Australasian Psychiatry • Vol 13, No 2 • June 2005 Scott Harden Psychiatrist, Bardon Specialist Group, Bardon, Qld, Australia. Stephen Stathis Consultant Psychiatrist, Child and Family Therapy Unit, Royal Children’s Hospital, Herston, Qld, Australia. Ingrid Wagner Principal Social Worker, Child and Youth Mental Health Services, Royal Children’s Hospital and Health Service District, Spring Hill, Qld, Australia. Correspondence: Dr Stephen Stathis, Royal Children’s Hospital, Herston Road, Herston, Qld 4029, Australia. Email: stephen stathis@health.qld.gov.au CHILD AND ADOLESCENT PSYCHIATRY Redevelopment of a consultation–liaison service at a tertiary paediatric hospital Scott Harden, Stephen Stathis and Ingrid Wagner Objective: This paper aims to describe the way a multidisciplinary team set out to redevelop a consultation–liaison (C-L) service at a tertiary paediatric hospital. Method: The activities and processes in which the team members engaged were documented within a continuous quality improvement cycle. These activ- ities included literature review, analysis of referral patterns, consultation with extant services, survey of referral sources and consultation with other tertiary paediatric services. Results: The outcomes of these initiatives were integrated into a re-formulated multidisciplinary team model dedicated to providing C-L services to the paedi- atric hospital. Significant challenges identified in the initial process were ongoing issues with caseload management and clarification of boundary demarcations. Conclusion: There has been a gradual acceptance of the new C-L service by medical staff. The structure has resulted in a focused and coordinated C-L team that has contributed to innovations in the C-L process within the hospital. Key words: consultation–liaison psychiatry, paediatric hospital. T he Child and Family Therapy Unit (CFTU) is a 10-bed inpatient fa- cility of the Child and Youth Mental Health Services (CYMHS) of the Royal Children’s Hospital and Health Service District (RCH and HSD) in Queensland, Australia. The CFTU primarily provides admission for young people aged up to 14 years who reside within the Central or Northern Health Zones of Queensland, and drains an area from north of the Brisbane River to the Torres Strait. Since 1983, the clinical team of the CFTU has also pro- vided a consultation–liaison (C-L) service to the main 168-bed paediatric hospital. In 1995, a review of the C-L service was conducted by a psychiatrist during a locum tenens at the CFTU. With this appointment, and in response to national policy changes, came a mandate to review the function of the unit and redevelop the service to provide more effective and efficient clinical services. Following this review, there was some increase in the C-L services offered to the paediatric hospital units. The urgency and immediacy of the demands associated with inpatient care meant that C-L requirements often took second place. Although this did not generally impair clinical service provision, the staff had little capacity to review the service scope and give consideration to the planning of service delivery. The mandate for service redevelopment occurred in the context of the continuing implementation of national and state mental health policies, 1–5 which have guided the initiatives implemented at the local level by the CYMHS. The role of the tertiary hospital has been changing, with devolu- tion of services to district-level hospitals and community-based services. The Queensland Health Strategy outlines a plan for the integration of services 169