Describes how a combination of individual & family therapies is used by staff & student trainees to handle difficult cases in the child & adolescent outpatient clinic of an inner-city hospital. The cases of a 15 year-old boy referred for school failure & difficulty at home & a 16 yr-old suicidal boy are presented to illustrate this focussed approach. The operation of the clinic is described in terms of staffing, funding & its relationship with the children’s hospital. (6 refs.)