Systems-Centered Focus Consultation-liaison models are sometimes differentiated based on whether the focus of the services are primarily on the patient ("patient-centered") or on the larger system the patient and family must rely on for medical care ("systems-centered"). In patient-centered services, the primary goal is to evaluate the patient in order to provide direct treatment. In systems-centered services, the focus of the services are on creating change in the professionals requesting the services to make them more effective in the intervention with the case in question, as well as in other similar cases. Inpatient Pediatric Consultation-Liaison As an inpatient pediatric consultation—liaison, the pediatric psychologist advises physicians or other medical professionals or provides direct services to medically hospitalized children regarding behavioral, emotional, or familial aspects of the child's illness and symptoms. The consultation-liaison psychologist's primary role includes evaluating children and their families for mental health concerns; recommending and providing treatments; and educating families, staff, and referring physicians on a wide array of factors associated with adjustment to medical illness and injury. Patient interventions include teaching coping skills, evaluating side effects of medication, helping manage physical pain, and addressing physical pain, among others. Defined narrowly, inpatient pediatric consultation-liaison involves a pediatric psychologist providing assessment and guidance to a pediatrician colleague regarding the care of a specific patient. Broadly defined, the pediatric consultation-liaison psychologist is a systems-level catalyst—in educating and empowering multiple interacting components of the health care system, fostering a responsive environment that maximizes the overall quality of life and psychological adjustment of patients and their families. Research on inpatient pediatric consultation-liaison services There are few studies illustrating the breadth of services provided by pediatric consultation-liaison psychologists. In a survey of 144 children's hospital-based child psychiatry consultation-liaison services, Shaw and colleagues reported that returned surveys (33%) indicated that the most common referral concerns for consultation-liaison services included patient depression, anxiety, suicide risk assessment, and medication evaluation. In the only case-controlled study of pediatric consultation-liaison services, Carter and colleagues (2003) matched 104 referrals with controls for age, gender, and illness type or severity and completed parent- and self-report behavioral rating scales to assess for adjustment. Nurses completed in-hospital ratings of behavioral or adjustment difficulties. Goal attainment and satisfaction ratings were obtained from referring physicians, parents, and the consultant. Results indicated that referrals exhibited more behavior, adjustment, or coping difficulties than nonreferrals by parent-, nurse- and self-report. Referring physician and consultant ratings of goal attainment