Texas Children's Hospital
Chief of Psychiatry Service
Diane Treadwell-Deering, M.D.
Texas Children's Hospital is the largest pediatric hospital in the country. With 715 licensed beds, over 20,000 children are hospitalized here each year. Over 75,000 visits are made to the Emergency Center and over 425,000 outpatient visits are made annually. Texas Children's Hospital and Baylor College of Medicine train approximately sixty percent of all pediatricians in the state of Texas.
The Psychiatry Service provides consultation services to the pediatric medical inpatient and outpatient services, as well as 24-hour consultation to the Emergency Center. Within the service, psychologists and psychiatrists frequently consult each other and members of each discipline may be involved in the care of a specific child. During the calendar year 2000, 195 new patients were seen in the hospital for a total of 407 visits. In addition, 160 consults were seen in the Emergency Center.
There is a broad payor mix. All patients referred for in-patient consultation are seen, regardless of their ability to pay, with the following exceptions: patients who have insurance coverage whose insurance companies refuse to authorize treatment or prefer to send "in network" providers to the hospital to see their patients.
Referral questions from the Emergency Center usually involve non-accidental over-ingestion of medications or other self-injurious behaviors, or altered mental status. In-patient consultation questions include psychological impact of chronic illness, behavioral or psychological difficulties that interfere with current medical treatment, evaluation of unexplained physical symptoms. Patients whose symptoms of mental health difficulties do not interfere significantly with their hospital treatment are usually referred for outpatient evaluations.
In a liaison capacity, the mental health professional develops an ongoing, collaborative relationship with a group of health care professionals and seeks to enhance their psychosocial understanding, sensitivity and clinical skills. The TCH service's role in liaison activities may include:
- designing protocols for medical staff to minimize the effect of family and child psychopathology on medical treatment,
- developing strategies to prevent the development of secondary psychological morbidity in children with medical illnesses, and
- increasing the communication and behavioral management skills of staff to improve patient outcome. Strong liaison relationships exist between the service and the Children's Asthma Center, the Feeding Team in Nutrition and GI and the Pain Team after pain team note Adolescent medicine with the eating disorder service.
- lecture series have been developed with the following services:
- Adolescent Medicine
- Clinic for Attention Problems (CAP)
- Critical Care
- Emergency Department
- Ben Taub Pediatric Service
Current outpatient psychiatric services include the Pediatric Psychopharmacology Clinic, the Clinic for Attention Problems, and the Psychology Clinic. The Clinic for Autistic Spectrum Disorders is in development.
The Pediatric Psychopharmacology Clinic specializes in the psychopharmacologic treatment and management of child and adolescent psychiatric disorders. Over 550 referrals were made to the clinic and over 200 new patients were offered services last year. Highest priority is given to patients who are referred by a TCH pediatrician or who already receive services in the TCH system. The evaluation includes obtaining a comprehensive history from the family and behavioral observations from the child's teachers, and an interactive diagnostic interview with the child. Evaluation feedback and treatment planning are done with the family after the evaluation is complete. Pharmacological treatment is managed in the follow-up clinic. We work with families to make educational decisions and to find appropriate therapy interventions. Very limited psychotherapy services are available through the clinic.
The Clinic for Attention Problems is a multidisciplinary clinic staffed by clinicians from the Learning Support Center, developmental pediatrics, and pediatric neurology, as well as child and adolescent psychiatry. Comprehensive evaluations, consensus diagnosis, treatment planning and the initiation of treatment occur in this clinic.
The Aftercare clinic maintains follow up for patients who were seen as a psychiatric consultation during their hospital stay. This clinic provides continuity of care and triage to appropriate outpatient mental health services after hospital discharge.
Mood disorders clinic conducts evaluations and on-going treatment for children and adolescents with predominant mood and anxiety symptoms. The main modality of treatment in this clinic is pharmacotherapy.
The Clinic for Autistic Spectrum Disorders is under development. No patients are being accepted at this time. However, this clinic will be multidisciplinary, utilizing the expertise of multiple pediatric sub-specialists and ancillary medical personnel. Diagnostic evaluations, treatment plans and treatment implementation, as well as research, will be components of this clinic.
The psychology service provides specialized outpatient therapy for a limited number of patients. The requests for assessment and treatment often revolve around a co-morbid medical condition for which the patient is receiving treatment in another clinic at Texas Children's Hospital. Psychological factors in the etiology and exacerbation of the condition, adherence with treatment, anxiety around procedures or adjustment to the medical condition are issues addressed in therapy. The therapy generally focuses on behavior change. Cognitive-behavioral and family therapy strategies are utilized.
Danita Czyzewski, Ph.D.
Dr. Czyzewski's research focus is in the interactive influences of environmental, physiological, and psychological influences on the experience of recurrent abdominal pain, as well as adaptation to chronic illness, especially the development of self-management skills in asthma and cystic fibrosis.
Toi Blakley Harris, M.D.
Dr. Harris research foci include the impact of acute and chronic illness on child and adolescent development, and programs to eliminate mental health and health care disparities. These interests involve research with multiple services. She is currently working in conjunction with Hematology-Oncology to evaluate psychosocial and vocational outcomes of long-term cancer survivors. Additionally, she is in collaboration with the Emergency Department with the suicide protocol and educational activities. The suicide protocol is in conjunction with John Sargent, M.D. at Ben Taub hospital. Dr. Harris serves as the Vice-President for Evidence-Based Research for the All Healers Mental Health Alliance (AHMHA). With AHMHA, she is developing research projects with national and community partners that include the faith-based community for short and long-term responses to natural disasters. This compliments her interests with socio-cultural and religious influences on medical and mental health treatment and outcomes.
Mariella Self, Ph.D.
Dr. Self's research interests include the assessment and improvement of symptom perception in pediatric asthma and diabetes, the relationship of perceptual accuracy to self-management behavior in those illnesses, assessment of pediatric health-related quality of life in a variety of pediatric health conditions, and adaptation to pediatric chronic illness. She is currently collaborating with Dr. Czyzewski in a study evaluating the impact of family, psychological, and physiological factors on the experience of recurrent abdominal pain. She is also collecting data on pediatric health-related quality of life in pediatric multiple sclerosis through the multi-disciplinary MS clinic at TCH.
Ayesha Mian, M.D.
Dr. Mian's focus is in the field of education. Her current work involves examining the attitudes of medical students and residents towards child psychiatry and improving recruitment into the field. Other interests include cultural and ethnic influences on the presentation, assessment and treatment of mood disorders and especially relating to suicidal behaviors.
C. Scott Moreland, D.O.
Dr. Moreland is involved in clinical research relating to the collaborative integration of mental health in the primary care setting – specifically the diagnosis and treatment of ADHD in a culturally diverse primary care pediatric setting, Ripley House. Other activities include the diagnosis and management of ADHD and it co-morbidity, novel treatment of Tourette's syndrome and the diagnosis and psychopharmacology of pediatric mood disorders. Other interests include the medical education and it's interfacing with information technology.
Diane Treadwell-Deering, M.D.
Dr. Treadwell-Deering is the site director and principal investigator for the Baylor College of Medicine Autism Treatment Network site. This national network is funded through Cure Autism Now/Autism Speaks. The ATN, modeled after the Cystic Fibrosis Network, is a network of treatment and research centers dedicated to improving medical care for children and adolescents with autism by establishing standards of clinical care based on research and shared clinical practice. Dr. Treadwell-Deering is also involved in two research projects funded through Autism Speaks, “Treatment of Sleep Problems in Children with Autism Spectrum Disorder with Melatonin: A Double-blind, placebo-controlled study” and “Identifying Gastrointestinal (GI) Conditions in Children with Autism Spectrum Disorders (ASD).” Dr. Treadwell-Deering collaborates with TCH/Baylor colleagues on a phenotypic characterization project for Potocki-Lupski syndrome. She is involved as a co-sponsor for a career development award for a post-doctoral fellow in the BCM Department of Molecular and Human genetics, as a mentor in the area of her diagnostic training in autism. Other research efforts are focused on co-morbid intellectual disabilities in autism.