Creative Solutions to a Big Problem

Article excerpt

Our nation's desperate shortage of child psychiatrists comes as no surprise. At a minimum, 10% of children in the United States have a mental health disorder. At least half of these children, I would say, would benefit by being seen by a child psychiatrist.

But there are not enough child psychiatrists to see even 5% of all children, and those in active practices tend to be distributed around large cities.

The reasons for the shortage are multifaceted. Child psychiatrists have a minimum of 5 years of training beyond medical school. But the lack of value society places on child psychiatrists is reflected in our reimbursement, which is far lower than that enjoyed by other specialists with comparable training. This discourages recruitment.

Child psychiatrists feel harried in our current medical environment. Our services are in high demand; we are constantly faced with difficult, even emergency situations; and we often feel underpaid. Some feel that managed care has narrowed our scope of practice to evaluations and psychopharmacology, with little support for psychotherapy or comprehensive care.

For those who treat children and adolescents, it might be a good idea to think about a hierarchy of referral.

One model that has been used successfully is to rent space within your practice to a child-trained licensed clinical social worker (LCSW).

Mental health information could be distributed in the waiting area. Parents and guardians can fill out screening forms in the waiting room that address major family discord, parental depression, and mental health issues. My pediatric symptom checklist and a guide to its use are available free of charge from http://psc.partners.org.

Positive responses to any of the checklists will merit further evaluation and perhaps a referral to the LCSW housed within the practice. From there, the triage continues. The LCSW might refer a depressed mom to an adult psychiatrist or a child having trouble in school to a child psychologist for educational testing and follow-up.

In a large enough practice, parent groups might be set up for common problems such as attention-deficit hyperactivity disorder (ADHD), anxiety, or issues surrounding divorce.

In some practices, partners might be willing to become more expert in certain common psychiatric disorders, taking on those patients with the understanding that the other partners would cross-subsidize them for the extra time it takes to treat chronic mental health disorders. …