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71
The psychiatrist, the psychiatric social workers and the psychologists
work together, and separately, to provide this service. Occasionally the
service is offered direct to clients, usually in cases in which they have
approached the clinic and subsequently been contacted by a psychiatric
social worker. The psychiatrist prefers the client or referring agent to be
in touch with a primary care physician in all cases with which he is
concerned.
The 1973 figures, set out below, illustrate trends towards:-
(a) increasing numbers of consultations with personnel from outside
agencies, without the clients/patients being seen by clinic professional
staff.
(b) increasing numbers of referrals from hospital paediatric units
(especially Northwick Park). There is a corresponding slight fall in
direct referrals from general practitioners, but these have continued
to provide the bulk of direct work with patients on the clinical side.
These trends which were noted in the Annual Report for 1972 have
continued into 1973.
Psychiatric responsibility for treatment is vested in the consultant
psychiatrist, and conducted through case conferences and/or periodic
reviews of the case. The specialist teacher, who is a full member of the
clinical organisation, plays an important part in the treatment of a small
number of cases.
The treatment service backs up the consultation service and is
essentially related to it. There is no treatment 'waiting list'. This enables
the psychiatrist to attempt therapeutic consultations during his first
contacts with the case. He can then act with confidence knowing that,
should the need for alternative approaches (such as intensive child
psychotherapy, extended casework) become apparent during the consultation,
then resources are available for them immediately. His work, and
that of his specially experienced colleagues, ensures that psychotherapeutic
skills, which can be developed within the setting of the clinic, or enhanced
by contact with its staff members, are widely applied. At the same time,
the child psychiatrist's responsibility for the on-going treatment or
supervision of quite large numbers of cases is maintained and exercised.
Number of New Cases 100*