Integrating behavioral health care into a low-barrier HIV clinic using the Collaborative Care Model: a mixed methods evaluation of patient care cascade outcomes and determinants

Halliday, Scott; Chwastiak, Lydia A.; Zinsli, Kaitlin; Emerson, Ramona; Wood, Teagan; Ramchandani, Meena S.; Sherr, Kenneth; Tsui, Judith I.; Wagenaar, Bradley H.; Rao, Deepa; Dombrowski, Julia C.

doi:10.1186/s43058-025-00738-5

Implementation Science Communications

Table 1 Specifying the multi-component Advancing Integrated Mental Health Solutions implementation strategy for the CoCM

From: Integrating behavioral health care into a low-barrier HIV clinic using the Collaborative Care Model: a mixed methods evaluation of patient care cascade outcomes and determinants

Domain	Involve patients & stakeholders	Local consensus discussions	Technical assistance	Care manager training	Visiting other sites^a	Conduct small tests of change
Definition	Individual in-depth interviews to identify anticipated barriers and facilitators to implementation	Small and large group meetings on implementation decisions, planning adaptations, and staff buy-in	Longitudinal supervision for the care manager and ongoing implementation support for delivery of the CoCM	A multi-component, protocolized training for the care manager in delivery of the CoCM	Care manager visited clinics implementing the CoCM to establish a professional network and to observe the CoCM	Interactive problem-solving process to adapt the CoCM to improve its contextual fit at the Clinic
Actors	Research team^b	Research team^b	Research team and external partners^b	Research team and external partners^b	Research team and external partners^b	Research and small group consensus team^b
Actions	Collect and analyze data and prepare discussion points for consensus discussions	Hold meetings and operationalize feedback into implementation plan	Use evidence, experience, and data to address implementation challenges	Combination of self-paced online didactic training sessions and 1:1 skill building sessions.³	Care manager visited clinics implementing the CoCM to observe other implementers and case reviews	Continuous quality improvement to respond to BH care manager, staff, and patient feedback
Action target	Patients and Clinic stakeholders	Clinic stakeholders	Care manager and Clinic stakeholders	Care manager	Care manager	Clinic stakeholders
Temporality	Pre-implementation	Pre-implementation	Pre-implementation and implementation	Pre-implementation and implementation	Pre-implementation	Implementation
Dose	One 30–60-min interview with each stakeholder and each purposely selected patient.^d	Small group: three 1 h meetings Large group: two 30 min presentations	Weekly 60-min meetings in early implementation phase; decreasing frequency later	Approximately three months of training in total.^c	Three half day visits to other Max Clinic clinics with the CoCM	Two quality improvement cycles resulted in targeted universal screening and adjusted care plans for patients
Implementation outcomes targeted	Feasibility	Acceptability, feasibility, appropriateness	Fidelity, penetration	Fidelity	Fidelity	Feasibility, penetration, sustainability
Justification	All components of the multi-component Advancing Integrated Mental Health Solutions implementation strategy for the CoCM were iteratively developed in conjunction with 20 years of implementation experience in response to implementation-related challenges. An observational study found that compared to low or basic levels of implementation support, healthcare settings implementing the CoCM for people with depression using the multi-component Advancing Integrated Mental Health Solutions implementation strategy had better health outcomes [26]

^aIncluded the Adult Medicine Clinic and the Mental Health and Addiction Services Clinic at Harborview Medical Center
^bResearch team includes Principal Investigator JD, study team University of Washington-affiliated co-investigators (LC, KS, JT, DR, Research Assistant (SH), and BH care manager (RE). External partners include other stakeholders affiliated with the site clinics visited by the BH care manager and/or stakeholders affiliated with the University of Washington Advancing Integrated Mental Health Solutions Center, which developed the training materials. Representatives from small group consensus meetings include 1 member from each care delivery team employed with the Max Clinic: disease intervention specialists, social workers (TW), and physicians (MR); a research team member (LC); the Research Assistant (SH); and the BH care manager (RE)
^cIncludes: self-paced, 6–8 hour online, didactic Advancing Integrated Mental Health Solutions Center course on epidemiology of depression, the CoCM’s evidence base, team member roles, and CoCM components; 1:1 skill development sessions with research team on registry, measurement-based care, systematic case review, and Behavioral Activation; 6 hour suicide prevention course offered by University of Washington Department of Psychiatry and Behavioral Sciences for Washington State physicians; a refresher training in office-based opioid treatment; psychological intervention modules with a focus on motivational interviewing and distress tolerance; and overview of HIV treatment module
^dSee Study Populations and Recruitment for details of the sampling process

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ISSN: 2662-2211

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