Archives of Disease in Childhood 1991; 66: 862-865
862
Referrals to child psychiatry-a staff attitudes
survey
of
S Oke, R Mayer
Abstract cians' questionnaire asked paediatricians how A questionnaire study was conducted in a often they would refer to child psychiatry a health district to evaluate the attitudes of range of clinical problems seen as inpatients and paediatricians and child psychiatry staff as to outpatients. Part 1 of the child psychiatry queswhich categories of problems should be refer- tionnaires asked child psychiatry staff how often red to child psychiatry. In the majority of they think paediatricians should refer these categories the two groups disagreed as to the problems to the child psychiatry department. frequency with which the problem should be The clinical problems were selected for inclureferred. In the categories relating to child sion after a review of the literature"8 and after sexual abuse responses were often not in discussions with our colleagues. Our list was not accord with Department of Health and Social exhaustive but represented most of the common Security guidelines. Reasons for not referring reasons for referral to child psychiatry. were also looked at and again it was found that Respondents were asked to indicate how frethere were a number of significant differences quently they felt a category of problem should in opinion as to what are reasons for not refer- be referred by answering 1-4 where l=rarely or ring to child psychiatry. Both groups agree never, 2=sometimes, 3=frequently, and 4= that lack of communication is a reason for always or nearly always. The categories of probnon-referral. Some suggestions are made as lems are shown in table 1. to how this problem could be addressed. The association between child psychiatry and paediatrics has been widely commented on during the past 30 years.1-5 We wished to explore whether locally there was agreement between disciplines as to the appropriateness of referral of various clinical problems and to look at factors that might lead to not referring. Method The study was a survey, using specially designed questionnaires, of paediatricians (all grades) and child psychiatry staff (psychiatrists, clinical psychologists, child psychotherapists, and social workers) in an inner London health district. The decision to survey only medical staff in paediatrics but all professional child psychiatry staff reflects the fact that whereas referral, although influenced or initiated by other professions, is primarily a medical decision, the child psychiatry departments assess and treat on multidisciplinary lines.
St Mary's Hospital and Paddington Green Department of Child Psychiatry,
THE QUESTIONNAIRES Two questionnaires were used, one for paediatricians and one for child psychiatry staff. They varied slightly in format, but were identical in
content.
Both questionnaires consisted of
two
London S Oke R Mayer
parts.
Correspondence to: Dr S Oke, Wonford House Hospital, Dryden Road, Wonford, Exeter EX2 5AF. Accepted 28 February 1991
Part I The aim of part 1 was to determine whether paediatricians and child psychiatrists agree as to which type of clinical problem should be referred to child psychiatry. Part of the paediatri-
Part 2 This section looked at factors that might negatively influence referral. The list of possible reasons we used was compiled after a review of the literature and after discussions with our colleagues. These possible reasons were given in the form of a list of statements and the respondents were asked to indicate 'yes' or 'no' to each of these depending on whether or not they thought the reason relevant in the decision not to refer to child psychiatry. These statements are shown in table 2. In this part of the questionnaire we were asking paediatricians direct attitudinal questions, but the child psychiatry staff were being asked to speculate whether they felt certain factors affected the paediatricians' decision to refezr. Both parts of the questionnaires included a section inviting further comments from the respondents. Questionnaires were sent to all the staff indicated above with an explanatory letter and prepaid reply envelopes. A reminder and a second copy of the questionnaire were sent if there was no response within three weeks. We indicated that respondents could reply anonymously if preferred. Results RESPONSE RATES
The response rate to the questionnaires was 23/ 37 (67-6%) for paediatricians and 25/37 (67-6%) for child psychiatry staff. We originally recorded the results by subgrouping the respondents according to department (paediatrics or child psychiatry), hospital or centre and either status, if paediatric, or discipline, if child psychiatric (for example, senior
863
Referrals to child psychiatry-a survey ofstaff attitudes
Table I Results to part I of the questionnaire: which type of clinical problem should be referred to child psychiatry Total Department* Respondents (%) who refer: Signifcance No of
Category of problem
(A) Self poisoning
P CP P (B) Emotional/ CP behavioural problems P (C) Obesity CP P (D) Helping families/children cope CP with terminal ilness (E) Helping famillies/children cope with P CP physical handicap/chronic illness (F) Repeated admissions (because mother P cannot cope) CP P (G) Physical illness exacerbated by CP psychological problems P (H) piagnostic difficulties CP P (I) Child sexual abuse+behavioural/ CP emotional problems P (J) Help with diagnosing child CP sexual abuse P (K) Encopresis CP P (L) Enuresis CP P (M) Admission problems/ CP separation anxiety P (N) Parental neglect/ CP non-accidental injury P (0) Drug/alcohol problems in child CP P (P) Anxiety over medical/ CP nursing procedures P (Q) Behaviour disturbance CP on ward P (R) Mother has difficulties with CP baby feeding/sleeping P (S) Don't know what CP else to do
*P=paediatrics, CP=child
Always
Frequently
Sometimes
Never
responses
71 88 4-5 56 0 12 22 8 0 0 0 20 4 20 16 53 53 88 27 44 17 16 0 12 0 20 4 32 32 44 0 8 14 50 4 36 4 24
24 8 32 28 0 24 13 48 17 16 22 8 26 48 36 22 19 8 27 36 39 64 0 60 19 40 13 28 55 40 5 20 24 33 13 28 4 16
0 4 54 5 11 55 60 38 40 61 80 48 64 52 8 40 20 19 4 14 16 31 20 47 28 48 28 48 40 13 16 43 52 52 17 48 36 57 44
5 0 9 7 45 4 17 4 22 4 30 8 17 0 8 5 9 0 32 4 13 0 53 0 33 12 35 0 0 0 52 20 10 0 35 0 8 16
21 25 22 25 22 25 22 25 23 25 23 25 23 25 25 22 21 25 22 25 23 25 23 25 21 25 23 25 22 25 21 25 21 25 23 25 23 25
NS
p
862
Referrals to child psychiatry-a staff attitudes
survey
of
S Oke, R Mayer
Abstract cians' questionnaire asked paediatricians how A questionnaire study was conducted in a often they would refer to child psychiatry a health district to evaluate the attitudes of range of clinical problems seen as inpatients and paediatricians and child psychiatry staff as to outpatients. Part 1 of the child psychiatry queswhich categories of problems should be refer- tionnaires asked child psychiatry staff how often red to child psychiatry. In the majority of they think paediatricians should refer these categories the two groups disagreed as to the problems to the child psychiatry department. frequency with which the problem should be The clinical problems were selected for inclureferred. In the categories relating to child sion after a review of the literature"8 and after sexual abuse responses were often not in discussions with our colleagues. Our list was not accord with Department of Health and Social exhaustive but represented most of the common Security guidelines. Reasons for not referring reasons for referral to child psychiatry. were also looked at and again it was found that Respondents were asked to indicate how frethere were a number of significant differences quently they felt a category of problem should in opinion as to what are reasons for not refer- be referred by answering 1-4 where l=rarely or ring to child psychiatry. Both groups agree never, 2=sometimes, 3=frequently, and 4= that lack of communication is a reason for always or nearly always. The categories of probnon-referral. Some suggestions are made as lems are shown in table 1. to how this problem could be addressed. The association between child psychiatry and paediatrics has been widely commented on during the past 30 years.1-5 We wished to explore whether locally there was agreement between disciplines as to the appropriateness of referral of various clinical problems and to look at factors that might lead to not referring. Method The study was a survey, using specially designed questionnaires, of paediatricians (all grades) and child psychiatry staff (psychiatrists, clinical psychologists, child psychotherapists, and social workers) in an inner London health district. The decision to survey only medical staff in paediatrics but all professional child psychiatry staff reflects the fact that whereas referral, although influenced or initiated by other professions, is primarily a medical decision, the child psychiatry departments assess and treat on multidisciplinary lines.
St Mary's Hospital and Paddington Green Department of Child Psychiatry,
THE QUESTIONNAIRES Two questionnaires were used, one for paediatricians and one for child psychiatry staff. They varied slightly in format, but were identical in
content.
Both questionnaires consisted of
two
London S Oke R Mayer
parts.
Correspondence to: Dr S Oke, Wonford House Hospital, Dryden Road, Wonford, Exeter EX2 5AF. Accepted 28 February 1991
Part I The aim of part 1 was to determine whether paediatricians and child psychiatrists agree as to which type of clinical problem should be referred to child psychiatry. Part of the paediatri-
Part 2 This section looked at factors that might negatively influence referral. The list of possible reasons we used was compiled after a review of the literature and after discussions with our colleagues. These possible reasons were given in the form of a list of statements and the respondents were asked to indicate 'yes' or 'no' to each of these depending on whether or not they thought the reason relevant in the decision not to refer to child psychiatry. These statements are shown in table 2. In this part of the questionnaire we were asking paediatricians direct attitudinal questions, but the child psychiatry staff were being asked to speculate whether they felt certain factors affected the paediatricians' decision to refezr. Both parts of the questionnaires included a section inviting further comments from the respondents. Questionnaires were sent to all the staff indicated above with an explanatory letter and prepaid reply envelopes. A reminder and a second copy of the questionnaire were sent if there was no response within three weeks. We indicated that respondents could reply anonymously if preferred. Results RESPONSE RATES
The response rate to the questionnaires was 23/ 37 (67-6%) for paediatricians and 25/37 (67-6%) for child psychiatry staff. We originally recorded the results by subgrouping the respondents according to department (paediatrics or child psychiatry), hospital or centre and either status, if paediatric, or discipline, if child psychiatric (for example, senior
863
Referrals to child psychiatry-a survey ofstaff attitudes
Table I Results to part I of the questionnaire: which type of clinical problem should be referred to child psychiatry Total Department* Respondents (%) who refer: Signifcance No of
Category of problem
(A) Self poisoning
P CP P (B) Emotional/ CP behavioural problems P (C) Obesity CP P (D) Helping families/children cope CP with terminal ilness (E) Helping famillies/children cope with P CP physical handicap/chronic illness (F) Repeated admissions (because mother P cannot cope) CP P (G) Physical illness exacerbated by CP psychological problems P (H) piagnostic difficulties CP P (I) Child sexual abuse+behavioural/ CP emotional problems P (J) Help with diagnosing child CP sexual abuse P (K) Encopresis CP P (L) Enuresis CP P (M) Admission problems/ CP separation anxiety P (N) Parental neglect/ CP non-accidental injury P (0) Drug/alcohol problems in child CP P (P) Anxiety over medical/ CP nursing procedures P (Q) Behaviour disturbance CP on ward P (R) Mother has difficulties with CP baby feeding/sleeping P (S) Don't know what CP else to do
*P=paediatrics, CP=child
Always
Frequently
Sometimes
Never
responses
71 88 4-5 56 0 12 22 8 0 0 0 20 4 20 16 53 53 88 27 44 17 16 0 12 0 20 4 32 32 44 0 8 14 50 4 36 4 24
24 8 32 28 0 24 13 48 17 16 22 8 26 48 36 22 19 8 27 36 39 64 0 60 19 40 13 28 55 40 5 20 24 33 13 28 4 16
0 4 54 5 11 55 60 38 40 61 80 48 64 52 8 40 20 19 4 14 16 31 20 47 28 48 28 48 40 13 16 43 52 52 17 48 36 57 44
5 0 9 7 45 4 17 4 22 4 30 8 17 0 8 5 9 0 32 4 13 0 53 0 33 12 35 0 0 0 52 20 10 0 35 0 8 16
21 25 22 25 22 25 22 25 23 25 23 25 23 25 25 22 21 25 22 25 23 25 23 25 21 25 23 25 22 25 21 25 21 25 23 25 23 25
NS
p
