adolescent psychiatry consultations and to compare characteristics of outpatient and inpatient consultations. Methods: A total of 354 patients who were consulted to child and adolescent psychiatry department of a university hospital were included in the study. Data were collected regarding sociodemographic characteristics of patients, departments requesting consultation, diagnoses, and treatment methods. Results: The cases included in the study had a mean age of 10.6±4.8 years,with 51.4% being girls. Adolescent girls formed the majority of the inpatient group. The pediatric neurology outpatient clinic had the highest frequency of requested consultations (22.3%), and the most common reason for consultation was a suicide attempt (12.1%). Of the cases for which consultation was requested, 67.8% were diagnosed with at least one psychiatric disorder, and the most common diagnoses were anxiety disorders, with 12.7%. In the inpatient group, impulsive suicide attempts and depressive disorders were more frequent compared to the outpatient group, while intellectual disability was less common. Parent education was provided for 97.2% of the cases, pharmacological treatment was recommended for 44.6% of the cases, and the most commonly prescribed medications were selective serotonin reuptake inhibitors. Psychotherapy and special education were significantly more common in the outpatient group compared to the inpatient treatment group. Conclusion: The current study revealed significant differences in consultations requested from child and adolescent psychiatry between the outpatient and inpatient groups regarding consultation reasons, diagnoses, and treatment modalities. The findings provide valuable information for clinical practice and service development.

Les premiers moments de l’introduction de la psychanalyse en pédopsychiatrie dans l’entre-deux-guerres en France

In this paper, the author describes the first moments of the introduction of psychoanalysis in child psychiatry and the context of their emergence in the 1920s and 1930s in France. They are contemporaneous with the difficult introduction of psychoanalysis into the medical world. Child psychoanalysis then appeared as a prophylaxis of neurotic disorders, and aroused the interest of educational psychologists and educators. It traces the pioneering work of psychoanalyst Sophie Morgenstern in Georges Heuyer's child psychiatry consultation, and that of Pierre Mâle in Henri Rousselle's child psychiatry consultation. After the Liberation, he became the recognized specialist in adolescent psychotherapy. On the other hand, Morgenstern's legacy will be forgotten or disowned by those who will succeed her, and the author wonders about the reasons for this phenomenon. This pioneering work, which drew a new face of normal and abnormal childhood, was to be greatly expanded after the Second World War.

Association between Maternal Depression and Sleep Disorders in Toddlers: A Case Report

Poor sleep quality in childhood can lead to socio-emotional and academic problems. In early childhood, sleep is mostly influenced by environmental factors, such as the mother’s mental health. The aim of this case report is to expand the body of knowledge surrounding the association between sleep disturbances in toddlers and maternal depression. An 18-month-old child was referred to a Child Psychiatry consultation due to multiple nocturnal awakening almost every night since he was 3 months old. The mother reports depressive symptoms. It was concluded that the child met criteria for night awakening disorder. The treatment plan included sessions to promote parenting skills and the use of prolonged-release melatonin. The literature shows that maternal depressive symptoms are related to difficulties in initiating and maintaining sleep in young children, and it is important to diagnose and treat this symptomatology to mitigate its impact on these children’s sleep.

Expanding Psychiatric Treatment in Primary Care Settings: Improved Care Through the Wisconsin Child Psychiatry Consultation Program.

The national shortage of child psychiatrists has resulted in the necessity of primary care providers (PCPs) managing increased mental health concerns of youth. The Wisconsin Child Psychiatry Consultation Program (WI CPCP) is one of several programs throughout the United States which provide PCPs with education, consultation, and resource support related to pediatric mental health. To evaluate initial impact of the program, data from 190 pediatricians and family practitioners from the Wisconsin Health Information Organization (WHIO) were analyzed. Enrollment in the WI CPCP was associated with a significant increase in rates of mental health diagnoses within primary care visits. In addition, the number of providers who made any mental health diagnosis increased from 56% of PCPs pre-enrollment to over 99% post-enrollment. These data provide additional support for pediatric psychiatry consultation programs within primary care.

Key attributes of child psychiatry access programs

The gap between the need for and the availability of pediatric mental health providers is well documented. One solution is regional/state Child Psychiatry Access Programs (CPAPs), which aid in the assessment and management of youth with behavioral health (BH) concerns by providing consultation to Pediatric Primary Care Clinicians. Our authorship team and the National Network of Child Psychiatry Access Programs (NNCPAP) board worked to describe operational definitions for CPAPs elements and related outcome monitoring processes and data systems. CPAP elements include regional child psychiatry availability by phone; real time phone availability; referral and resource assistance; and, expedited face-to-face psychiatric evaluation. Defining a child psychiatry consultation program as a CPAP and describing key attributes for CPAPs is an important step in facilitating implementation of the model and advancing research into its effectiveness.

Exposition des enfants à la violence conjugale : troubles mentaux et facteurs de résilience. Étude transversale tunisienne

Conjugal violence is a social problem whose impact extends beyond the couple, to the children who are exposed. ObjectiveTo study the psychological impact of exposure to conjugal violence in children and adolescents in child psychiatry consultation and the factors associated with their capacity for resilience. Patients and methodsWe conducted a cross-sectional study on a sample of 30 children and adolescents, aged between 6 and 18 years and exposed to conjugal violence. Patients were recruited from the child psychiatry unit of the Hospital University of HediChaker of Sfax. We conducted clinical interviews to identify the psychological impact of conjugal violence on children. The resilience evaluation was done by self or hetero passation of the Child and Youth Resilience Measure (CYRM). ResultsChildren and adolescents exposed to conjugal violence suffered from trauma-related disorders and stressors in 40% of cases, mood disorders in 33.3% of cases and externalized disorders in 6.6% of cases. We found that children were more resilient than adolescents in the area of emotional care provided by their parents (12.66±2.02 vs. 9.46±2.69 among adolescents; P=0.001). In contrast, adolescents were significantly more resilient than children in the area of contextual factors including spirituality (6.46±1.4 vs. 4.53±1.06; P=0.000), education (11.13±2.13 vs. 8.4±1.54; P=0.000) and culture (11.13±2.13 vs. 8.4±1.54; P=0.000). The child's education and good mental health for the mother were associated with better resilience in the children. The child's exposure to conjugal violence by being both a witness and a victim was associated with a reduced capacity for resilience. ConclusionExposure to conjugal violence has a significant impact on the mental health of children exposed. The study of resilience and associated factors could thus be useful in order to limit the deleterious repercussions on children and provide them with harmonious development both on the somatic and psychological levels.

Urgent psychiatric consultations for suicide attempt and suicidal ideation before and after the COVID-19 pandemic in an Italian pediatric emergency setting.

Suicidal attempts (SAs) in youth have been increasing during the last decades. We studied consultations, SA, and suicidal ideation (SI) in a pediatric emergency department (ED). From 1 January 2011 to 31 May 2022, 606,159 patients accessed the ED, 8,397 of who had a child psychiatry consultation (CPC). CPCs increased significantly by 11 times in the last decade (155 in 2011 vs. 1,824 in 2021, p < 0.001); CPCs for SA increased significantly by 33 times, from 6 in 2011 to 200 in 2021 (3.9% of total CPC vs. 11%, p < 0.001). While total CPCs increased constantly during the entire period (annual percent change (APC) of 21.7 from 2011 to 2021 in a 0 joinpoint model), CPCs for SA increased significantly from 2011 to 2016, were approximately stable from 2016 to 2020, and then had a peak in 2021 after the COVID-19 pandemic (APC from 2011 to 2016 of 64.1, APC of 1.2 from 2016 to 2020, and APC of 230 after 2020 in a 2-joinpoint model). Total CPCs in ED as well as evaluation for SA and SI increased significantly during the last decade. CPCs for SA had an additional increase after the COVID-19 pandemic. This picture warrants timely and efficient improvements in emergency settings and mental health resources.

Les adolescents aux urgences psychiatriques : motifs de consultation, diagnostics psychiatriques et orientation

IntroductionThe CPOA (Centre Psychiatrique d’Orientation et d’Accueil) is the largest psychiatric emergency center in France, with more than 10,000 consultations per year. The aim of our retrospective observational study is to describe the population of patients aged 15 to 18 years (18 years old not included) consulting our center (reasons for consultation, psychiatric diagnoses, referral decision by specifying the structures to which these minors are referred) and to describe a predictive model for the decision to hospitalize. MethodsAll consecutive patients aged over 15 and under 18 consulting in the CPOA between January 1, 2017 and December 31, 2021 were included in the study. The characteristics of our study sample are described in terms of proportions for qualitative variables and with means and standard deviations for quantitative variables. The probability of being hospitalized was modeled on the entire sample using a multivariate Probit model for which the hypotheses of validity were tested. ResultsWe have recorded 2712 visits, corresponding to 1873 patients included in our study (mean age=16.2±0.72, 54% girls), i.e. an average of 5.2% of the total patients. The main reasons for consultation were depressive ideations (22%), anxiety (19%), and suicidal thoughts (18%). The most frequently diagnosed psychiatric disorders according to the 10th revision of the International Classification of Diseases were F30-39 (mood disorders) (34%), F40-48 (neurotic, stress-related and somatoform disorders) (24%) and F60–69 (personality and behavioral disorders) (11%). Among the patients with an indication for hospitalization, i.e. 27%, 85% were admitted in adult units and fewer than 12% in adolescent specific units, while among the patients with an outpatient care, i.e. 65% in total, only 11% were referred to child psychiatry consultations. An older age, a suicide attempt in the week preceding the visit to the psychiatric emergency department, suicidal behaviour and suicidal ideations, hetero-aggressive behaviour, psychomotor agitation or excitement, delusions, wandering, running away or pathological travel, and a diagnosis of type F20–F29 (Schizophrenia, schizotypal disorder and delusional disorders) and F30–F39 were significantly predictive of a decision to hospitalize. ConclusionPsychiatric hospitalization of adolescents consulting due to psychiatric emergencies is a major problem. The predictive factors for hospitalization reflect an absolute need for immediate care. Unfortunately the lack of structures dedicated to adolescents is such that three quarters of adolescents end up hospitalized in adult structures, which is neither appropriate nor acceptable.

Troubles de la régulation sensorielle en pédopsychiatrie

IntroductionThe processing of sensory information determines the development and growth of a child's abilities. Dysfunction in the processing of sensory stimuli can affect a child's behavior and can disrupt development. Sensory Regulation Disorders are frequently associated with Autism Spectrum Disorder (ASD), with the DSM-5 even including it as a diagnostic criterion. However, they are also observed in other neurodevelopmental disorders. At present, the frequency of Sensory Regulation Disorders in children consulting child psychiatry has never been evaluated, although it seems to be a population at risk. ObjectivesTo evaluate the frequency of sensory regulation disorders in children between 3 and 6 years old who first consult a child psychiatrist in Marseille. To determine whether certain reasons for consultation are correlated with the presence of sensory regulation disorders. MethodsA multicenter cross-sectional study was conducted for four months in Marseille. Sensory regulation disorders were assessed by the second version of Dunn's short sensory profile. ResultsFifty-eight patients were included. A significant difference was found between the frequency of SRT in our primary child psychiatry population and the general population. Subgroup analyses according to the reason for consultation showed that there would be more SRT in the Motor Instability/Inattention, Conduct Disorder and Socialization Disorder subgroups. ConclusionWe observed a higher frequency of SRT in the child psychiatry consultation population. SRT could explain, or at least partly participate in, the children's symptomatology. The results are in favor of an early detection of SRT in the population of children consulting child psychiatry. The evaluation of the sensory profiles of these children allows a better understanding of the child's functioning and an adjustment of the intervention and support strategies proposed to the family.

Utilization and Outcomes of Direct Consultation in a Child Psychiatry Access Program.

The high prevalence of child and adolescent psychiatric disorders in the United States, coupled with the severe and pervasive shortage of child and adolescent psychiatrists, has led 46 states and territories to launch programs providing child psychiatry consultation to pediatricians. Although these programs aim to increase access to psychiatric expertise, evidence of favorable program outcomes beyond user satisfaction has been limited. Findings from the authors' child psychiatry consultation program suggest that such programs may enable pediatricians to manage most cases referred for consultation, thereby extending the behavioral health workforce to the primary care setting.

45.2 North Carolina Psychiatry Access Line: Supporting Pediatric Prescribers Caring for Children in Foster Care

The North Carolina Psychiatry Access Line (NC-PAL) is a statewide telephone consultation program for pediatric behavioral health that launched in 2018. Since that time, the program has provided consultation to more than 700 primary care providers (PCPs) and trained more than 150 PCPs. To provide consultation to support providers caring for children in foster care, the NC-PAL program in partnership with the North Carolina State Department of Health and Human Services (NC DHHS) is deploying 4 interventions: 1) child and adolescent psychiatry input on a daily basis for high-needs cases; 2) child and adolescent psychiatry consultation to clinicians and Department of Social Services (DSS) staff members caring for children in foster care; 3) education of clinicians and DSS staff members caring for children in foster care; and 4) review of Medicaid and DSS data to target interventions.

A Clinical and Psychopathological Approach to Radicalization Among Adolescents.

Recent studies have shown higher rates of radicalization of adolescents than in the 2000s. Since 2015, radicalization prevention units have been implemented in child and adolescent psychiatry departments in France. We aimed to report on the psychopathology of adolescents who were followed up in a university department due to their “radical conduct.” Based on the available clinical data (from child psychiatry consultations, long-term family and/or individual therapy, and psychological testing) for 20 adolescents with “radical conduct,” we examined the nature of their radical conduct, their psychopathology, their family characteristics, and the existence or absence of traumatic experiences. Among the 20 adolescents, 4 had radical conduct associated with a delusional syndrome (schizophrenia or a psychotic episode after substance abuse). For the other 16, we found no psychotic conditions. The analysis of other data showed that the adolescents shared some characteristics, such as an important prevalence of intrafamilial violence, sexual abuse, imprisonment of family members, traumatic family histories, and significant psychological control or dependence phenomena occurring in divided families. This diversity of psychopathologies appears consistent with previous studies highlighting the relevance of diverse profiles depending on the presence of a delusional syndrome, the individual's gender and the individual's attraction to violence. Finally, we discuss some psychopathological hypotheses and make therapeutic recommendations. We believe that child and adolescent psychotherapy/psychiatry has a role to play in countering violent extremism by offering adolescents a way out of radical commitment.

The sociodemographic and clinical profile of children with an autism spectrum disorder in the oriental region of Morocco

BackgroundThe objective of our study is to assess the clinical profile of autistic children in Morocco and the cultural perception of their parents. We collect data with a standard questionnaire on 130 children with autism spectrum disorder (ASD). They were recruited from child psychiatry consultation in the hospital for mental health from 2017 to 2019. This questionnaire assesses the socio-demographic characteristics of children and parents, personal and family medical history, the progress of pregnancy and childbirth. For each child, we determined the developmental age, signs of autism, the comorbidities, the nature of the treatment, the evolution. We complete the examination with parents' perception and attitude towards autism.ResultsThe age of diagnosis was 3.4 years. The sex ratio in our study was 4.6. A low rate of children screened by general practitioners (4.6%). Language impairment was the main reason for the consultation, followed by social withdrawal and stereotypies. 75% of the children benefited from multidisciplinary care. The autism age of screening was significantly lower among families belonging to medium and high socioeconomic status (F = 11.233; p = 0.001).Acceptance of diagnosis was present in 83% of cases, while 73.6% were involved in the care. Only 24% of parents thought that autism etiology is genetic, 75.4% notice improvement with age, and 80.2% consider it a source of family suffering.ConclusionsThese findings underscore the sociodemographic and clinical profile of children with ASD in the oriental region in Morocco. It could be relevant for early screening, intervention, and guidance for families with children having these conditions.

Psychiatric Boarders on Pediatric Medical Floors: A Call for Action and Collaboration

Clinical Vignette: A 14-year-old male patient with history of attention-deficit/hyperactivity disorder (ADHD), disruptive mood dysregulation disorder (DMDD), and autism spectrum disorder (ASD) was brought to the emergency department (ED) when he was found to be aggressive towards family members. He has history of multiple psychiatric hospitalizations relating to aggression and was taking a complex regimen of psychotropic medications. ED staff recommended inpatient psychiatric care. After waiting for hours in the ED, a decision was made to transfer him to a pediatric medical floor, and he was put on waitlist without immediate bed availability in any of the inpatient units in the area. Due to lack of child psychiatry consultation liaison services at our institution, an outpatient child and adolescent psychiatrist was called by pediatric hospitalists for “curbside consultation” to provide input on treatment for this patient while he waited placement at an inpatient psychiatric facility.

Anti-NMDAR Encephalitis: Multidisciplinary Development of a Clinical Practice Guideline.

Anti-NMDAR Encephalitis: Multidisciplinary Development of a Clinical Practice Guideline.

Profil de consultants dans un service de pédopsychiatrie d’un hôpital général

ObjectivesWe propose to explore the sociodemographic, clinical and therapeutic characteristics of patients who presented to a child and adolescent psychiatric outpatient department. MethodsIt is a retrospective descriptive study focused on patients who consulted at the first time the child and adolescent psychiatric outpatient department of the Mongi Slim Hospital between January and November 2018. We have collected the sociodemographic data of the child and his parents. We specified who accompanied the child the consultation in a child psychiatry consultation, the reason for consultation and the origin of the request for the child psychiatry consultation. The psychiatric diagnoses were retained according to the criteria of the DSM-5. For patients requiring follow-up, the indicated management methods have been specified. After collection, the statistical processing of the data was carried out using SPSS 20.0 software. ResultsWe collected 1013 cases. The children average age was 8 years and 5 months with extremes ranging from 7 months to 19 years. The sex-ratio was estimated at 1.54. In the case of an age of over 11 years, the female sex was predominant with a sex-ratio equal to 0.86; (P < 10−3). The consultants lived in the north of Tunisia in 98.7% of cases, within 94.9% of cases in the north-eastern governorates. The children were the eldest of their siblings in 35% of cases. Children attended primary school in 49.3%. We find that 879 patients were accompanied by one or both parents while five adolescents (four girls and one boy) consulted alone in the service. Among the 1013 patients included in our study, 65.84% (667 patients) were referred to our consultation by doctors. The reasons for consultations were academic difficulties in 23.4%, behavioral problems in 15.1% and language disorders in 11.3% of cases. We did not retain a diagnosis according to DSM-5 criteria for 76 consultants (7.5%), a psychiatric diagnosis was made for 768 patients (75.8%) and a psychiatric diagnosis was suspected, but deferred for 169 consultants (16.7%). Twenty-five of them had an associated organic comorbidity. The psychiatric diagnoses were intellectual disability in 15.69%, depressive disorders in 12.63%, adjustment disorders in 9.47% and autism spectrum disorder in 9.2%. Following the first consultation, we indicated a psychiatric follow-up for 919 consultants (90.7%), among which 635 patients (69.1%) consulted again. Among the 919 patients requiring follow-up, hospitalization in psychiatric hospital was indicated in 11 patients (1.2%). We indicated psychotherapy for 326 patients (35.5%). The psychotherapies indicated were of the type: Listening and support in 280 patients (85.9%), Eye Movement Desensitization And Reprocessing in 23 patients (7.1%), Cognitive and Behavioral Therapy in 21 patients (6.4%) and Narrative Exposure Therapy for Kids in 2 patients (0.6%). One or both parents were referred to an adult psychiatric consultation in 61 cases (6%). An intervention by the child protection representative was requested in 7.6% of cases (70 patients) while an intervention with the school structures attended was necessary for 17.2% of the consultants (158 patients). Medication was necessary in 14.25% of cases. The prescribed therapeutic classes were anxiolytics (23.7%), neuroleptics (16%), psychostimulants (16%) and antidepressants (13%). The most prescribed drugs were Hydroxyzine in 23.7%, Methylphenidate (14.5%), Risperidone (11.4%) and Sertraline (11.4%). ConclusionKnowing the profile of the child psychiatry outpatient will allow us to adapt the training of future doctors and child psychiatrists according to needs and to the specificities of the population.

Multifamily Therapy for Adolescents With School Refusal: Perspectives of the Adolescents and Their Parents.

Introduction: School refusal is an important public health concern in adolescent psychiatry increasing over the past several years (5% of child and adolescent psychiatry consultations in France). Multifamily therapy has developed over 30 years. Its efficacy is validated in adult, child and adolescent psychiatry, including for children at risk of school exclusion. In this study, we aimed to explore the adolescents and their parent's experience of a multifamily therapy treatment of school refusal with a qualitative method.Materials and Methods: This qualitative study is based on an Interpretative Phenomenological Analysis approach. We conducted 15 semi-structured interviews, participants were adolescents (n = 6) and their parents (n = 9) who experienced multifamily therapy in an adolescent department in Paris. Data analysis was performed independently by two researchers.Results: For the six families, school was a source of suffering, system paralysis and social exclusion. Families reported painful emotions and separation anxiety. For teenagers, multifamily therapy increased self-confidence and allowed group experience. For parents, it gave support and relieved from feelings of stigmatization and guilt. Parents became more aware of their adolescent's suffering and their insight. They all considered that multifamily therapy improved intra-family communication and expression of emotion. Participants highlighted the benefits of intergenerational interactions, activities, group and guidance from therapists.Discussion: Multifamily therapy uses therapeutic tools from both family therapy (joining, resonance, family competence, and metacommunication) and group therapy (use of media, identity device, and mirror reactions). Parents expect school solutions from multifamily therapy and question how psychiatric treatment can deal with school, school refusal being therefore understood as a social functioning disorder.

Child Psychiatry Consultation Clinic for Pediatricians: Long-Term Outcomes.

There is an urgent need for new clinical models to improve access to child mental health care. Pediatricians are tasked to care for youth with mild to moderate mental health problems, but require additional training. This article describes an outpatient child psychiatry consultation clinic (CPC) designed to empower pediatricians to care for youth with depression, anxiety, and attention deficit/hyperactivity disorder. Over a 2-year period, 40 primary care physicians (PCPs) referred 159 patients to the CPC. The most common primary diagnoses of patients seen for consultation were generalized anxiety disorder (35%), major depressive disorder (24%), and attention deficit/hyperactivity disorder (20%). Most patients (89%) had at least 2 psychiatric diagnoses. Nearly four fifths (79%) of these patients successfully returned to their PCP for ongoing care. PCPs reported that the CPC enhanced their skills and improved access to mental health care. Similar models are needed to facilitate early intervention for the millions of youth with mental health problems.