Residents anddirectors of accredited child and adolescent psychiatry programs (N = 117) in the United States were surveyed (with a response rate of 89% and 76.9%, respectively) to determine the extent and adequacy of training offered for the identification and management of substance abuse disorders. Of the responders, 24% of the residents indicated some exposure (≥1 hour) to an adolescent drug abuse treatment facility during their training. In contrast, 46% of the directors reported that their residents had such exposure. Residents consistently reported training to be less adequate than did directors. Only half of the residents reported that they felt adequately prepared to identify and initially manage a substance-abusing adolescent, whereas a somewhat higher percentage of the directors (59%) felt that their residents were adequately prepared for this function.

In order to determine the needs and goals of substance abuse teaching, vis-à-vis child psychiatry training, a questionnaire was sent to the training directors at every child psychiatry program accredited by the Accreditation Council of Graduate Medical Examination. The results demonstrated that most child psychiatry programs schedule at least some didactic time specifically for substance abuse topics. However, only 59% of the training directors felt that their fellows were adequately educated to identify and at least initially manage a drug abusing adolescent.

Systematic investigation of consultee concordance with the recommendations of the psychiatric consultant in general medical settings can enhance the role of the consultant as well as measure the efficacy of the psychiatric consultation service. Two hundred psychiatric consultations in a community based teaching hospital were studied for concordance with suggestions for psychotropic medications and diagnostic tests as well as the representation of the psychiatric diagnosis in the discharge summary. Results indicated that orders for medications and suggestions for diagnostic tests had a greater yield if the consultant personally wrote such orders. There was no difference in concordance rates between consultees who were private practitioners or resident physicians. Finally psychiatric diagnoses of dysthymic disorders and adjustment disorders were more likely to be omitted from the discharge summary than other psychiatric disorders.