The revised Child Welfare Law, which came into effect in April 1998, appended an advisory/consultant function to the duties of the Child Welfare Council, to advise child guidance centers in cases that were difficult to determine, and in those requiring expert advice (medicine, law, etc.). Each municipality responded to the amendment through establishment and operation of a subcommittee under the Council to undertake this role. The author has been involved with the Subcommittee in Mie Prefecture throughout the 18 years since its inception. Its history and activities are recorded from the standpoint of a child psychiatrist, and presented alongside the issues and challenges facing child welfare today, made visible through transition in the function of the Subcommittee to date.
Hospitalized children with physical diseases have been recognized as having significant consultation/liaison (C/L) needs at pediatric general hospitals. The C/L contents are presumed to vary according to the size or characteristics of the involved hospitals and clinical departments. Herein, we review the C/L services provided from 2008 to 2013 at Shizuoka Children's Hospital, and demonstrate the features of C/L services: the relationships among referring departments, reasons for making referrals, diagnoses and treatments. We also consider the role of child-adolescent psychiatrists in the C/L services provided at our pediatric general hospital.
Needs differed according to each of the characteristics of the clinical departments, and it was necessary to provide different forms of clinical care for each of these needs.
The severity of “reaction to stress”, which was the most frequent reason for referral, differed markedly among individuals, ranging from severe to slight symptoms. Sharing roles among medical professionals was thus useful. As to the referrals made for “consultation about the family”, cooperation with other medical professionals, educational institutions and institutions related to social welfare was often needed. Child-adolescent psychiatrists play crucial roles in managing the medical team when referrals are made for “reaction to stress” and “consultation about the family”.
When referrals were for “somatization/dissociation” and “developmental and psychological disorder as previous history”, continuation of outpatient treatment after discharge was often needed.
Referrals for “delirium” and “suicide attempt” were not particularly frequent, but child-adolescent psychiatrists were required to take the initiative in these cases to perform the needed treatment and casework.
As to the referrals for “treatment refusal”, which were not frequent, support for medical staff members, who were perplexed by refusal to undergo treatments, was needed.
Therefore, child-adolescent psychiatrists should understand the roles and characteristics of various clinical departments, and may play a crucial role in treatment and management, occasionally sharing roles and working cooperatively with other medical professionals, as well as communicating with doctors and other medical staff members, and supporting smooth medical team management.