Foreword

An increasing number of children and adolescents in distress need hospital-based emergency services. Factors that have contributed to this increase include the shortage of inpatient psychiatric facilities and the inadequate lengths of stay that commonly occur; in addition, shortages of suitable residential facilities and a lack of appropriate outpatient services give rise to long waiting lists. These and other factors are discussed by Lynelle Thomas, the Guest Editor for this issue of the Child and Adolescent Psychiatric Clinics of North America.

Dr. Thomas has selected a group of authors to address more fully some important issues in emergency psychiatric care for children and adolescents. Anthony Guerrero describes the special work-up that is required to provide an accurate diagnosis and formulation. Londino, Mabe, and Josephson discuss the importance of defining the patterns of family functioning that contribute to the current crisis that results in the need for emergency diagnosis and treatment. Spirito and Overholser focus on the important issues that are involved in the diagnosis and care of children and adolescents who are at risk for or who have attempted suicide. Heyneman addresses aggression and the potential for violence in the child and adolescent seen in an emergency room who may need some kind of restraint. Semper and McClellan discuss issues in the assessment of psychosis.

Solhkhah discusses substance abuse and intoxication. Pumariega and Rothe address cultural sensitivity. Fortunati and Zonana review legal considerations. Berkowitz and Marans discuss the traumatized child and the collaboration between pediatrician and child psychiatrist. Pumariega and Winters discuss research and the need for multiple evidence-based modalities.

I am very grateful to Dr. Thomas and the sterling group of authors she has assembled for this thoughtful and comprehensive account of the knowledge and special skills that are required in providing emergency psychiatric care to children, adolescents, and their families.