Table 3.

Themes that describe challenges with implementation of a collaborative care model

Theme	Quotation
Lack of onsite medical services	“The fact that we don’t have everything under one roof is one of our biggest problems.” [ADM]
Integration of care manager	“We’ve parachuted some roles into the clinic setting on top of people who already had other work to do. And it felt     burdensome, particularly for the social workers who wanted to start doing care management tasks on top of the     tasks that they’re already responsible for.” [PSY]
Provider and patient buy-in to   use of model	“Asking primary care providers to be engaged in treatment and addressing mental health issues… requires a certain     change in culture and outlook. And you have to have significant buy-in from the different members of the team.”     [SW]
	“Our referral process and getting the patients to the services and just the steps that we have to follow. It seems to be     ever changing.” [PCP]
	“There are some patients who say they agree to the care management, to the collaborative care model, and they     really don’t. They don’t want anybody calling their house… you can’t get in touch with them, for whatever     reason.” [CM]
Patient registry	“We looked into the online database type patient registry. Although it was good in and of itself, we were also at a     point where we were trying to implement our electronic medical record system so we felt that it was necessary for     us to put in our energies into establishing our own in-house system.” [ADM-2]
Screening tools	“… the PHQ-9. In one sense it’s appealing because it’s objective and it’s something that you can quickly look at as     snapshot for progress. On the other hand I’ve noticed and we’ve had a lot of comments from those in our     organization about it, feeling that it wasn’t accurate.” [PCP-2]
	“I find the PHQ9 is not the best screening tool because sometimes the patients are confused by it… (they) have a     hard time reading it and understanding what we’re really asking.” [PCP-3]

ADM= administrator; CM= care manager; PCP= primary care provider; SW= social worker