Application of the CFIR model
First, survey questions assessing each CF Program’s experience were grouped into 1 of the 5 primary domains of the CFIR model: 1)Intervention Characteristics —annual mental health screening, provision of psychological interventions by CF care team members, referrals for treatment; 2) Outer Setting —educational materials developed by the MHAC, courses and presentations focused on mental health at the North American CF Conference (NACFC), leadership at the CF Foundation; 3) Inner Setting —program characteristics, the practice of utilizing a multidisciplinary team, training in quality improvement, family education days, leadership provided by the CF Center Director; 4) Characteristics of Individuals —professional background and training of the MHC and years of experience working on a CF team; and 5) Processes of Implementation —development of the role of the MHC on the multidisciplinary team, integration of mental health data into team discussions, plans for execution of annual screening, follow-up of elevated scores and/or suicidal ideation and provision of mental health interventions.
The next step of this pragmatic application of the CFIR model18 quantified each CF program’s success with implementation based on response scores that ranged from basic to advanced. As seen in Figure 1, levels of implementation were categorized as follows: 1) Pre-implementation/Basic, 2) Implementation of standardized screening, 3) Addressing barriers to implementation, 4) Full Implementation, and 5) Sustainability.