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Given the gap in child psychiatric services available to meet existing pediatric behavioral health needs, children and families are increasingly seeking behavioral health services from their primary care clinicians (PCCs). However, many pediatricians report not feeling adequately trained to meet these needs. As a result, child psychiatric access projects (CPAPs) are being developed around the country to support the integration of care for children. Despite the promise and success of these programs, there are barriers, including the challenge of effective communication between PCCs and child psychiatrists. Consultants from the Maryland CPAP, the Behavioral Health Integration in Pediatric Primary Care (BHIPP) project, have developed a framework called the Five S's. The Five S's are Safety, Specific Behaviors, Setting, Scary Things, and Screening/Services. It is a tool that can be used to help PCCs and child psychiatrists communicate and collaborate to formulate pediatric behavioral health cases for consultation or referral requests. Each of these components and its importance to the case consultation are described. Two case studies are presented that illustrate how the Five S's tool can be used in clinical consultation between PCC and child psychiatrist. We also describe the utility of the tool beyond its use in behavioral health consultation.

Assessment procedures for infants, toddlers, and preschoolers should include caregiver interviews, caregiver-report questionnaires, observational coding procedures, and collateral reports (i.e., medical, child care, etc.). This multimodal assessment approach provides clinicians a systematic means to incorporate the many factors that impact an infant’s clinical presentation. The prior chapter focuses on one aspect of a multimodal psychiatric evaluation, specifically observing the dyadic interaction. In this chapter, we outline key considerations regarding instrument selection, application and interpretation, and provide an in-depth list of dyadic observational measures which have been found to have useful clinical applications.