Background/Purpose: High levels of emotional distress have been reported in children with juvenile myositis (JM). Inadequate recognition of mental health concerns by healthcare providers (HCPs) can contribute to poor disease outcomes. A recent multicenter study confirmed the feasibility and acceptability of mental health screening (MHS) in patients with JM. The global aim of this quality improvement project was to implement MHS with referrals to an integrated social worker as standard of care for patients ≥5 years of age seen in the SickKids JM clinic. The specific aims were to 1) increase the rate of MHS from 0 to ≥50% in a 90-day period, and 2) ensure that all patients with moderate or severe screening results received referrals for social work assessment.

Methods: A multidisciplinary stakeholder team (rheumatologists, physical therapists, nurse, social worker, research coordinators, and patient/caregiver advisors) iteratively developed screening and referral workflows, and educational resources for HCPs and families. Patients attending the JM clinic were to be screened for anxiety and depression [12-18 years old: Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire (PHQ-9); caregivers of patients 5 to < 12 years old: Pediatric Symptom Checklist (PSC-17)]. All patients were to receive a mental health resource handout and patients with positive screens were to be reviewed by physicians who decided whether to refer to the social worker. HCPs were to document MHS in patients’ After Visit Summary (AVS) and electronic health record (EHR). Feedback was sought from HCPs and patients/caregivers who agreed to participate in surveys, which informed successive plan, do, study, and act (PDSA) cycles.

Results: Prior to implementation we did not perform MHS as standard care in JM clinic. We conducted three PDSA cycles from March 7 to May 30, 2023. All 32 patients (100%) seen in the clinic received MHS and the resource handout (Table 1). Documentation of MHS in the AVS and EHR rose from 25% to 92.3% and 71.4% to 100%, respectively. There were seven positive screens (22%), of which, six(86%) were referred to the integrated social worker and one was not as they were being seen at our clinic for a secondary opinion. All patient/caregiver survey participants (n=16) indicated that they were satisfied with the MHS process.

Conclusion: The JM clinic has successfully implemented MHS for all its patients within 90days and achieved timely referral to integrated social work. Additional PDSA cycles are needed to support its sustainability as well as build a robust culture of documentation. Future work will include development of tailored mental health resources to address the needs of patients with JM, caregivers, and siblings.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/successful-implementation-of-a-mental-health-screening-program-for-youth-with-juvenile-dermatomyositis/