Table 2

QI project timeline

Year 1:
getting started
Assembled our core QI depression and CF team and developed our screening algorithm and processes
Sent letter from our director to all eligible patients and families on depression and CF and inviting them to participate in depression screening
Inclusion of mental health topics in our centre’s quarterly newsletter, Shooting the Breeze
Began annual depression screening for all individuals with CF ≥12 years
Year 2:
improving our process
Added depression screening for caregivers of children with CF <18 years of age
Extended screening period for patients, and developed an inpatient screening process for individuals that do not attend outpatient CF clinic visits but present for CF exacerbations and for transplant patients who attend clinic visits annually
Started a monthly multidisciplinary mental health meeting to promote team culture around mental health and involve stakeholders on the CF team
Created a database to track screening
Added mental health to preclinic paediatric and adult team meetings
Developed guide to depression screening at a CF centre to share and disseminate with other centres
Year 3:
patient and caregiver satisfaction
Patient (≥18 years) and caregiver satisfaction surveys
Added annual anxiety screening for patients ≥12 years and caregivers
Shared our process with the Ann & Robert H. Lurie Children’s Hospital of Chicago to obtain feedback
Examined the efficiency of our process
CF education night for family members and virtually with people with CF to reinforce importance of mental health screening
Mental Health Corner added to quarterly CF Centre Newsletter for patients and their family members
Year 4: disseminating
our work and sustaining our work
Spreading our QI project:
  • North American CF Conference: presented our work and distributed zip drives of all our resources to >100 attendees

  • Adapted our manual of procedures for inclusion as a supplement to the International Guidelines on Depression and Anxiety in CF

  • Disseminated resources on the Mental Health in CF listserv

  • Opened our Dropbox of resources

Began billing for depression screening
Hired a Mental Health Coordinator (MHC) to become the champion of annual screening and follow-up, coordinate treatment, and maintain our referral network.
Year 5:
sustaining our improvements
Expanded the role of the MHC
The MHC began to provide evidenced-based psychotherapy (EBP) within the CF centre
Year 6:
sustaining our MHC
Billing efforts for EBP
Advocacy with senior leaders
Paediatric grand rounds to disseminate process to other paediatric specialty clinics
Year 7:
expanding our efforts
Adaptation of our algorithms and processes to substance misuse in CF
Expanding mental health treatment options within our centre
  • CF, cystic fibrosis; QI, quality improvement.