Pediatric Consult-Liaison Rotation-at SLCH-CAP 2
Rotation Director: Eric Spiegel, M.D.
Other Faculty: John Constantino, M.D., Anne Glowinski, M.D., MPE, Gary Boxer, M.D., Joan
Luby, M.D, John Pruett, M.D., Ph.D., Angela Reiersen, M.D., Kelly Botteron, M.D., Cynthia
Rogers, M.D., Brooke Ayden, M.D., Natasha Marrus, M.D., Ginger Nicol, M.D., Mini Tandon,
D.O.
Number of residents per rotation: One
Length of Rotation: 3 months, approximately 60% of time varying day to day, depending on
number and complexity of consults
Time of Rotation: Second year of training
Please contact C/L Director at least 2 weeks before the beginning of this rotation.to discuss
orientation logistics (communication) and round times.
Goal
The goal of this rotation is to provide advanced second year residents with an in-depth exposure
to the interface between pediatric and psychiatric care in an academic hospital setting, where both
common pediatric illness and complex pediatrics specialty care co-exist. The nature of child
psychiatry consult-liaison at SLCH is team based including rotating attending faculty, C/L
director, the fellow and trainees supervised by the fellow (medical students and Child Neurology
residents on child psychiatry). Although teaching (rounds, recommended readings, participation
in c/l specific multi-disciplinary care meetings, case based) is prominent on this rotation, it is also
expected that this rotation will allow second year fellows to show case their advancing skills and
to have a significant level of autonomy.
Objectives
To develop competence in the following areas:
Patient Care
The resident will learn provision of consult-liaison services at SLCH including:
 Clarification of consult question and of goals and objectives of consult as a dynamic
process which starts at the outset and continues throughout the consultative process
 Approaching hospital patient and family who may or may not be enthusiastic about
psychiatric consultation
 Assessing the impact of chronic disease on children, adolescents and their families
 Refinement of child and family therapeutic interviewing skills in a busy hospital setting
 Observing and interpreting family, ward, health care and other relationships and their
pertinence to the presenting consult question

Producing recommendations which are clear and practical for healthcare team, patient
and family to be implemented in hospital and beyond

Assessment of risk and appropriateness of outpatient (vs. more intensive) treatment post
SLCH stay
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Prevention of self-harm and harm to others

Assessment of psychiatric follow up needs and facilitation of follow up care arrangement

Familiarity and competence with psychopharmacological interventions in children with
multiple medical problems and often on multiple medications, including attention to
drug-drug interactions and drug contraindications
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Psychoeducation of patients, families, and health care team members
Supportive therapy and grief/loss counseling
Hospital behavioral management
Medical Knowledge
The resident will gain medical knowledge through working in a clinical team and accompanying
didactics and reading of the pertinent consult CAP or related literature. Knowledge developed on
this rotation will include:
 Presentations of major child psychiatric disorders in acute pediatric settings including
knowledge of epidemiology, known etiological or risk factors, disorder phenomenology,
diagnostic criteria, predictive value of diagnosis (e.g., adjustment disorders, depressive
and anxiety disorders, abnormal illness behaviors, psychological factors complicating
medical conditions, psychiatric disorders secondary to medical factors, delirium,
cognitive and behavioral impairments related to medical factors)

Understanding the appropriate use of laboratory testing and adjunctive data collection in
the elucidation of clinical presentation in the hospital setting

Understanding the appropriate elicitation of information from pediatric colleagues to
appreciate fully the medical phenomenology of illness

Basic knowledge of pediatric disorders which commonly affect patients fellows are
consulted on (e.g., overdoses and sequelae, diabetes, sickle cell, cystic fibrosis,
dystrophies, epilepsy)

Critical knowledge of effective treatment strategies including psychopharmacological and
psychotherapeutic approaches and strengths and limitations of approaches (combined or
not combined with one another)

Knowledge of consultation role and its boundaries
 Use of electronic systems to access hospital care, medical, and scientific information
Interpersonal/Communication Skills
The resident will effectively communicate with the members of the pediatric care team including
key members of the team responsible for consult initiation, patients, their families and all other
members of the treatment team
 Conducting age appropriate interview techniques, as well as comprehensive mental status
examination on children and adolescents in hospital settings; this may include use of less
anxiety provoking observational settings such as play room and SLCH garden.

Effective communication with all involved in care of patient including verbal, non-verbal
and written communication and oral communication of written recommendations to key
individuals

Ability to efficiently summarize findings and recommendations in a timely manner,
respectful of the rapid pace of hospital care

Leadership and teaching of medical students and neurology residents assigned to consult
team (e.g., allowing these trainees to progress during their one month rotation to an
evaluative role under the supervision of fellow)

Develop and maintain therapeutic alliances with health care team, patients families and
troubleshoot difficulties encountered in the maintenance of therapeutic alliances (e.g.,
splitting, blaming, triangulations, poorly understood perspective differences)

Empathy and understanding for role and burdens of different members of the health care
team as applicable (e.g., pediatricians, nurses, pediatricians in training, ward staff, social
workers, child abuse team members, psychology staff)

Collaborative relationship in particular with psychology
Practice Based Learning:
The fellow will develop competence in continuous learning and improvement through practice
and related activities including
 Active participation in didactics and conferences which are particularly salient to practice
in the hospital setting (e.g., as applicable psychotherapy seminar, early bird rounds,
pediatric grand rounds, interdisciplinary conferences)
 Active case based learning in the hospital

Critical review of patient’s records

Integration of literature findings into patient care and/or communication with others

Ability to research and troubleshoot complexities and difficulties that arise in
consultation
Professionalism
The resident will demonstrate sensitivity and compassion to children and adolescents affected by
psychopathology and to their families or their caretakers and will continue to develop in
relationship with other professionals or professionals in training, including supervisors,
colleagues, students and allied professionals. In the c/l rotation, major aspects of professional
development will include:
 Perform a consultation which respectfully addresses the specific questions paused by the
referring physician
 Developing intra-professionally by managing adaptively their own emotional reactions to
other medical providers and health care team members, youth and families seen in the
hosptial
 Responsibility for consultation role as demonstrated by timely response or
communication with families, attending(s), and other health professionals and passing on
of salient information to other fellows (e.g., before weekend call)
 Acknowledgement and remediation of errors
 Intra-professionalism: ability to understand and remedy factors which interfere with one’s
proper professional conduct
System Based Care
A quintessential rotation to gain competence on system based care by providing consults
requested by multiple systems and participating in interdisciplinary meetings where multiple
systems of care intersect
 Understanding the roles of other professionals including pediatricians, sub-specialists,
psychologists, nursing staff, social workers, occupational therapists, child abuse team.
 Development of time management skills including management of other clinical
responsibilities during the c/l rotation
 Familiarity with consult billing procedures
 Appreciation of perception of psychiatric systems of care by others
 Understanding the limitation of community mental health care for children and its impact
on mental health care at St. Louis Children’s Hospital
Measurement of Objectives
Feedback by other professionals
Standard Program evaluations
Medical Records Review by Faculty
Clinical Skills Exams
Description of Rotation
This hospital based rotation involves managing all consults from the hospital staff (inpatient)
including consult clarification, timely initiation of consult (within 24 hours of request), timely
recommendations, communication with primary c/l attending and consult director, management of
hospital staff’s expectations regarding consults, facilitations of transfer to psychiatric hospitals if
needed, weekly attendance at the Behavioral Response Team meeting and leadership of other
trainees on child psychiatry rotation. Rounds with primary attending occur daily.