New Guidance on Mental Health Screening in Pediatric Rheumatology

Most rheumatology providers are probably already attempting to connect patients to resources if a potential mental health issue becomes apparent during an appointment, but patients don’t always volunteer this information organically.

“The idea here is to do something more routine, using validated measures, so you have the best chance of capturing all kids who are struggling,” says Dr. Knight.

She adds that although more frequent screening may be ideal—many pediatric rheumatologists already performing such screening do it every three to six months—annual screening provides a starting point.

Another recommendation specifically addresses the fact that minority groups are less likely to be diagnosed and referred for mental health treatment, noting that providers should keep these potential inequities in mind when implementing mental health screening.

Dr. Knight says this can happen due to a variety of reasons, including religious or cultural differences, language barriers or systemic biases. Routine screening and standardizing practices related to mental health, alongside considerations of these potential barriers, is important to provide equitable care.

Collaborative Management

One guidance statement recommends urgent assessment by a mental health specialist, if possible, for patients with moderate to severe mental health symptoms, which should include potential medication management as well as psychological interventions. Another statement addresses patients with mild symptoms, who might instead receive follow-up care with a primary care provider.

Dr. Natoshia Cunningham

One of the behavioral health specialists leading the team was Natoshia R. Cunningham, PhD, a licensed clinical psychologist and an associate professor in the department of family medicine at Michigan State University, Grand Rapids. “We recognize the availability of pediatric behavioral health providers is limited,” she says, “so we tried to think about a stepwise approach where we reserve the more intense support for the people who have the most complex and pressing needs.”

In an ideal world, she shares, patients would receive collaborative care with real-time communication between rheumatologists and mental health providers, potentially embedded as part of a multidisciplinary pediatric rheumatology clinic team. But realistically, this is not always possible.

Dr. Rubinstein encourages providers to think about what collaborative care may look like in their particular practice. Psychiatrists, psychologists, primary care providers, adolescent medicine providers, social workers and child life specialists can all prove helpful collaborators, and sometimes school mental health programs can be an additional resource.

Dr. Cunningham also leads research that trains school providers to address chronic pain, fatigue and mental health symptoms using cognitive behavioral strategies.⁵