"Whom Do You Serve?" School Mental Health Clinics and the Child and Adolescent Psychiatrist.

One of my roles as a child and adolescent psychiatrist is the provision of onsite consultation and treatment services to a population of children with severe behavioral challenges in an alternative school system. The school mental health service agreement among the parents, school, and provider allows for dialogue between the provider and school staff (typically the school clinician) concerning evaluation findings and recommendations. I have twice faced scenarios in which parents have become upset and disengaged from treatment because of anonymous reports to child protective services made by school staff and attributed to the child psychiatrist by the parent.