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Pediatric Consult and Liaison Psychiatry

Welcome to the Child C/L Team! We look forward to working with you this block!

Please see our information guide below that describes our team members and goals within the inpatient setting.  Our general Goals and Objectives for the rotation, pediatric agitation management guide, and disordered eating protocol are also linked for your reference. Our team meets at PUP rounds each morning at 9AM to do a needs assessment and to devise a plan each day.

Child Psychiatry Consultation/Liaison Service

  • WHAT is the function of the Service?
    • To assist hospital staff in providing optimal care with regard to emotional, interpersonal and social issues of children and families during what is often a highly stressful time
  • WHO is part of the C/L Service?
      • Brian Skehan, M.D.Ph.D, Child & Adolescent Psychiatrist, Director of Child Psychiatry CL/EMHS
      • Erin Tangney, Ph.D. Psychologist, Associate Director of Child Psychiatry CL
      • Colin Whitworh, D.O., Child & Adolescent Psychiatrist, Primary Site Supervisor
      • Geri Fuhrmann, Psy.D. Psychologist
      • Erin Tangney, Ph.D. Psychologist, Associate Director of Child Psychiatry CL
      • Catherine Ferrante, LICSW, Clinical Social Worker for Pediatric Behavioral Health
      • Resident/Fellow in Child and Adolescent Psychiatry
      • Medical Student(s)
      • Kathleen Anderson, Coordinator

      • Pat Opokudoku does our bed searches for patients admitted to the hospital and DeAnna Pedro-Pham, LICSW, does our bed searches for patients in the pedi ED or EMH. DeAnna will also alert us if there is a stuck patient in the ER who could benefit from a consult/evaluation.

  • Typical Day Structure for a full day
    • 8:30-9AM: Review charts from the following evening. Check for new consults
    • 9AM: PUP rounds on 5 East
    • 9:15/30AM: CL table rounds on the 7th floor (conf room or library)
    • 10AM-12PM: We try to see all follow ups in the AM unless there is a pressing new consult
    • 12-1PM (ish): Lunch
    • 1PM (ish): Reconvene in library or conference room to review what needs to get done for the afternoon
    • 1:30-6PM: Seeing patients, didactics/teaching, wrapping things up for the day
  • Work expectations
    • Generally, fellows (and rotating pedi residents) should expect to see 1 full consult or three follow ups per half day on service.
    • Supervision: The attending psychiatrists and psychologists will provide supervision for all clinical cases. We encourage all trainees to learn from every member of our interdisciplinary team.  The primary site supervisor will typically meet with the fellow/resident from noon-1pm on the last Wednesday of each month for bi-directional feedback and lunch.  Fellows/residents will be expected to provide appropriate supervision to medical students and sub-interns. 
  • WHEN to request a consultation?
    • As soon as possible during the weekdays, even if the identified child is not yet able to talk or cooperate, to allow enough time to establish a working alliance with the family.
    • Situations appropriate for consultation:
      • Self-injurious behavior including suicide attempts or concern about suicidal behavior in the context of an accident.
      • Children whose psychiatric symptomatology led to admission or complicates treatment (depression/anxiety).
      • Poor compliance with treatment.
      • Behavioral problems on the unit.
      • Subjective symptoms (pain, neurological deficits etc.) that are not adequately supported by objective findings, as in Conversion Disorder and Pain Syndromes.
      • Physical signs not adequately supported by objective findings as in Failure to Thrive and Factitious Disorder Imposed on Another.
      • Eating Disorders, especially all cases of Anorexia Nervosa.
      • Trauma, especially in cases involving:
        • Whenever the child experiences intense arousal and/or fear at the time of trauma (including in-house procedures) that is interfering with treatment.
        • Burns, motor vehicle accidents, loss of limb, disfigurement which perpetuates a drastic decline in the patient’s ability to cope and interferes with treatment
        • Injury or death of a person significant to the patient that interferes with treatment.
      • Acute mental status change, especially in the absence of identifiable medical cause.
      • When there is a question about the need for psychotropic medications. (This may be an informal consultation.)
      • Whenever there are serious concerns about the relationships between the family and the child, including major mental illness in a parent, or interpersonal and social issues serious enough to interfere with treatment. *This may be an informal consult in conjunction with social work/DCF involvement.
    • If there are questions about whether a consult is indicated, how to best present the consult request to parents, or otherwise, the service is available for informal consultation.  Please call psychiatric team member on call or discuss with the team at PUP rounds.
  • HOW to request a consult?
    • If patient is under a Section 12, order can be placed immediately.
    • If patient is not under a Section 12, consent from parent/guardian to have Pedi CL team involved in patient care MUST be obtained before we will see the patient.
    • Enter order in EPIC for “Inpatient consult to Child/Adolescent Psychiatry.”
    • The Pedi resident should then contact the Child Psychiatry Team Member on call to discuss the case including: the patient’s name, date of birth, medical record number, room number, admitting attending, resident on the case with his/her contact number, date of admission and reason for the consultation which includes a description of the specific concern and question. (EPIC chat may also be used but please get confirmation from CL team as weekday and weekend coverage changes).
  • WHAT to expect:
    • The consultation service is available on weekdays and a response will occur within 24-hours and almost always on the same day as the request. To verify contact information of C/L Service on weekdays, please check the schedule on EPIC or Qgenda.  
    • On weekends and holidays, the Child & Adolescent Psychiatry Fellow on-call may be paged for an emergency consultation that cannot wait until the next business day (i.e., suicide attempt that is medically cleared but needs psychiatric clearance for discharge).  In such cases, please reach out to the covering Child & Adolescent Psychiatry Fellow on-call.
    • Consultation consists of:
      • Review of the case with the medical team, including nursing, social work, and child life.
      • Chart review.
      • Interviews with the child, the parents and siblings as indicated.
      • Contact with collateral sources, if indicated (e.g. school, therapist).
      • A consultation note with specific recommendations.
      • Follow-up verbal contact with involved care providers.
      • Follow-up with the child and family, as indicated.
      • Referrals for inpatient psychiatry placement will be facilitated if indicated, by our placement specialist.
      • Referrals for outpatient follow-up may be facilitated, if possible and as indicated.
    • The evaluation may take more than one day to complete, depending on the complexity of the case.

Other Child Psychiatry Resources 

Further Advanced Reading for Biopsychosocial Formulation of Children

If you would like to update the information on this page, email kathryn.wynne@umassmemorial.org