Quittner Alexandra L, Barker David, Graziano Sonia, Georgiopoulos Anna M, Muther Emily, Verkleij Marieke, Schechter Michael S, Tillman Laura, Mueller Amy, Lomas Paula, Hempstead Sarah, Smith Beth A
Joe DiMaggio Cystic Fibrosis, Pulmonary Medicine and Sleep Center, Hollywood, Florida, USA.
Psychiatry & Human Development, Bradley Hasbro Children's Research Center, Brown University, Providence, Rhode Island, USA.
Pediatr Pulmonol. 2023 Jun;58(6):1768-1776. doi: 10.1002/ppul.26400. Epub 2023 Apr 4.
The CF Foundation sponsored competitive awards for Mental Health Coordinators (MHCs) from 2016 to 2018 to implement the international guidelines for mental health screening and treatment in US CF centers. Longitudinal surveys evaluated success in implementing these guidelines using the Consolidated Framework for Implementation Research (CFIR).
MHCs completed annual surveys assessing implementation from preparation/basic implementation (e.g., using recommended screeners) to full implementation/sustainability (e.g., providing evidence-based treatments). Points were assigned to questions through consensus, with higher scores assigned to more complex tasks. Linear regression and mixed effects models were used to: (1) examine differences in centers and MHC characteristics, (2) identify predictors of success, (3) model the longitudinal trajectory of implementation scores.
A total of 122 MHCs (88.4% responded): Cohort 1, N = 80; Cohort 2, N = 30; and Cohort 3, N = 12. No differences in center characteristics were found. Significant improvements in implementation were observed across centers over time. Years of experience on a CF team was the only significant predictor of success; those with 1-5 years or longer reported the highest implementation scores. Change over time was predicted by >5 years of experience.
Implementation of the mental health guidelines was highly successful over time. Funding for MHCs with dedicated time was critical. Longitudinal modeling indicated that CF centers with diverse characteristics could implement them, supported by evidence from the CF Patient Registry showing nearly universal uptake of mental health screening in the United States. Years of experience predicted better implementation, suggesting that education and training of MHCs and retention of experienced providers are critical to success.
囊性纤维化基金会在2016年至2018年为心理健康协调员（MHC）提供了竞争性奖项，以在美国囊性纤维化中心实施心理健康筛查和治疗的国际指南。纵向调查使用实施研究综合框架（CFIR）评估了实施这些指南的成功情况。
MHC完成年度调查，评估从准备/基本实施（例如，使用推荐的筛查工具）到全面实施/可持续性（例如，提供循证治疗）的实施情况。通过共识为问题分配分数，更复杂的任务分配更高的分数。使用线性回归和混合效应模型来：（1）检查中心和MHC特征的差异，（2）确定成功的预测因素，（3）模拟实施分数的纵向轨迹。
共有122名MHC（88.4%做出回应）：第1组，N = 80；第2组，N = 30；第3组，N = 12。未发现中心特征存在差异。随着时间的推移，各中心在实施方面均有显著改善。在囊性纤维化团队的工作年限是成功的唯一显著预测因素；工作1 - 5年或更长时间的人报告的实施分数最高。超过5年的工作经验可预测随时间的变化。
随着时间的推移，心理健康指南的实施非常成功。为MHC提供有专门时间的资金至关重要。纵向建模表明，具有不同特征的囊性纤维化中心可以实施这些指南，囊性纤维化患者登记处的证据显示美国几乎普遍采用心理健康筛查也支持了这一点。工作年限预示着更好的实施效果，这表明对MHC的教育和培训以及留住经验丰富的工作人员对成功至关重要。
