The collaboration between psychiatrist Judith Koontz, M.D., and the
pediatric practice at PeaceHealth in Bellingham, Wash., has parallels
elsewhere, but not enough, according to child psychiatrists (see Pediatricians
Gain 'Safety Net' Through Psychiatric Consults).
"This is a common practice today, but we'd like it to be more
common," said Kristin Kroeger Ptakowski, director of government affairs
and clinical practice at the American Academy of Child and Adolescent
Psychiatry in Washington, D.C., in an interview.
As examples, she cited a model in North Carolina in which psychiatrists and
primary care physicians work out of the same office, a Massachusetts program
that places child and adolescent psychiatrists from the state's medical
school on call for phone conversations during the workday, and several
programs in Minnesota.
At St. Cloud Hospital/CentraCare in St. Cloud, Minn., for instance, child
psychiatrists are developing an electronic screening program for introduction
in January. Initially, the program will be used at well-child visits. The age
range of children handled by the program will be expanded until eventually
adults are included as well, said child psychiatrist and pediatrician L. Read
Sulik, M.D., the hospital's medical director. Sulik also holds regular
consultations with pediatricians in the hospital.
The same hospital has adopted a program called DART—Diagnostic
Assessment for Referral and Triage—run by therapists who can decide
which patients need a more comprehensive evaluation and can schedule them into
protected blocks of time held open each week. She sees 300 to 450 patients a
year, and only 20 percent need to see the child psychiatrist.
"In the past, all of them would have gone on a waiting list, so now
we are using our time much more efficiently," said Sulik. "The
triage therapist is critical. Many patients can be referred back to the
pediatrician with recommendations for treatment, but they can also refer back
to us if needed."