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.