Scaling Implementation of Collaborative Care for Depression: Adaptation of the Stages of Implementation Completion (SIC)
Tools to monitor implementation progress could facilitate scale-up of effective treatments. Most treatment for depression, a common and disabling condition, is provided in primary care settings. Collaborative Care Management (CoCM) is an evidence-based model for treating common mental health conditions, including depression, in this setting; yet, it is not widely implemented. The Stages of Implementation Completion (SIC) was adapted for CoCM and piloted in eight rural primary care clinics serving adults challenged by low-income status. The CoCM-SIC accurately assessed implementation effectiveness and detected site variations in performance, suggesting key implementation activities to aid future scale-ups of CoCM for diverse populations.
KeywordsCollaborative Care CoCM Depression Adaptation Implementation SIC
The preparation of this article was supported in part by the Implementation Research Institute (IRI), at the George Warren Brown School of Social Work, Washington University in St. Louis; through an award from the National Institute of Mental Health (R25 MH080916-01A2) and the Department of Veterans Affairs, Health Services Research & Development Service, Quality Enhancement Research Initiative (QUERI); funding from the National Institute of Mental Health (R01 MH097748, Saldana; R01 MH108548, Bennett); and through an award from The John A. Hartford Foundation (2012-0213, Unützer) that includes support from the Corporation for National and Community Service Social Innovation Fund.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
This article does not contain any studies with human participants performed by any of the authors.
- Areán, P.A., Ayalon, L., Hunkeler, E., Lin, E.H., Tang, L., Harpole, L., … Unützer, J. (2005). Improving depression care for older, minority patients in primary care. Medical Care, 43(4), 381–90. https://doi.org/10.1097/01.mlr.0000156852.09920.b1.
- Bauer, A. M., Chan, Y. F., Huang, H., Vannoy, S., & Unützer, J. (2013). Characteristics, management, and depression outcomes of primary care patients who endorse thoughts of death or suicide on the PHQ-9. Journal of General Internal Medicine, 28, 363–369. https://doi.org/10.1007/s11606-012-2194-2.CrossRefGoogle Scholar
- Brown, C. H., Chamberlain, P., Saldana, L., Padgett, C., Wang, W., & Cruden, G. (2014). Evaluation of two implementation strategies in 51 child county public service systems in two states: results of a cluster randomized head-to-head implementation trial. Implementation Science, 9, 134. https://doi.org/10.1186/s13012-014-0134-8.CrossRefGoogle Scholar
- Chamberlain, P., Saldana, L., Brown, C. H., & Leve, L. (2010). Implementation of multidimensional treatment foster care in California: a randomized control trial of an evidence-based practice. In M. Roberts-DeGennaro & S. Fogel (Eds.), Using evidence to inform practice for community and organizational change (pp. 218–234). Chicago: Lyceum Books.Google Scholar
- Coventry, P.A., Hudson, J.L., Kontopantelis, E., Archer, J., Richards, D.A., Gilbody, S., … Bower, P. (2014). Characteristics of effective collaborative care for treatment of depression: a systematic review and meta-regression of 74 randomised controlled trials. PLoS ONE 9, e108114. https://doi.org/10.1371/journal.pone.0108114.
- Grumbach, K., Bainbridge, E., & Bodenheimer, T. (2012). Facilitating improvement in primary care: the promise of practice coaching. Washington: The Commonwealth Fund.Google Scholar
- Huang, H., Chan, Y.F., Katon, W., Tabb, K., Sieu, N., Bauer, A.M., … Unützer, J. (2012). Variations in depression care and outcomes among high-risk mothers from different racial/ethnic groups. Family Practice, 29(4), 394–400. https://doi.org/10.1093/fampra/cmr108.
- Katon, W., Unützer, J., Wells, K., & Jones, L. (2010). Collaborative depression care: history, evolution and ways to enhance dissemination and sustainability. General Hospital Psychiatry, 32, 456–464. https://doi.org/10.1016/j.genhosppsych.2010.04.001.CrossRefGoogle Scholar
- Levine, S., Unützer, J., Yip, J.Y., Hoffing, M., Leung, M., Fan, M.Y., … Langston, C.A. (2005). Physicians’ satisfaction with a collaborative disease management program for late-life depression in primary care. General Hospital Psychiatry, 27(6), 383–391. https://doi.org/10.1016/j.genhosppsych.2005.06.001.
- Regier, D. A., Narrow, W. E., Rae, D. S., Manderscheid, R. W., Locke, B. Z., & Goodwin, F. K. (1993). The de facto US mental and addictive disorders service system. Archives of General Psychiatry, 50, 85–94. https://doi.org/10.1001/archpsyc.1993.01820140007001.CrossRefGoogle Scholar
- Rossom, R. C., Solberg, L. I., Magnan, S., Crain, A. L., Beck, A., Coleman, K. J., … Unützer, J. (2017). Impact of a national collaborative care initiative for patients with depression and diabetes or cardiovascular disease. General Hospital Psychiatry, 44, 77-85. https://doi.org/10.1016/j.genhosppsych.2016.05.006.
- Rush, A. J., Trivedi, M., Carmody, T. J., Biggs, M. M., Shores-Wilson, K., Ibrahim, H., et al. (2004). One-year clinical outcomes of depressed public sector outpatients: a benchmark for subsequent studies. Biological Psychiatry, 56(1), 46–53. https://doi.org/10.1016/j.biopsych.2004.04.005.CrossRefGoogle Scholar
- Saldana, L., Chamberlain, P., Bradford, W. D., Campbell, M., & Landsverk, J. (2013). The cost of implementing new strategies (COINS): a method for mapping implementation resources using the stages of implementation completion. Children and Youth Services Review, 39, 177–182. https://doi.org/10.1016/j.childyouth.2013.10.006.CrossRefGoogle Scholar
- Saldana, L., Schaper, H., Campbell, M., & Chapman, J. (2015). Standardized measurement of implementation: the Universal SIC. 7th Annual conference on the science of the dissemination and implementation in health. Implementation Science, 10(S1), A73. https://doi.org/10.1186/1748-5908-10-s1-a73.CrossRefGoogle Scholar
- Solberg, L. I. (2014). Impact of a learning health care network on depression care: the DIAMOND initiative. Paper presented at the the 22nd NIMH Conference on Mental Health Services Research, Bethesda.Google Scholar
- Solberg, L.I., Crain, A.L., Jaeckels, N., Ohnsorg, K.A., Margolis, K.L., Beck, A.,… Van de Ven, A.H. (2013). The DIAMOND initiative: implementing collaborative care for depression in 75 primary care clinics. Implementation Science, 8. https://doi.org/10.1186/1748-5908-8-135.
- Solberg, L.I., Crain, A.L., Maciosek, M.V., Unützer, J., Ohnsorg, K.A., Beck, A., … Glasgow, R.E. (2015). A stepped-wedge evaluation of an initiative to spread the collaborative care model for depression in primary care. The Annals of Family Medicine, 13(5), 412–420. https://doi.org/10.1370/afm.1842.
- Unützer, J., Katon, W., Callahan, C.M., Williams Jr, J.W., Hunkeler, E., Harpole, L., … Areán, P.A. (2002). Collaborative care management of late-life depression in the primary care setting. JAMA, 288(22), 2836–2845. https://doi.org/10.1001/jama.288.22.2836.
- Vannoy, S.D., Mauer, B., Kern, J., Girn, K., Ingoglia, C., Campbell, J., … Unützer, J. (2011). A learning collaborative of CMHCs and CHCs to support integration of behavioral health and general medical care. Psychiatric Services, 62, 753-758. https://doi.org/10.1176/ps.62.7.pss6207_0753.
- Wang, P. S., Lane, M., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2005). Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 629–640. https://doi.org/10.1001/archpsyc.62.6.629.CrossRefGoogle Scholar
- Whiteford, H.A., Degenhardt, L., Rehm, J., Baxter, A.J., Ferrari, A.J., Erskine, H.E., … Burstein, R. (2013). Global burden of disease attributable to mental and substance use disorders: findings from the global burden of disease study 2010. Lancet, 382(9904), 1575–1586. https://doi.org/10.1016/s0140-6736(13)61611-6.