(288) Treatment targets in the psychological care of youth with CF

Background: Inclusion of a psychologist within the CF care model affords increased attention to mental and behavioral health needs, including screening, assessment, and provision of empirically-supported interventions. This abstract describes the outpatient utilization of the psychologist embedded in the interdisciplinary pediatric CF team, specifically treatment targets during outpatient visits.

Methods: A smartphrase was developed within the EMR with an embedded smartlist. Each outpatient encounter (during and outside of CF medical visit; in person and telemedicine combined) with the psychologist starting in May 2021-March 2022 was examined for treatment targets documented in the EMR. Category types were developed via consensus by CF psychosocial and CF leadership team members.

Results: A total of 209 encounters were examined for analysis, from 56 discrete patients. Mean age was 10.7 yrs (SD=6.0 yrs; range = 6 mo-20 yrs) and 68% were female. Total encounter results indicated that individuals with CF and their families were in greatest need of strategies to support overall adjustment and coping with CF care demands and impacts. Depression, anxiety (general and procedural), and adherence and healthy habits (including nutrition and sleep) were frequent treatment targets. Behavioral support for ADHD was also a common clinical focus and families of young children received targeted behavior management strategies to develop cooperation and compliance to instruction skills (Table 1). Average number of visits with psychologist were = 3.7 (SD=4.0; MIN= 1; MAX= 23). Patient age (years) by % visit was the following: birth-2 yrs = 11%; 3-5 yrs = 11%; 6-11 yrs = 36.4; 12-17 yrs = 23.9%; 18+yrs = 17.7%.

Conclusions: We aimed to develop a process to improve monitoring of clinical treatment targets during outpatient appointments with the psychologist embedded in our pediatric CF team. The development of the process was informed by interdisciplinary team members and increased their ability to more efficiently identify treatment targets within the psychologist’s EMR documentation. The inclusion of treatment targets in the smartphrase were refined over time and new targets were added as clinically appropriate. Specifically, procedural anxiety was broken out from the general anxiety category following the initiation of the smartphrase. The smartlist includes a variety of topics which does not allow for increased specificity. If greater refinement is desired, this could be programmed based on goals of data monitoring. Limitations of the data include clinician adherence to using smartphrase and accurately categorizing interventions. In addition, the smartphrase/smart list did not include treatment target of addressing gender health issues.

Acknowledgements: This work was supported by the CCHMC CFF Center grant (mental health coordination).

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