Child and adolescent Liaison-Consultation Psychiatry and Psychosomatic Medicine in a Clinical-Teaching Hospital. / Psiquiatría de Enlace y Medicina Psicosomática Infanto Juvenil en un Hospital Clínico-Docente.

Psychosomatic medicine explores the psychological, behavioral, and social elements that influence people's health and quality of life. This discipline develops skills and knowledge used in the evalua tion and management of psychosocial elements interfering in the process of illness and healing. The Child and Adolescent Consultation-Liaison Psychiatry (CACLP) is a discipline that has been empi rically installed in order to favor adherence to treatments and recovery of children and teenagers du ring the process of illness. There is a need for developing this discipline in Chile, but so far there are limited national and international records and literature dedicated to it. The objective of this article is to update the concepts of structure and describe how a CACLP unit in a high complexity teaching hospital works in general, discussing the clinical challenges involved in these issues.

Massachusetts Child Psychiatry Access Project 2.0: A Case Study in Child Psychiatry Access Program Redesign.

The Massachusetts Child Psychiatry Access Program is a statewide public mental health initiative designed to provide consultation, care navigation, and education to assist pediatric primary care providers in addressing mental health problems for children and families. To improve program performance, adapt to changes in the environment of pediatric primary care services, and ensure the program's long-term sustainability, program leadership in consultation with the Massachusetts Department of Mental Health embarked on a process of redesign. The redesign process is described, moving from an initial strategic assessment of program and the planning of structural and functional changes, through transition and implementation.

From Theory to Action: Children's Community Pediatrics Behavioral Health System.

Integrated health care models attempt to cross the barrier between behavioral and medical worlds in order to improve access to quality care that meets the needs of the whole patient. Unfortunately, the integration of behavioral health and physical health providers in one space is not enough to actually promote integration. There are many models for promoting integration and collaboration within the primary care context. This article uses the experience of the Children's Community Pediatrics Behavioral Health Services system to highlight components of collaboration that should be considered in order to successfully integrate behavioral health within a medical home.

[Structural quality in inpatient and daycare child and adolescent psychiatry- indicators for planning future staff ratios for the era following the Psychiatry Personnel Act]. / Strukturqualität in der stationären und teilstationären Kinder- und Jugendpsychiatrie.

The German Psychiatry Personnel Act, which went into effect in 1990, has led to a decrease in the number of child and adolescent psychiatry inpatient beds, to a decrease in the length of stay, and to an increase in inpatient psychotherapy. Today, this act is outdated~ for a number of reasons, such as changes in the morbidity of the population, the rising number of emergencies, and new professional standards such as documentation. In addition, new legal provisions and conventions (like the UN Convention on the Rights of the Child) necessitate a complete reevaluation. Child and adolescent psychiatry needs a normative act to enable the necessary implementation. Many different rationales are available to support the debate.

Play therapy as a mental health intervention for children and adolescents.

Play therapy is a child-centred therapy for children between the ages of 3 and 16 years who have mental health and/or other difficulties. The play therapist works one to one with the child, allowing children to explore their inner emotional world in almost any way they choose in the play room. The therapist sets a few necessary behavioural limits in order to safeguard physical and emotional safety during the weekly sessions. Children from all kinds of families come for play therapy. Some have witnessed domestic violence, or experienced abuse or other trauma. Some have conflicted relationships with the parents or carers arising out of insecure attachment and/or other issues. Provided that the child has some level of symbolic play, play therapy has the potential to help. The other provisos are that the home environment is sufficiently supportive at a basic level, and that the parent or carer is willing to support therapy. Children typically have play therapy for between two and 12 months, depending on the complexity of their difficulties. Play therapists analyse sessions and track changes to determine when to plan the ending with the child. Play therapists come from a range of professions and undertake full-time or part-time training in play therapy leading to a post-qualifying diploma or Master's degree. Qualified play therapists work in, or undertake work for, Child and Adolescent Mental Health (CAMH) services, Children's Services (Social Care), schools, and voluntary sector agencies.

Redevelopment of a consultation-liaison service at a tertiary paediatric hospital.

OBJECTIVE: This paper aims to describe the way a multidisciplinary team set out to redevelop a consultation-liaison (C-L) service at a tertiary paediatric hospital. METHOD: The activities and processes in which the team members engaged were documented within a continuous quality improvement cycle. These activities included literature review, analysis of referral patterns, consultation with extant services, survey of referral sources and consultation with other tertiary paediatric services. RESULTS: The outcomes of these initiatives were integrated into a re-formulated multidisciplinary team model dedicated to providing C-L services to the paediatric hospital. Significant challenges identified in the initial process were ongoing issues with caseload management and clarification of boundary demarcations. CONCLUSION: There has been a gradual acceptance of the new C-L service by medical staff. The structure has resulted in a focused and coordinated C-L team that has contributed to innovations in the C-L process within the hospital.

Equine-facilitated group psychotherapy: applications for therapeutic vaulting.

In this day of high-tech, managed-care service delivery with an emphasis on medication and brief treatment, it is important for nurses to be aware of nontraditional treatment options that may be uniquely beneficial for some clients. Although it may still be considered a novelty, including animals in the healing milieu is not a new idea. Florence Nightingale herself suggested that "a small pet animal is often an excellent companion for the sick, for long chronic cases especially" (Nightingale, 1969, p. 102). Healing, according to one recent nursing article, can be seen as "a gradual awakening to a deeper sense of the self (and of the self in relation to others) in a way that effects profound change" (Dorsey & Dorsey, 1998, p. 36). Equine-facilitated psychotherapy, while not a new idea, is a little-known experiential intervention that offers the opportunity to achieve this type of awakening. In this article, the reader is introduced to equine-facilitated psychotherapy's theoretical underpinnings, techniques, and outcomes as illustrated by actual clinical vignettes and research findings.

Superkids: short-term group therapy for children with abusive backgrounds.

Many children who are hospitalized have a history of physical or sexual abuse. A short-term therapy group for children with abusive backgrounds, called Superkids, was led by nurse therapists using a combination of active role playing, masks, picture drawing, and discussion. The group was structured and covered five topics over a 2 1/2 week period: shame, anger, fear, trust and love. Clinical observations suggest that the Superkids group structure helps children talk about their feelings and the abuse they have suffered. Through a brief intervention group, members learn they are not alone and that they are accepted by their peers.