Clinical Social Worker Stanford Healthcare, Stanford, CA, USA Stanford, California, United States
Background: 2020 was a year of transformation in cystic fibrosis (CF) care. Many adults with CF started Trikafta while COVID-19 was unfolding. Occurring almost simultaneously, these 2 events created a dramatic shift in the disease landscape. Hospital admissions plummeted, and physical health improved. Clinic appointments turned virtual and people with CF sheltered at home for months. These changes created opportunities for CF team members to adapt roles to meet evolving needs. Social work (SW) hours devoted to inpatient care, end of life, and discharge planning could be reallocated to other areas. While many patients were improved from a physical standpoint, mental health problems increased. Between 2020 to 2022, the demand for MH services increased exponentially, creating a national MH crisis; however, inequities in insurance coverage existed between physical and MH care. Finding a MH provider became an almost-impossible task. This author sought to address insurance inequity and increased demand for MH services by offering Cognitive Behavior Therapy (CBT) sessions to adults with CF to optimize their health and wellbeing. CBT is considered an evidence-based approach for most MH problems.
Methods: Eight adults at the Stanford Adult CF Center were referred for CBT with SW over a period of 9 months (Aug 2021 to April 2022). Referrals were based on: MH crisis, elevated MH screenings, insurance barriers, or lack of MH providers. Therapy sessions were offered via telehealth as part of the multidisciplinary care at the CF center. Patients were not billed for the sessions. The number of sessions was variable with a mean of 10.5 sessions per patient. The frequency and content of sessions were tailored patients’ unique needs. Referrals were accepted on a continuous basis, space available. MH problems included anxiety, depression, alcohol use disorder, trauma, and gender dysphoria
Results: All 8 patients receiving CBT demonstrated significant improvement in MH symptoms as evidenced by a mean reduction in PHQ9 score of 3 and GAD7 score of 3.3 (6 of 8 patients were screened pre and post therapy). Other measures of improvement were patient self-report, as documented in therapy notes, sessions being tapered or discontinued as goals were met, and reduction or stoppage of psychotropic medication usage
Conclusions: MH is a vital component of health and should be properly addressed as part of CF care. While MH care in CF has come a long way, patients continue to lack proper access to trained providers, especially those with expertise in CBT and/or CF. Given the current MH crisis and shortage of therapists to meet new demands, there are serious implications for the long-term health outcomes for people with CF. As more studies are published demonstrating the effectiveness of CBT and other forms of therapy in the CF population, CF providers can adapt roles to implement new interventions in addressing MH problems as part of CF care, rather than referring patients to community providers which often are poorly positioned to meet their needs. Moving forward, the Stanford CF program will continue to utilize SW role to provide MH services
Acknowledgements: Randy Messier, MT, MSA, PCHM CCE
References: Friedman D, Smith B, Sher Y, Bruce A, Chaudhary N, Hardcastle M, Pollinger S, Polineni D, Mohabir P, Shea N, Roach C, Miller C, Richards C, Dvorak M, Quittner A, Georgiopoulos A. Perceived stress and quality of life in adults with CF with mild depression and anxiety. Journal of Cystic Fibrosis. 2021 Nov 1;20:S145-6
