Kashurba is the only child psychiatrist in a four-county area of rural Pennsylvania that is roughly the size of Massachusetts and home to about half a million people, he said. He evaluates 500 to 1,000 children a year.
He works at six different sites: an outpatient facility; an intermediate unit for special education services, where he established an autism assessment program; a partial-hospitalization facility; a residential treatment center; a small outpatient private practice that includes legal work; and a maximum-security prison for juvenile offenders.
After 15 years of working in the area, Kashurba said that he has given up on the idea of recruiting another child psychiatrist. "They just don't come here," he said. And with a dearth of child psychiatrists, "What ends up happening is that kids need services and they end up seeing somebody other than a child psychiatrist for those services."
That, he said, places additional stress on the system by forcing adult psychiatrists, pediatricians and family physicians to spend time practicing outside of areas where they feel comfortable.
Kashurba is co-chair of AACAP's workgroup on consumer issues. The group puts together the "Facts for Families" portion of the academy's Web site
"You have to be very creative in what you do," he said. "You have to have good working relationships with the psychologists, the pediatricians, the family doc."
Having been in the Somerset, Pa., area for so long, Kashurba has established those relationships. When he first moved there, he set up an inpatient psychiatric facility for adults and adolescents at the local hospital. He was able to work closely with other physicians, allowing him to gain their trust.
When he left the hospital to devote his practice to child and adolescent psychiatry, doctors felt comfortable calling him for advice about managing their young patients' medications, he said.