Implementation strategies for depression and anxiety screening in a pediatric cystic fibrosis center: A quality improvement project

Pediatr Pulmonol. 2020 Dec;55(12):3328-3336. doi: 10.1002/ppul.24951. Epub 2020 Oct 16.


Background: Guidelines to integrate mental health screening (MHS) into Cystic fibrosis (CF) care has increased adoption across the United States and European CF Centers, however, there has been limited discussion on specific strategies for implementation.

Objective: Share key strategies that led to successful MHS implementation in one pediatric CF center and report implementation and screening outcomes.

Methods: Parent partners, mental health experts from the Department of Psychiatry, and the CF clinic team codesigned interventions to support three major stakeholders: (a) patients and families (b) clinic team, and (c) hospital system. The mental health coordinator approached patients (12 and older) to introduce MHS and administered screening and reviewed results using an electronic tablet and digital measurement-feedback system. We used strategies that promoted visibility of screening progress and sharing of data with hospital administration. Descriptive statistics were used to assess prevalence of clinically significant symptoms of anxiety and depression and symptom severity within our sample.

Results: Over the first 2 years of the project, we exceeded our goal of screening 80% of eligible patients per year (80%-95% screened) and are on a similar trajectory within the first 7 months of year 3. We identified high prevalence of clinically significant symptoms of depression (16%) and anxiety (14%) similar to those found in other chronic illness populations. These data helped us advocate hospital leadership to support the development of new mental health services to address identified needs at our center.

Conclusion: Leveraging coproduction to address stakeholder needs led to successful implementation of a sustainable MHS process.

Keywords: Cystic fibrosis; adolescents; coproduction; implementation strategies; mental health screening; quality improvement.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Anxiety / diagnosis*
  • Anxiety / epidemiology
  • Cystic Fibrosis / epidemiology
  • Cystic Fibrosis / psychology*
  • Depression / diagnosis*
  • Depression / epidemiology
  • Female
  • Humans
  • Male
  • Mass Screening / methods*
  • Prevalence
  • Quality Improvement