Consultation - Liaison Program

The Child and Adolescent Psychiatry Consult-Liaison Program provides integrated clinical services and teaching for Mott Children’s Hospital and receives approximately 120 consultations annually. Consultations are provided to all pediatrics inpatient services, including general pediatric inpatient services, pediatric intensive care unit, neonatal intensive care unit, pediatric medicine and rehabilitation, pediatric neurology, and other pediatric sub-specialty services. Formal requests for consultations do not come directly from patients, but rather from other professionals providing direct inpatient services. When functioning as consultant, the Child & Adolescent Psychiatry Consultation Liaison service provides expert opinions on psychosocial problems to professionals of disciplines other than Psychiatry.

Consultation Questions:

The nature of consultation requests received by the program is highly varied. A typical consultation request is for assistance with diagnostic clarification and treatment recommendations for patients who present with atypical symptoms. For example, patients may present with symptoms that are unusual in presentation, of protracted duration, or of unexpected severity. The symptoms may not fit with common medical or neurological problems. The challenge to the Child & Adolescent Consultation Liaison service is to evaluate the patient and determine the degree to which psychiatric illness and/or psychological factors play a role in the patient’s symptom presentation. The Consultation Liaison team strives to provide a comprehensive bio-psycho-social formulation of the case that will be useful for the pediatric inpatient team. More often than not, it is determined that both medical and psychological factors play a role in the patients’ problems. Patients are frequently diagnosed with both medical and psychiatric disorders. The Consultation Liaison service will then make recommendations to the inpatient team for treatment. The Consultation Liaison service does not assume responsibility for management of the patient after a consultation is made. However, if requested to do so, the service can provide co-management of patients as a part of a multidisciplinary clinical team.

The Consultation Liaison service is also asked to evaluate patients with suspected co-morbid psychiatric illness. For examples, children and adolescents may have pre-existing psychiatric illness (such as, pre-existing depressive or behavioral disorders.) In addition, children and adolescents with medical illness (particularly chronic illness, catastrophic trauma, or life-threatening illness) may develop secondary psychiatric symptoms and require psychiatric evaluation and treatment in order to progress with optimal medical treatment.

The Consultation Liaison service is sometimes asked to provide consultative assistance for systems within the hospital. For example, the care of a particular patient or group of patients may cause stress to clinical staff or unmask difficulties within the inpatient team that impede their clinical effectiveness. In such cases, the consultation service will assist the consulting service deal with psychosocial problems encountered in their ongoing work. The particular patient in question may allow the Consultation Liaison staff and inpatient team to understand these other issues.

Clinical Resources:

The Child and Adolescent Consultation Liaison service, through its liaison role, provides a myriad of administrative and clinical functions in Mott Children’s Hospital. Assistance is given regularly to patients, their families, and inpatient pediatric staff in identification and facilitation of inpatient, outpatient, and residential mental health services for patients following discharge from Mott Children’s hospital. Upon discharge, if needed, children may be admitted to the Child and Adolescent Inpatient Psychiatry Unit or may be followed up through the Child and Adolescent Psychiatry Outpatient Clinic located in Taubman Center. Other children may be referred to Community Mental Health agencies or private mental health providers in their area. Members of the Consultation Liaison program frequently attend clinical and administrative work groups to address ongoing challenges such as management of suicidal youth in the hospital and management of child abuse. Members of the Consultation Liaison service regularly organize and attend multidisciplinary case treatment meetings as well as family and/or staff meetings.

Education:

The Consultation Liaison service plays a strong educational role for both Child & Adolescent Psychiatry and Pediatric trainees. Child & Adolescent Psychiatry fellows spend a total of 8 months rotating through the Consulation Liaison service, for six months in their first years and two months in their second year of fellowship. There are typically three first year and one second year Child and Adolescent Psychiatry fellows on service at any given time. In addition, medical stuents, General Psychiatry residents, and Pediatric Psychology trainees rotate through the service.

Dr. Charles Krasnow coordinates weekly teaching conferences for Child Psychiatry fellows, General Psychiatry residents and medical students rotating through the division, and Pediatric residents. On the first Thursday of each month Dr. Krasnow organizes a Collaborative Case Discussion in which faculty and trainees of various departments (Child & Adolescent Psychiatry, Pediatric Psychology, Behavioral & Developmental Pediatrics, Pediatric Medicine & Rehabilitation, and others) discuss challenging clinical vignettes. On each second Thursday, Child Psychiatry Fellows present a case for discussion to Drs. Krasnow and Riolo. Every fourth Thursday, Drs. Krasnow and Riolo present a lecture and with case discussion to general pediatric residents. In addition, Dr. Riolo coordinates a didactic series for Child Psychiatry Fellows on Fridays. In this series, topics relevant to consultation liaison psychiatry are presented through lectures, videos, and case discussions.

Faculty:

The Child and Adolescent Psychiatry Consultation Liaison program director is Dr. Jason Bynum and other members of the Child & Adolescent Psychiatry Division also provide clinical supervision for the service.

For Consultation Contact:

Karyn Kitchen
Email: ksk@umich.edu
Tel: (734) 936-6335
Fax: (734) 936-8907

Moved. Moved. Moved. Moved.