Department of Psychiatry, Center for Rural and Community Behavioral Health, University of New Mexico, Albuquerque, NM 87131-0001, USA.
Child Adolesc Psychiatr Clin N Am. 2010 Jan;19(1):149-62; table of contents. doi: 10.1016/j.chc.2009.08.005.
Because the majority of children with mental health needs are most likely to receive treatment in a school setting, there is a long history of linking child and adolescent psychiatrists to schools. Psychiatrists traditionally have been involved in assessing, diagnosing, and treating the severely mentally ill or consulting with school-based providers. With no end in sight to the dearth of child and adolescent psychiatrists, not to mention child and adolescent behavioral health providers in other disciplines, this role has been broadened in recent years by several programs in which the child and adolescent psychiatrist provides flexible, population-based, systemic, and context-specific approaches to working in schools. In this article, the authors first review some of the traditional roles for child and adolescent psychiatrists working in school mental health settings. Then 2 national programs are highlighted, which successfully integrate psychiatrist trainees into comprehensive school mental health programs. The theoretical approach to a specific community-oriented, strengths-based model for school mental health support used in New Mexico by the University of New Mexico (UNM) Psychiatry Department's Center for Rural and Community Behavioral Health school telepsychiatry program, which supports rural and frontier school mental health programs and school-based health centers, is discussed in detail. The UNM model involves a strength-and resiliency-based collaboration between the child and adolescent psychiatrist, students, families, educators, and those who support them. The psychiatrist co-creates a "community of concern" and support for students, including not only customary participants such as parents, educators, and health care providers but also peers, families of choice, lay professionals, community gatekeepers, and others identified by the student as critical to his or her well-being. The advantages for child and adolescent psychiatry trainees being exposed to a wider variety of potential roles working with schools are also discussed.
由于大多数有心理健康需求的儿童最有可能在学校环境中接受治疗，因此儿童和青少年精神病医生与学校联系的历史由来已久。精神病医生传统上一直参与评估、诊断和治疗严重精神疾病，或为学校提供咨询。由于儿童和青少年精神病医生短缺，更不用说其他学科的儿童和青少年行为健康提供者，这种角色近年来已经通过几个项目得到了扩展，这些项目使儿童和青少年精神病医生能够在学校中提供灵活、基于人群、系统和具体情况的方法。在本文中，作者首先回顾了在学校心理健康环境中工作的儿童和青少年精神病医生的一些传统角色。然后，重点介绍了两个国家项目，这些项目成功地将精神科住院医师纳入综合学校心理健康计划。新墨西哥大学（UNM）精神病学系农村和社区行为健康中心学校远程精神病学计划在新墨西哥州使用的一种特定面向社区、基于优势的学校心理健康支持模式的理论方法，该模式支持农村和前沿学校心理健康计划和学校保健中心，进行了详细讨论。UNM 模式涉及儿童和青少年精神病医生、学生、家庭、教育工作者和支持他们的人员之间基于优势和适应力的合作。精神病医生共同创建了一个“关注社区”，为学生提供支持，包括不仅是父母、教育工作者和医疗保健提供者等传统参与者，还包括同龄人、选择的家庭、非专业人员、社区把关人以及学生认为对其福祉至关重要的其他人。还讨论了儿童和青少年精神病学住院医师接触更广泛的潜在学校工作角色的优势。
