The Changing Landscape of Pediatric Consultation-Liaison Psychology: Ethical Considerations for the Care of Youth Boarding in Pediatric Hospitals

Abstract

Objective: The boarding of psychiatric patients on pediatric medical units has increased since the start of the COVID-19 pandemic and the ensuing mental health crisis. Boarding poses many challenges for youth and the care teams tasked with appropriately managing their acute needs. Pediatric consultation-liaison (CL) psychologists are critical in the management of psychiatrically complex patients. Ethical challenges abound when systemic barriers exist to optimal patient care. Methods: We aim to identify common ethical dilemmas for CL psychologists working with pediatric patients boarding on medical units and provide practical recommendations to enhance patient care, help staff navigate burnout and moral distress, improve supervision of psychology trainees, and advocate for systematic change at the institutional, state, and national level. Results: Through a hypothetical case example, recommendations are provided for improving interventions, training, and advocacy efforts to better support pediatric boarders and those who care for them. Conclusion: CL psychologists are encouraged to leverage their expertise in evidence-based care, patient advocacy, and conflict management to promote practices that enhance the ethical treatment of youth while boarding.

Implications for Impact Statement

With the current mental health crisis, pediatric psychologists are working with more youth who are boarding in medical settings as they await psychiatric placement. This paper offers several suggestions for addressing the numerous ethical dilemmas and challenges that arise when a health system is overtaxed, providers step outside their comfort zone, and children wait for appropriate services. Pediatric psychologists are well positioned to promote ethical and just treatment of these patients and to advocate for system change.