Approved by Council, June 1990
To be reviewed

An important factor in the assurance of quality treatment of an individual patient is that an appropriately qualified physician is responsible for the patient's admission and ongoing treatment. The overall quality of services provided by a hospital is the responsibility of an organized medical staff actively involved in monitoring, evaluating, and modifying the various processes involved in the provision of treatment. The American Academy of Child and Adolescent Psychiatry has a special concern that the inpatient psychiatric treatment of children and adolescents be of high quality and clinically appropriate.

In order to assure quality of treatment in a hospital setting, hospital medical staff membership should be limited to licensed, qualified physicians. A thorough investigation of the physician's practice of medicine at other facilities and in other locations, of any professional liability claims, health status and on going monitoring of quality of treatment, and peer recommendations are needed to substantiate acceptable quality and ethical behavior.

As recognized by the Joint Commission on the accreditation of Healthcare Organizations (JCAHO), hospital specific criteria for clinical privileges (authorization by the governing body to provide specific patient care and treatment services in an organization, within well-defined limits, based on an individual's license, education, training, experience, competence, and judgement) are the mechanisms to be sure that the physician's admitting and treating psychiatric patients meet appropriate training and performance criteria. The Academy's position is that to be a member of a hospital's department of psychiatry and to be able to admit and treat patients on a psychiatric unit, physicians must meet specialty qualifications in psychiatry. This is either 1) board certification in general psychiatry, or 2) successful completion of a four-year residency in psychiatry in a program approved by the Accreditation Council on Graduate Medical Education (ACGME).

The inpatient admission and treatment of adolescents and children should be done only by those psychiatrists who have specific clinical privileges to admit and treat patients in this developmental age group.

• For patients under 14 years of age, a qualified psychiatrist is a child and adolescent psychiatrist who is board certified in child and adolescent psychiatry or a psychiatrist who in addition to general psychiatry training has successfully completed a training program in child adolescent psychiatry accredited by the Accreditation Council on Graduate Medical Education.
• For patients 14-17 years of age or older, a qualified psychiatrist is a child and adolescent psychiatrist as noted above or general psychiatrist who has documented sufficient, specialized training and experience in working with adolescents and their families on an inpatient treatment program, and has demonstrated competence to examine and treat adolescents comprehensively.

The responsible physician, according to the AACAP Guidelines for Treatment Resources, Quality Assurance, Peer Review and Reimbursement, is a licensed physician and qualified psychiatrist (by reason of having completed successfully an ACGME approved residency program in general psychiatry), who is qualified by both documented experience and documented training to treat patients of this age and their families; such training and experience are to assure competence to acquire, complete and integrate the required data from the Comprehensive Evaluation, Formulation, Differential Diagnosis, Treatment Goals, Treatment Plan, Discharge Plan, Discharge Planning, and Collaboration and Consultation with schools.

The expertise of the general psychiatrist with special training in working with hospitalized adolescents should be supplemented by consultation with a qualified child and adolescent psychiatrist. This should be done within seven days of admission for patients age 14 and 15 and every 30 days thereafter or within 21 days for patients age 16 or 17 and thereafter within 45 days.

The above criteria are set with the intention of meeting the current standards of the Joint Commission (JCAHO) Accreditation Manual for Hospitals:

The governing body requires a process or processes designed to assure that all individuals responsible for assessment, treatment, or care of patients are competent in the following, as appropriate to the ages of the patients served:

• The ability to obtain information in terms of patient's needs.
• Knowledge of growth and development.
• An understanding of the range of treatments needed by these patients.

In addition to the training noted above, at the same time of application and at the point of reapplication for clinical privileges, the physician's current experience in providing inpatient treatment to children and adolescents, competence as judged by monitoring and evaluation activities and peer review, health status, and documented continuing education must be considered.

Individuals meeting the above criteria for admission and treatment of children and adolescents and who have completed an ACGME accredited child and adolescent psychiatry training program should also be considered as qualified for the general and special clinical privileges listed below. Qualifications is contingent upon continuing evidence of experience, current competence, appropriate continuing medical education, and peer recommendations. Those qualifying through other training experiences must provide documentation of specific relevant training and competency.

General Privileges

• General medical care of children and adolescent psychiatric patients.
• Individual medical psychotherapy of children and adolescents.
• Family medical psychotherapy of children and adolescents.
• Group medical psychotherapy of children and adolescents.
• Pharmacotherapy of children and adolescents.
• Child and adolescent psychiatric consultation.
• Continuing treatment planning and hospital care management of children and adolescents.
• Milieu treatment management of children and adolescents.
• Consultation and liaison to other physicians.
• Behavior therapy of children and adolescents.
• Cognitive therapy of children and adolescents.
• Treatment of psychiatric disorders in children and adolescents with severe physical illness.

Special Privileges

The following more specialized and individually considered clinical privileges in child and adolescent psychiatry include the following:

• Admission and treatment of infants.
• Hypnotherapy of children and adolescents.
• Forensic evaluation and treatment of children and adolescents.
• Consultation to other child and adolescent psychiatrists.
• Biofeedback therapy of children and adolescents.
• Substance abuse, detoxification and treatment of children and adolescents.
• Any other special procedures.

To qualify for these privileges, in addition to the general qualifications noted above, the physicians should present documented training, continuing medical education, or supervised experience in these areas.

In order to assure that children and adolescents receive appropriate, high quality psychiatric treatment, the Academy encourages its members who are members of hospital medical staffs and members of its regional organizations who are aware of practices in local hospitals, to support actively this position with their hospital staffs and hospital administrators.