Evolution of child psychiatric teamwork in a somatic hospital

This paper outlines the evolution of child psychiatric team work within the context of a general hospital. It focuses especially on the professional challenges and systemic problems arising during this 8 year long process. The question of what happens when two cultures meet in the same arena is discussed, and the process whereby a minority becomes a reality in a well-established majority system is described. Special attention is devoted to those principles appearing to play a major role in the evolutionary process. Prominent among these are: (1) operating within the already established; (2) transforming the 'ugly duckling into a swan', and (3) breaking into the established. The paper concludes with a brief discussion of the problems associated with maintaining enthusiasm in the team, scapegoating, and 'burn out'.