As one of the facilitators stated at one of the Collaboration Essentials programs,
“By the end, the residents were talking about calling each other if they need help
from colleagues.” This Collaboration Office Rounds Case Manual is designed to
facilitate the implementation of this program into all pediatrics and child psychiatry
residency training programs. The American Academy of Pediatrics recently renewed
its commitment to the prevention, early detection, and management of behavioral,
developmental, and social problems as an important focus in pediatric practice (AAP,
2001). The policy statement on “the new morbidity revisited” notes that “the
cooperation of pediatric residency directors, educators, practicing pediatricians, and
developmental and behavioral pediatricians will be required for training residents and
experienced pediatricians.” The recent Task Force on The Future of Pediatric Education
II (2000) noted the importance of establishing collaborative working relationships. The
use of the Collaboration Essentials program within individual training institutions offers
pediatric programs a vehicle to approach these critical aims.

The Accreditation Council for Graduate Medical Education (ACGME) mandated that all
residency review committees incorporate the general core competencies into their
requirements (Sexson et al., 2001). One of these areas is system-based practice that
involves the treatment of children with medical or psychiatric problems within the
context of multiple complex systems. The Psychiatry Residency Review Committee
mandated that child and adolescent psychiatry programs develop this competency
effective January 1, 2001 (Sexson et al., 2001). Psychiatry residents are expected to
demonstrate the ability to work in a mutually respectful manner, while displaying
knowledge of the diverse systems involved in the treatment of children and adolescents,
integrating multiple systems of care in treatment planning, collaborating in a shared
treatment plan, and advocating for children and adolescents in various systems of
care. They are expected to demonstrate skills in communicating with and providing
consultation to multiple systems (Sexson et al., 2001). This program offers child and
adolescent psychiatrists another venue for learning important system-based practice
principles.

Phillips et al. (1998) outlined the problems pediatricians face when referring patients
for mental health services; these are related to access to care, quality of providers and
service, attitudes of patients and providers, and lack of adequate communication. They underscored the utility of developing and maintaining a relationship with mental health
referral sources. Fritz (2003) commented on the general similarities and differences
between the two disciplines. These researchers noted that both pediatricians and child
and adolescent psychiatrists have a professional life devoted to children, tend to be
more liberal politically, and have lower incomes than other physicians. At the same
time, they stated that child psychiatrists tend to be more reflective, tolerant of anxiety,
pessimistic about childhood, and interested in psychopathology and private facilitation
while pediatricians are more practical, assuring, optimistic about childhood, and
interested in normal development and public advocacy. Fritz (2003) also stressed that
recognizing these differences as real, permanent, and desirable is important for
successful collaboration. Both research groups highlighted the value of developing
strong relationships between the two specialties as well as the need for joint child
advocacy efforts.

The Collaboration Essentials program offers trainees an innovative opportunity to
better appreciate each other’s approaches and thoughts early in their careers, which
can go a long way toward facilitating mutual understanding and, ultimately, toward
improving patient care. The cases that follow are designed to not only educate
residents about substance abuse, depression, and chronic physical illnesses, but also
to allow residents to experience successful collaboration first hand. We urge programs
across the United States to incorporate this curriculum into their training.