Table 1.

Standardized versus tailored protocol and focus

Contextual factor	Implementation strategies	Standardized focus	Tailored focus
Resources	Paper-based PHQ-9 with score entered in EHR for clinician review	Client completion of PHQ-9 on paper and score entered in EHR for review by the clinician	Client completion of PHQ-9 on paper and score entered in EHR for review by the clinician
Networks and linkages	Form implementation teams for each site consisting of the site administrator, a clinician identified as an opinion leader, a self-nominated MBC champion, an office professional staff member, and research staff using data from the initial needs assessment. Each team will meet triweekly over the course of the active implementation period	Team meetings focus on monitoring and promoting MBC fidelity per the guideline	Team meetings focus on identifying remaining barriers
Policies and incentives	Guideline for PHQ-9 administration frequency	Each session w/client	Determined by site
Norms and attitudes	Initial MBC training	Standardized training material	Tailored training material targeting identified barriers from the needs assessment
Structure and process	Progress note modifications	For clinician score review	For clinician score review
Media and change agents	Triweekly consultation with experts	Consultation focuses on MBC fidelity, particularly on incorporating clinician PHQ-9 score review into sessions, encouraging discussion of scores with clients, and providing tips on targeting lack of progress	Consultation focuses on targeting identified barriers in addition to MBC fidelity. However, emphasis will be placed on tailoring review, discussion, and targeting lack of progress to the site-specific PHQ-9 guidelines to address contextual and other barriers as they are identified throughout the course of implementation