Anxiety Disorder and OCD Clinical Pathway — Outpatient Behavioral Health and Primary Care

Evaluation & Diagnostic Assessment

Screening and assessing a patient for anxiety and OCD can be effectively done through:

Elements of the Anxiety and OCD Evaluation can be completed in one or more visits.

Elements include:

Child and Caregivers interview, both separately and together
Information from other treating clinicians, school representatives
Review of medical record

Primary care clinicians may consider referring patients for behavioral health consultation for initial evaluation, diagnosis, treatment recommendations and cadence of follow-up with Primary Care.

Evaluation

Safety Risk	Safety is a priority, screen / assess for the following: Suicidal Ideation (SI) Homicidal Ideation Physical/ sexual abuse Substance use Other Violence Domestic, community, access to weapons Examples of Screening Tools include: Columbia Suicide Severity Rating Scale Pediatric Quick Screen C-SSRS — Very Young Child/Cognitively Impaired – Lifetime Recent C-SSRS — Very Young Child/Cognitively Impaired – Since Last Contact Assess using Columbia Suicide Severity Rating Scale (C-SSRS) assessment tool whenever a suicide screen is positive. Examples of Assessment Tools include: C-SSRS — Very Young Child/Cognitively Impaired – Lifetime Recent C-SSRS — Very Young Child/Cognitively Impaired – Since Last Contact Safety Plan using the Safety Plan Intervention when indicated
Medical History and Evaluation	Past and current medical illness Hospitalizations, surgeries Medications (prescriptions, over the counter) Allergies Complete physical exam to screen for medical illness, include weight, vital signs Refer for medical evaluation as clinically indicated
Current and Past Anxiety Symptoms	Assess Current and Past Anxiety/OCD Symptoms using one of the following: Structured or Semi-Structured Interview Instruments: Used primarily in BH setting, useful for accurate diagnosis Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) Clinical Interview assessing DSM-5 or ICD-10 diagnostic criteria: Explore presence of excessive worry, anxiety, and impairment (home, friends, school) Anxiety and Related Disorders Interview Schedule for DSM-5, Child and Parent Version: Parent Interview Schedule
Current and Past Psychiatric Symptoms	Use clinical interview, structured or semi-structured interviews, symptom check-lists, and/or parent and self-report measures to screen/ assess for presence of: Other psychiatric conditions, for example: Mood disorders (e.g. Depression, Bipolar Disorder) Attention Deficit Hyperactivity Disorder Post-Traumatic Stress Disorder Note: Co-morbidities are common, screening/assessment of other psychiatric conditions is important as their presence affects treatment choices and outcomes
Mental Health Treatment History	Past or current: Mental health diagnoses Outpatient treatment Partial hospitalization treatment Inpatient treatment Medication (current, past)
Psychosocial History	Past or current psychosocial risk and protective factors across multiple domains. Such as: History of trauma Personal/ interpersonal variables Family system and relationships Peer relationships Societal/ community variables
Academic History	Past and current: Academic performance Early intervention School accommodations e.g., 504 plans, read: IEPs, GIEPs Review results of psychological testing as available
Family Medical and Mental Health History	Assess for a family history of: Anxiety disorders Mood disorders Eating disorders Substance use disorders Suicidal behaviors
Level of Functioning, Impairment, Distress	Assess level of functioning and impairment and symptom distress to aid in diagnosis and severity. These include the patient’s: Ability to interact with others, form relationships Ability to handle day-to-day tasks Impact of psychiatric symptoms on a patient’s day-to-day life Psychosocial functioning can be assessed using: Clinical Global Assessment of Functioning Scale (CGAS), The Columbia Impairment Scale (CIS), Youth and Parent versions, and the Clinical Global Impression Scale (CGI)

If you have questions about any of the clinical pathways or about the process of creating a clinical pathway, please contact us.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Anxiety Disorder and OCD Clinical Pathway — Outpatient Behavioral Health and Primary Care

Evaluation & Diagnostic Assessment

Evaluation

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Anxiety and OCD — Evaluation and Diagnostic — Clinical Pathway: Outpatient Behavioral Health and Primary Care

Anxiety Disorder and OCD Clinical Pathway — Outpatient Behavioral Health and Primary Care

Evaluation & Diagnostic Assessment

Evaluation