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Arthritis Care Res (Hoboken). 2019 May;71(5):591-601. doi: 10.1002/acr.23683. Epub 2019 Apr 8.

Gaps in Mental Health Care for Youth With Rheumatologic Conditions: A Mixed Methods Study of Perspectives From Behavioral Health Providers.

Author information

1
Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
2
Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
3
Monroe Carell Junior Children's Hospital, Vanderbilt University School of Medicine, Nashville, Tennessee.
4
Children's Mercy Kansas City, University of Missouri, Kansas City.
5
University of Utah, Salt Lake City.
6
Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana.
7
Hospital for Special Surgery, Weill Cornell Medicine, New York, New York.
8
Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York.
9
Mississippi Center for Advanced Medicine, Madison, Mississippi.
10
Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts.
11
Columbia University Medical Center, New York, New York.
12
University of California, Los Angeles.
13
Stanford University, Stanford, California.
14
University of California, San Francisco.

Abstract

OBJECTIVE:

To identify behavioral health provider perspectives on gaps in mental health care for youth with rheumatologic conditions.

METHODS:

Social workers (n = 34) and psychologists (n = 8) at pediatric rheumatology centers in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) completed an online survey assessing current practices and mental health care needs of youth with rheumatologic conditions. Responses were compared to a published survey of CARRA rheumatologists (n = 119). Thematic analysis of 20 semi-structured interviews with behavioral health providers was performed.

RESULTS:

One-third of CARRA centers (n = 100) had no affiliated social worker or psychologist. Only 1 behavioral health provider reported current universal mental health screening at their rheumatology clinic, yet routine depression screening was supported by >85% of behavioral health providers and rheumatologists. Support for anxiety screening was higher among behavioral health providers (90% versus 65%; P < 0.01). Interviews illustrated a need for interventions addressing illness-related anxiety, adjustment/coping/distress, transition, parent/caregiver mental health, and peer support. Limited resources, lack of protocols, and patient cost/time burden were the most frequent barriers to intervention. Inadequate follow-up of mental health referrals was indicated by 52% of providers. More behavioral health providers than rheumatologists favored mental health services in rheumatology settings (55% versus 19%; P < 0.01). Only 7 social workers (21%) provided counseling/therapy, and interviews indicated their perceived underutilization of these services.

CONCLUSION:

Behavioral health providers indicated an unmet need for mental health interventions that address illness-related issues affecting youth with rheumatologic conditions. Implementation of mental health protocols and optimizing utilization of social workers may improve mental health care for these youth.

PMID:
29953741
DOI:
10.1002/acr.23683

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