Table 4.

Implementation Strategies.

Implementation Strategy		Key Implementation Themes Identified by Stakeholders	Stakeholder Group Endorsing Strategy	Intervention Characteristic Addressed by Strategy
Financial	•	Adjust or develop billing codes to match services included in PCARE	Administrators,  mental health  providers, primary  care providers, and  consumer advocates	Cost, complexity
	•	Split intervention tasks among existing staff to maximize human resources
	•	Use start-up funds to support initial implementation
Restructuring	•	Reduce staff burden by hiring new staff or splitting intervention tasks among existing staff	Administrators, mental  health providers,  and primary care  providers	Compatibility to  organization,  complexity
	•	Tackle staff resistance to change via clarification of responsibilities and involving staff in the implementation process with leadership support
Education	•	Make training materials and curriculums available and accessible	Administrators and  mental health  providers	Complexity,  trialability
	•	Use interactive and experiential clinical training formats to learn PCARE
	•	Include training to develop skills in team-based care
Planning	•	Develop planning process that involves stakeholders at multiple levels to build buy-in, improve trust, and address resistant to change	Administrators and  mental health  providers	Compatibility to  organization
	•	Involve top leadership and management to facilitate changes in organizational policies and procedures
	•	Involve organizations bringing the new program into the planning process to develop trust and tailor implementation approach to the realities of the organization
Quality  management	•	Use of continuous measurement systems to manage program and monitor process and outcome measures.	Administrators,  mental health  providers, primary  care providers, and  consumer advocates	Relative  advantage
	•	Generate local evidence of PCARE’s impact across multiple outcomes to support program implementation
Attending to  the policy  context	•	Anticipate unintended consequences of implementing PCARE	Administrators and  mental health  providers	Compatibility to  organization,  cost
	•	Think strategically and act proactively to position organization in the changing policy context
Cultural  adaptations	•	Attention to the sociocultural and economic characteristics of the patient population being served is critical for making PCARE compatible with patients’ needs, preferences, and culture	Mental health  providers, primary  care providers, and  consumer advocates	Compatibility to  Hispanics
	•	PCARE needs to convey recovery-oriented and patient-centered values and principles
	•	PCARE needs to be delivered in the patients’ preferred language and pay attention to langue in patient navigation