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Summary: Immense changes in the developmental/behavioral aspects of primary care pediatrics have resulted from revisions in special education laws, introduction of managed care, widened dissemination of information about disabilities to parents, and the changing character of American society. Challenges associated with contemporary pediatric practice can be diminished by routine collaboration with school psychologists. An alliance with school-based psychologists permits pediatricians access to children in their natural environments and potential collaboration for preventing illness and emotional/behavior problems. Further, school psychologists can provide a partner for assessing and treating both common and low-incident disorders without the constraints imposed by managed care. Clin Pediatr. 1999;38:597-606
Introduction
Pediatric psychology, a subspecialty of clinical psychology, has enjoyed considerable visibility in its relationship with pediatric medicine. Drotar,1,2 for example, has written extensively on the graduate training of psychologists in medical settings. Pediatric residents are now routinely exposed to pediatric psychologists in hospital settings. When surveyed, pediatricians provide data to indicate their satisfaction with the transdisciplinary collaboration that occurs in hospital-based clinics and inpatient settings.3 However, it is becoming more apparent that many children are being seen in primary care settings for school-related problems in the area of development and behavior. Consistent with the pediatric psychology-pediatric medicine interface, this article proposes a readily accessible partnership that depends on collaboration with psychologists who practice in school settings (i.e., school psychologists) capable of meeting the daily needs of primary care pediatricians. Complementary to the existing pediatrician-pediatric psychology relationship, the pediatrician-school psychology relationship is supported by several distinctive factors.
The practice of primary care pediatrics has undergone dramatic changes during the last two decades. Especially now, pediatricians require traditional expertise regarding physical illness and the increasingly meaningful realm of behavior and development. Pediatricians may spend up to onehalf of their practice time addressing childrearing, discipline, school, developmental, behavioral, and interpersonal concerns.-6 A recent survey suggests that more than a quarter of their patients have problems in at least one psychosocial sphere.7 For example, office visits associated with managing methylphenidate have increased 140 fold since 1980.11 Contemporary society is producing uncountable infants born to teenage mothers, deprived of proper prenatal care, reared in poverty, subjected to violence, or forced at early ages into understaffed child care centers.9
Further, pediatricians in the 1990s are confronted with...