Table 3.

Convergence and divergence in referral procedures for Site Bravo

Redundant concept	Convergence or divergence	Supporting data
PC/MHI has improved access	Convergence	MHL: Co-location and the size of the clinic promote positive interactions, as providers see each other at lunch and at meetings.
	Convergence	MHL: PC/MHI goal is immediate access; PCMH is always available.
	Convergence	PCMH: Conducting a pilot study to provide access to walk-in patients.
	Divergence	PCMH: Getting buy-in from PC is biggest challenge; informal discussions in the lunch room and “selling ourselves” increased curbside consults.
	Divergence	PCP: Psychiatrists resisted helping PC manage behavioral aspects of chronic diseases, but negotiations have resulted in progress.
Referrals include standard referrals and curbside consults	Divergence	PCMH: Nurse routine screening often initiates referrals and some nurses refer patients inappropriately; working with nurse manager to educate staff.
	Convergence	PCP: Norms indicate that knocking on doors is appropriate, even if it interrupts ongoing psychological care.

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.