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“For the Sake of the Children”: Trials and Tribulations of Child Psychiatry-Liaison Service

This paper describes the development of a child psychiatry liaison service to pediatrics in a university hospital setting and discusses the authors' preference for the liaison type of relationship over strictly consultative psychiatry. The success of the liaison service in promoting comprehensive pediatric care can be related to an effective team approach which includes a pediatric social worker and a child psychiatry nurse specialist. In addition to the usual methods of handling consultation requests for psychiatric services, weekly teaching conferences on the pediatric wards were established to draw the house officers' attention to a bio-psycho-social approach to pediatric care, to allow ventilation of intradepartmental conflicts, and to enable nurses and residents to express their feelings freely about difficult patient problems such as the chronically ill and the dying child. The common lack of continuity of house officers and attendings on the pediatric wards hampers efforts to provide well planned and coordinated child care, both during admission and after discharge. This difficulty often gets compounded by the extensive use of consulting “super-specialists,” leaving the young pediatrician uncertain about his functions as the child's primary physician. We propose that the liaison psychiatrist may assume the role of a coordinator of comprehensive child care in many of these “disintegrated” ward situations. Because of inherent difficulties in the acceptance of the coordinator role by the child psychiatrist, we suggest that this role can be adopted more easily by those psychiatrists who have had previous experience in pediatrics or general medicine.