You and Your Skin: developing and trialling a new history-taking aid for psychological wellbeing in children and young people with skin conditions

Abstract The mental health burden in children and young people (CYP) living with skin conditions is profound and well documented. There is a lack of integrated psychology/psychiatry provision within paediatric dermatology departments, and dermatologists can struggle to explore psychological wellbeing as part of their clinic consultations due to limited time and/or a lack of confidence and/or training. The British Society for Paediatric and Adolescent Dermatology formed a working group to address the mental health needs of CYP presenting with skin conditions. A multidisciplinary consensus group was formed to assess evidence and develop appropriate guidance. A systematic review found that no single psychological measure or patient-related outcome measure (PROM) adequately captures the psychological burden and impact of living with a skin condition. Patient feedback was clear that PROMs can be less useful than an appropriate clinical consultation. This identified a need for an appropriate clinical tool to help explore CYP psychological wellbeing as part of dermatology consultations: You and Your Skin (YAYS) was developed as a self-completed history-taking aid for CYP > 8 years old and a parent/carer for those < 8 years old. The YAYS was created iteratively using adapted validated and clinically relevant domains from the Children’s Dermatology Quality of Life Questionnaire, the Teenage Quality of Life Questionnaire, the British Association of Dermatologists Acne 3 questions and the Patient Health Questionnaire-9, including self-harm and risk. Questions explore how CYP feel about their skin today and how their skin condition has affected their daily life, caused embarrassment and bullying, and impacted on sleep and mood, and whether they had any thoughts of life not being worth living. The YAYS was co-developed with patients, parents/carers and an external expert stakeholder consensus group (dermatologists, psychologists, psychiatrists, general practitioners, nurse specialists and patient support groups) with revisions done according to feedback on the usability, accessibility and appropriateness of questions. This process has involved 12 revisions of YAYS for CYP and eight revisions of the YAYS parent/carer form, and has been trialled in three paediatric dermatology centres in London, Oxford and Nottingham with 354 CYP and 29 parent/carer forms completed to date. The YAYS development process, findings from YAYS and feedback will be presented. The purpose of YAYS is to enable CYP to raise issues and guide clinicians in evaluation and discussion of mental health concerns in CYP, collaboratively as part of their clinic appointment. Feedback has been very positive from CYP who feel empowered that the impact of their skin disease on all areas of wellbeing can be addressed.