Table 2.

Convergence and divergence in referral procedures for Site Alpha

Redundant concept	Convergence or divergence	Supporting data
Psychologists are co-located in primary care	Convergence	MHL: Multiple revisions to service agreements were needed to tailor the implementation to primary care needs.
	Divergence	PCP: PC/MHI could be expanded to help manage difficult medical patients.
Traditional consultation-liaison service	Convergence	MHL: PC/MHI supplements the consultation-liaison (POD) services.
	Convergence	PCMH: POD services are separate from the implementation.
	Divergence	PCMH: POD restricts access to specialty mental health.
	Divergence	PCP: POD availability has improved since the implementation, but POD sometimes refers patients back to PC without treatment.
Implementation limited by a lack of space	Convergence	PCMH: Reported a growth in referrals since implementation and implemented innovative new procedures to make use of limited co-located staffing.
	Convergence	PCP: Acknowledged improved access, but doubted long-term impact due to lack of space.

Note: Supporting data are presented as either convergent or divergent with the redundant concept. MHL refers to the mental health leader at the site; PCMH refers to the Primary Care/Mental Health Integration (PC/MHI) informants at the site; PCP refers to the primary care physician informants at the site. POD = psychiatrist on duty.