The Child and Adolescent Consultation Service to Pediatrics has three basic patient care goals. The first is to consult with the pediatric staff in establishing an appropriate diagnosis. Second, guided by psychodynamic principles and a clinical understanding of the medical disorder, the Service works to ease the suffering of severely ill children and their families. The third goal is to understand and support the medical and nursing staff’s sustained and stressful management of hospitalized children and their families. Under the leadership of Paula Rauch, M.D., Director, the service provides the child and adolescent psychiatry resident with an understanding of the child psychiatry consultation-liaison process, common consultation requests and various treatment interventions.
The MGH Children’s Service has 83 beds spread over three floors, including a pediatric intensive care unit, a newborn intensive care unit, an adolescent unit and a younger children’s unit. The Service is staffed by four staff psychiatrists: Dr. Paula Rauch, Dr. Lawrence Selter, Dr. Annah Abrams and Dr. Nina Muriel. In Year 1, each resident will spend six months rotating through the service. An effort is made to be sure that each resident has experience with patients of all ages and the full range of diagnoses. Since 1980, when the Consultation Service was reorganized, the number of consults has increased to more than 200 per year. All consult requests are called into the intake coordinator in the Consultation Service. He/she then informs the resident and staff psychiatrist. Every patient is seen by a resident and a staff psychiatrist.
There is a wide range of cases. They include adjustment disorders, mood disorders, psychosomatic illnesses, anorexia nervosa, suicide gestures, behavior problems and organic syndromes. The Service also consults routinely on all hematology/oncology admissions, inflammatory bowel disease cases, transplant cases and patients with cystic fibrosis. Some patients are seen only for evaluation, some are seen for evaluation and disposition, and the majority are seen for diagnosis and inpatient management. Patients may be seen up to several times a week for a few months. The resident will have extensive opportunity to learn about working in multidisciplinary teams managing serious pediatric illness. They will have the opportunity to instruct pediatric house officers in the diagnosis and treatment of psychiatric disorders.
Supervision will be carried out through the following:
• Residents will participate in the presentation of cases in weekly Consultation Rounds with other members of the Service. The three staff child psychiatrists based at MGH are joined by Dr. Frederick Stoddard, child psychiatrist at the Shriners Burns Institute and Dr. Lucienne Cahen, child psychiatrist at Spaulding Rehabilitation Hospital. These weekly rounds offer trainees the unparalleled experience of discussing consultation cases with seven attending child psychiatrists, who each specialize in the psychological care of medically ill children and their families.
• Each consult case is discussed with the covering staff child psychiatrist, who may see the case with the resident or separately.
• The staff child psychiatrists are available during several designated hours during the week to see cases with the residents or discuss cases as needed.
Although an independent service, the Child and Adolescent Psychiatry Consultation Service has close collaborative clinical, research and academic ties with the Adult Psychiatry Consultation Service, under the direction of Dr. Ted Stern. The Adult Consultation Service provides a weekly teaching conference, the Psychosomatic Conference, which is chaired by Dr. Stern and attended by the Service’s general psychiatry residents and staff. Child and adolescent psychiatry residents are welcome to attend this seminar in their elective time. The principal goals of this conference are to familiarize participants with major psychosomatic conditions and psychiatric syndromes commonly affecting medical and surgical patients.
The Pediatric Consultation Service will be responsible for providing daytime consultation to the MGH Acute Psychiatry Service. Residents will serve to assist the general psychiatry residents in child, adolescent and family emergencies, which require evaluation, crisis intervention and treatment in the APS. In addition, residents will provide consultation to pediatrics in the MGH Emergency Department.