The Psychiatric Consultation/Liaison Service is a multidisciplinary team that evaluates and treats the emotional, behavioral, and cognitive needs of pediatric patients receiving care in the medical setting.
As a member of this team, the Child and Adolescent Psychiatry Fellow provide consultation for children and adolescents at Children's Medical Center of Dallas. Patients with co-morbid medical and psychiatric illnesses are seen in the general hospital, emergency room, first care, and outpatient clinics.
Children's Medical Center is a 250-bed tertiary care referral children's hospital that serves a full spectrum of cultural and ethnic backgrounds. The residents provide consultation for children and adolescents of all ages. Common diagnoses include: somatoform disorders; psychological factors affecting a medical condition; depression; status post suicide attempt; psychiatric symptoms due to a general medical disorder; acute stress and posttraumatic stress disorders; anxiety disorders; school refusal; and problems with family functioning that impact medical care.
Patients may be seen in multidisciplinary clinics where psychiatry has an active presence. The C/L team has liaison affiliations with the Trauma Clinic, Solid Organ Transplant Program, Endocrine Clinic, Hematology-Oncology Clinic, Adolescent Clinic, Cystic Fibrosis Clinic, and Anesthesia Pain Clinic.
Patients seen for consultation can be followed-up in the weekly psychiatric Consult Clinic. This clinic ensures that patients receive necessary psychiatric management until they can secure outpatient treatment in the community. It also provides a valuable learning opportunity for residents and fellows by affording access to patients longitudinally and in multiple settings. Providers can evaluate patients' responses to initial treatment recommendations.
During the first year of fellowship, residents complete two ten-week rotations on the C/L Service. Two fellows work together on the service. The average inpatient consultation caseload for the consulting resident is 7 new consults a week, plus appropriate follow-up of cases in the hospital or in clinics. Inpatients are seen immediately or within 24 hours, depending on the urgency. Outpatients are seen in the emergency room settings, in specialty clinics or the outpatient psychiatry clinic. Residents assess the problems of the patient for whom the consult is requested from a systemic, bio-psycho-social viewpoint. Interventions are then formulated as necessary to support the patient, their family, and/or the clinical team. Residents often facilitate the transfer of patients to the inpatient psychiatric unit and day treatment.
During the C/L rotation, residents learn the basic principles of psychiatric consultation. Residents work with complex pediatric systems while providing the full range of interventions from medication to brief focused psychodynamic psychotherapy to behavioral interventions. Working with the relationship dynamics between the child and the family and/or various ward staff, managing transference issues in families under stress, and working with families' resistance to treatment all provide rich opportunities for fellows to hone therapeutic skills. Working at a major medical center provides a rich opportunity for fellows to witness and learn psychiatric presentations of medical illnesses.
The Psychiatric Consultation/Liaison Service is a multidisciplinary team, including Corinne Fribley, M.D., Medical Director of the service, psychiatrists, psychologists, a nurse practitioner, registered play therapists, a family therapist, and LPC’s, as well as trainees from these various disciplines. Residents receive 7 hours of supervision and clinical teaching each week during rounds. Additional supervision is provided in the Consult Clinic and in individual supervision of patients.
