(324) National Implementation of depression and anxiety screening and treatment at US CF Centers: What predicts success?

Background: From 2016-2018, the CF Foundation sponsored competitive awards for Mental Health Coordinators (MHCs) to implement the international guidelines for screening and treating depression and anxiety in US CF centers. Three cohorts were funded, each for 3 years: Cohort 1
n

=84, Cohort 2
n

=36, Cohort 3
n

=18. This study used survey data to evaluate how successful these CF centers were in implementing the guidelines using the Consolidated Framework for Implementation Research (CFIR).

Methods: MHCs were asked to complete annual surveys that assessed CFIR levels of implementation from Preparation/Basic Implementation (e.g., using recommended screening tools) to Full Implementation/Sustainability (e.g., providing evidence-based treatments). Points (0-4) were assigned to survey questions through consensus, with higher scores assigned to more complex implementation tasks (e.g., counseling those in moderate/severe range). Linear regression and mixed effects models were used to: 1) examine differences in center and MHC characteristics, 2) identify predictors of implementation success, and 3) model the longitudinal trajectory of implementation scores over time

Results: A total of 122 MHCs (88.4%) responded (Cohort 1
n

=80, Cohort 2
n

=30, Cohort 3
n

=12). No differences in center characteristics were found across cohorts (e.g., center size, pediatric vs. adult, time in MHC role, professional training). Statistically significant improvements in implementation scores were observed across centers over time (Figure 1). Implementation scores doubled from Year 1 to 2 for Cohort 1 (Year 1
score

M

=21.12, Year 2
M

=41.31). The only significant predictor of implementation scores across the 3 cohorts was years of experience in CF; those on a CF team for 1-5 years or longer reported the highest implementation scores. C
hange over time

was predicted by > 5 years of experience in CF.

Conclusions: Implementation of the mental health guidelines was highly successful over time, with most centers reaching Full Implementation. Funding for MHCs with dedicated time was critical. Longitudinal modeling indicated that CF centers with a diverse range of characteristics could implement the guidelines, which is supported by CFF Registry data showing nearly universal uptake of mental health screening in the US. Years of experience in a CF center was the only variable that predicted implementation success, suggesting that education and training of MHCs and retention of experienced providers are important goals.

Acknowledgements: Supported by the CF Foundation.

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