New Guidance on Mental Health Screening in Pediatric Rheumatology

“I have truly come to believe that I cannot effectively control patients’ rheumatologic conditions without understanding how they’re doing emotionally and socially,” says Dr. Rubinstein. “If they’re struggling, that needs to be addressed. Otherwise, I’m not going to be able to effectively care for them, and they’re not going to have the overall health outcomes we want.”

Guidance Document Development

In the process of creating the guidance document, Dr. Rubinstein shares that the development team sometimes faced a tension between the ideal world and the real world, between what they would like to see in terms of mental health support and what is practically feasible for a rheumatology workforce already struggling to meet various demands.

Like all ACR guidance documents, this serves as a resource to promote standardized, evidence-based approaches to medical care, but providers have a great deal of leeway in how to best employ the guidance in the context of their practice.

“We wanted to give a road map, something everyone could use to start somewhere, even clinicians with more minimal resources,” shares Dr. Rubinstein. “The idea is to really empower people to feel like they can do something within their agency and within the current level of resources and tools.”

The CARRA Task Force panel included pediatric rheumatologists and pediatric mental health providers, as well as patients and parents of affected children, who produced initial guidance statements. After an initial open comment period, a sampling of the CARRA membership voted on the revised statements, and 31 out of 34 achieved consensus. After further review, the CARRA Task Force decided to center the guidance on the 11 statements with the highest level of empirical support, which were reviewed and endorsed by the ACR.

Screening & Identification Guidance Statements

Dr. Andrea Knight

Seven guidance statements address different aspects to consider in identifying mental health concerns. Dr. Knight points out that much of the research to date on mental health in pediatric rheumatic diseases has focused on screening, and some providers have already been performing regular screening in their practice. Thus, compared with other areas, a greater number of guidance statements related to screening met the higher level of evidence necessary for inclusion.

Among these are recommendations to screen at least annually for anxiety, depression and suicidal ideation, using developmentally appropriate and validated screening measures, with screening occurring as soon as feasible following the initial rheumatology visit. Moreover, patients should receive more frequent screening during stressful periods (e.g., periods of greater disease activity or marked by major social changes, such as moving to a new school). Patients with positive screening should be reassessed at subsequent visits.