ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 124

Underutilization of Social Workers for Mental Health Care of Adolescents in Pediatric Rheumatology: A Mixed Methods Study

Andrea Knight1,2, Michelle Vickery3, Lauren Faust4, Eyal Muscal5, Alaina M. Davis6, Julia Harris7, Aimee O. Hersh8, Martha Rodriguez9, Karen Onel10, Laura E. Schanberg11, Tamar Rubinstein12, Nina Washington13,14, Elissa Weitzman15,16, Hana Conlon17, Dana Gerstbacher18, Jennifer Woo19 and Emily Von Scheven20, 1Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, 2Center for Pediatric Clinical Effectiveness & PolicyLab, Philadelphia, PA, 3PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA, 4Children's Hospital of Philadelphia, Philadelphia, PA, 5Immunology, Allergy and Rheumatology, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, 6Pediatric Rheumatology, Monroe Carell Junior Children's Hospital at Vanderbilt, Division of Pediatric Rheumatology, Nashville, TN, 7Children's Mercy Kansas City, Kansas City, MO, 8Pediatrics/Rheumatology, University of Utah, Salt Lake City, UT, 9Pediatrics, University of Chicago Medical Center, Chicago, IL, 10Hospital for Special Surgery, New York, NY, 11Pediatrics, Duke Medical Center, Durham, NC, 12Albert Einstein College of Medicine, Children's Hospital at Montefiore, New York, NY, 13University of Mississippi Medical Center, Jackson, MS, 14Dept. of Pediatric Rheumatology, University of Mississippi Medical Center, Jackson, MS, 15Boston Children's Hospital, Boston, MA, 16Harvard Medical School, Boston, MA, 17Columbia University, New York, NY, 18Stanford University, Palo Alto, CA, 19University of California Los Angeles, Los Angeles, CA, 20Dept of Pediatric Rheumatology, Univ of California San Francisco, San Francisco, CA

Meeting: 2017 Pediatric Rheumatology Symposium

Keywords: ,

Session Information

Date: Thursday, May 18, 2017

Session Title: Clinical and Therapeutic Poster Session

Session Type: Abstract Submissions

Session Time: 5:30PM-7:00PM

Background/Purpose: Mental health problems are common, but undertreated in adolescents with rheumatologic conditions. As social workers help manage medical and psychosocial aspects of illness, we examined their perspectives to identify opportunities for improving mental health care of these adolescents.

Methods: We surveyed social workers at pediatric rheumatology centers in the Childhood Arthritis and Rheumatology Research Alliance (CARRA). The online survey assessed demographics, beliefs, preferences, and practices for mental health care of adolescents with lupus, juvenile idiopathic arthritis, or juvenile dermatomyositis. Participants rated the frequency of 15 barriers to mental health screening and 18 barriers to treatment on a 4-point Likert scale. Survey participants were invited for semi-structured qualitative interviews to collect in-depth information to complement the survey data.

Results: One third of CARRA centers had no social worker. Of 44 social workers contacted, 37 (84%) responded to the survey. Excluding 5 incomplete responses, 32 were analyzed. Social workers were located mostly at US university-based (81%) and urban (75%) centers, spending a mean of 0.5 full-time effort (SD 0.3) in pediatric rheumatology. Most supported routine universal screening of rheumatology adolescents for depression (94%), anxiety (94%), and distress/coping (100%); none reported this as current practice. Willingness to administer screening was expressed by 88%. Of the 15 (47%) reporting screening of selected patients, only 4 had a protocol for handling the results. High accessibility of on-site psychologists and psychiatrists was reported by 32% and 19%, respectively. Forty-seven percent reported that follow-up by their center after mental health referral was inadequate. Although 94% had formal mental health training, only 6 (19%) provided psychological counseling/therapy to adolescents in rheumatology; of the 26 not providing therapy, 81% said it was not in their current scope of practice. Limited resources, lack of policy, and patient cost/time burden were among the most frequent barriers to mental health care (Figure 1).  Interviews (n=15) revealed detailed information on barriers and facilitators (Table 1).

Conclusion: Almost all social workers at pediatric rheumatology centers have mental health training, and although willing, are underutilized to provide services. With adolescents facing many barriers to mental health care, social workers represent an untapped resource for routine mental health screening and timely intervention as part of comprehensive rheumatology care. 

Disclosure: A. Knight, None; M. Vickery, None; L. Faust, None; E. Muscal, None; A. M. Davis, None; J. Harris, None; A. O. Hersh, None; M. Rodriguez, None; K. Onel, None; L. E. Schanberg, 9,9,9; T. Rubinstein, None; N. Washington, None; E. Weitzman, None; H. Conlon, None; D. Gerstbacher, None; J. Woo, None; E. Von Scheven, None.

To cite this abstract in AMA style:

Knight A, Vickery M, Faust L, Muscal E, Davis AM, Harris J, Hersh AO, Rodriguez M, Onel K, Schanberg LE, Rubinstein T, Washington N, Weitzman E, Conlon H, Gerstbacher D, Woo J, Von Scheven E. Underutilization of Social Workers for Mental Health Care of Adolescents in Pediatric Rheumatology: A Mixed Methods Study [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 4). https://acrabstracts.org/abstract/underutilization-of-social-workers-for-mental-health-care-of-adolescents-in-pediatric-rheumatology-a-mixed-methods-study/. Accessed February 2, 2023.

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