1. Plenary III: There is No Health Without Mental Health

2. Disclosures Alexandra Quittner – Investigator-initiated grants: Novartis & Insmed – Consultant to Vertex, AbbVie, and Novartis – Research support from CF Foundation, EU, Australia NHMRC Stuart Elborn – Clinical trials and consultancy with Novartis, Vertex, Celtaxsys, Corbus – Research support from MRC, EC Framework 7, CF Trust UK – European CF Society Beth Smith – Grant support from the Cystic Fibrosis Foundation and the New York State Office of Mental Health

3. There Is No Health Without Mental Health Beth A. Smith, MD University of Buffalo School of Medicine and Biomedical Sciences Buffalo NY USA

4. Mental Health Screening Recommendations Indicated Patient PopulationOrganization Children, 11-21 yrsAmerican Academy of Pediatrics 1 Adolescents & AdultsUS Preventative Services Task Force 2, 3 AdultsUK NICE Mental Health Guidelines 4 CancerAmerican Society of Clinical Oncology 5 Coronary Heart DiseaseAmerican Heart Association 6 DiabetesAmerican Diabetes Association 7 3-Ann of Internal Med. 2009;151(11):784-792 2-Pediatr. 2009;123(4):1223-1228 5-Oncology. 2014;32(15):1605-1619 6- Circulation. 2008;118(17):1768-1775 7- Diabetes care. 2008;31 Suppl 1:S12-54. 1-Pediatr. 2014;133(3):568-570 4- BPS. 2010

5. From Consensus to Action We have a great opportunity to improve the health and quality of life of our patients and families – But there is a lot of work to do! Currently, our capacity to provide comprehensive mental health care is modest

6. How Are We Going To Do This?

7. Implementation Support

8. Recommendations Educational Materials Guidance on What to Do and How to Do it The International Committee on Mental Health in CF Implementation

9. The CF Foundation Mental Health Task Force A committee established by the CF Foundation – Responsible for supporting implementation of the International Mental Health Guidelines – Our goal: accessible toolkits for implementation Produced CF Mental Health White Paper: "Recommendations for CFF Support of Prevention, Screening and Treatment of Anxiety and Depression in Individuals with Cystic Fibrosis and Their Parent Caregivers” – Current scientific evidence – Expert consensus – Comprehensive analysis of centers currently screening

10. Manual of Procedures and Toolkit for Guideline Implementation Created at Buffalo, used by Lurie Children's Hospital in Chicago to implement their screening This tool assists the CF center in putting the mental health guidelines into practice – User friendly and applicable tool for real world CF center practices – Provides step by step information, recommendations, educational resources, and tools – Tools are broadly relevant, easy to use, and free

11. Educational Materials for Staff

12. Pamphlets for Patients/Families

13. Additional Resources Psychotherapy – Manual: How to Create Referral Networks – Handouts on psychotherapy for patients/parents – Handout on CF for mental health care providers – Training: CBT Short Course Psychopharmacology – Tabulation of 1 st line medications recommended to treat depression and/or anxiety 1 Dosing, titration schedule, target doses Adjustments for renal and hepatic impairments Drug-Drug interactions – Training: Psychopharmacology Short Course 1 Quittner et al. Thorax. October 2015; epub

14. Integrating Behavioral Health into the CF Clinic: The Collaborative Care Model Establish a position of mental health coordinator – (clinical social worker, psychologist, etc.) Task with developing and implementing strategies for: – Prevention – Screening – Case management for those needing interventions Provide direct care if trained in psychotherapy

15. CF Foundation RFA for Mental Health Support Designed to facilitate implementation of the Guideline recommendations Seed funding for a CF Foundation Mental Health Coordinator Designated for hiring additional staff or increase in FTE of existing staff who will focus on mental health coordination or psychosocial intervention

16. Summary Mental health is an unmet clinical need which can positively affect CF disease management Mental Health Guidelines are a step to assist the CF community in the assessment and treatment of anxiety and depression – Patients and families recognize this need and are receptive to screening We have worked hard to remove implementation barriers – < 10 minutes to perform the screening – CF Foundation Mental Health RFA provides a vehicle to support these activities in CF Centers

17. There Is No Health Without Mental Health