Table 5.

Empirical support for within-site and between-site implementation themes

Site	Within-site theme	Support for within-site theme	Support for between-site theme
Alpha	Coordination processes between services rather than structural factors required for implementation	· Co-located structure present, but limited cross-service collaboration	· Space and preexisting consultation-liaison agreements are structural barriers
		· POD and PC/MHI viewed as separate mechanisms for mental health access	· Neither barrier resolved by collaboration; space resolved through PCMH innovation
		· Local tailoring of processes addressed structural space barrier
Bravo	Communication and collaboration facilitated PC/MHI implementation	· Inter-service collaboration resolved differences	· Mutual awareness of concerns between services
		· Open communication facilitates patient access and process improvement	· Similar barriers to Site Alpha, but in Site Bravo, barriers were resolved through negotiation
Yankee	Poor collaboration between primary care and mental health caused implementation problems	· Space conflict	· Space and ER coverage agreements are structural barriers
		· ER referral procedure conflict	· Lack of collaboration appears to lead to conflicts over structural differences
		· Different definitions of intervention success
Zulu	Prior failure implementing co-located care influenced decision to physically separate services	· MH leader report of prior failure	· Prior space limitation influenced implementation
		· No divergent perspectives of shared phenomena, possibly due to physical separation between PC and MH	· PC/MHI adapted to preexisting space barrier

Note: Between-site implementation theme: pre-existing structure influenced how PC/MHI was implemented; collaboration and cooperation among leaders and providers helped overcome these structural implementation barriers. POD = Psychiatrist on duty; PC/MHI = Primary Care/Mental Health Integration; ER = emergency room; PC = primary care; MH = mental health.