180 Chapter 9—What to Do When Treatment Is Not Successful When to Consider Consultation or a Second Opinion It is appropriate to seek consultation anytime a pediatric PCC has doubts or questions about an evaluation, treatment plan, or a patient’s clinical status. Positing specific questions and concerns may improve quality of the con- sultative feedback. Pediatric PCCs are encouraged to establish relationships with mental health specialists in their community or with their regional medical center so that these issues can be addressed when concerns arise. When to Consider Referral for All or Part of the Patient’s Ongoing Behavioral Health Care Whenever a pediatric PCC feels that a patient’s evaluation or treatment will require knowledge or skills beyond her or his repertoire, a referral to another clinician for part or all of the patient’s mental and behavioral health care is recommended. Even when such a referral is for all mental and behavioral care, the pediatric PCC can play an important role in the patient’s overall care, especially in monitoring medication adverse effects, encouraging the patient and family to continue the mental and behavioral health treatment, providing preventive services, and coordinating care of any comorbid medi- cal conditions. References 1. Costello EJ, Edelbrock C, Costello AJ, Dulcan MK, Burns BJ, Brent D. Psychopathology in pediatric primary care: the new hidden morbidity. Pediatrics. 1988 82(3 pt 2):415–424 2. Jellinek MS, Murphy JM, Little M, Pagano ME, Comer DM, Kelleher KJ. Use of the Pediatric Symptom Checklist to screen for psychosocial problems in pediatric primary care: a national feasibility study. Arch Pediatr Adolesc Med. 1999 153(3):254–260 3. Elia J, Borcherding BG, Rapoport JL, Keysor CS. Methylphenidate and dextroam- phetamine treatments of hyperactivity: are there true nonresponders? Psychiatry Res. 1991 36(2):141–155 4. Brent D, Emslie G, Zelazny J, et al. Switching to another SSRI or to venlafaxine with or without cognitive behavioral therapy for adolescents with SSRI-resistant depression: the TORDIA randomized control trial. JAMA. 2008 299(8):901–913 5. Hughes CW, Emslie GJ, Crismon ML, et al. Texas Children’s Medication Algorithm Project: update from Texas Consensus Conference Panel on Medication Treatment of Childhood Major Depressive Disorder. J Am Acad Child Adolesc Psychiatry. 2007 46(6):667–686
Previous Page Next Page