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Collaborative Care is a model of care where trained mental health specialists, such as psychiatrists and psychologists, work closely together with care managers and family physicians to support patients with mental illness. The ultimate goal of this model is to deliver the best evidence-based mental health care to a defined population.

Research has suggested that implementing Collaborative Care increases access to mental health care, provides better clinical outcomes and improves cost effectiveness of care. Collaborative Care can effectively reduce the population burden of mental illness.

It is for these reasons that Collaborative Care is a key component of provincial mental health and addiction strategies, and Canada’s vision for primary care.

What are some of the issues with how Collaborative Care is used today?

Ideally, collaborative care is practised by a trained and experienced team including psychiatrists, psychologists, family physicians, and social workers or case managers. This team develops a population registry, and works closely together to engage the patient population and advance their care according to current practice guidelines and patient-identified needs and goals. The team conducts regular evaluations of and improvements to the care at the individual patient and program levels.

However, Collaborative Care models implemented in Canadian primary care settings are variable and do not necessarily align with research evidence. Organizational, financial, knowledge-based and attitudinal barriers hinder the implementation of Collaborative Care. These models typically do not employ population registries or care management. Rarely are these models evaluated. This has led to a knowledge-to-practice gap regarding the comparative effectiveness of the different Collaborative Care practices that teams and organizations may use to achieve desired outcomes.

Poor implementation of Collaborative Care can contribute to poor integration of physical and mental health care, variations in clinical care, non-guideline-based pharmacotherapy, delayed follow up after treatments, treatment drop-outs and less improvement in client symptoms.

By developing a shared model of Collaborative Care that uses a consistent approach and closes current gaps in implementation, we will be closer to meeting the needs of people living with mental health challenges.

How can a Collaborative Care Quality Framework help to address these issues?

The Quality Improvement for Collaborative Care (Qi4CC) research team has developed a Quality Framework, which outlines measures and a comprehensive evaluation strategy for Collaborative Care in primary care settings across Canada.

The Qi4CC project was funded by the Ministry of Health and Long Term Care (MoHLTC) through the Alternate Funding Program Innovation Fund.

The objectives of this Quality Framework are to provide teams and organizations with a framework for:

1. Implementing evidence-informed models of Collaborative Care; and
2. Guiding the evaluation of such models by suggesting different loci for measurement and improvement to close the evidence-to-practice gap.

This framework will give you an understanding of what makes up evidence-informed Collaborative Care . It will also suggest different loci for measurement and improvement.

What’s in the Collaborative Care Quality Framework:

Our Quality Framework is comprised of 14 broad domains (illustrated below).

The domains represent major quality constructs describing the aims and objectives of Collaborative Care, the key care processes required to achieve those aims, and the necessary infrastructure and supports for successful implementation. The specific dimensions capture organizational-, team- and individual-level phenomena that are evidence-informed, and that could be measured to understand how Collaborative Care is functioning.

Find out how the Quality Framework was developed here.

How can you use the Collaborative Care Quality Framework?

Our Quality Framework can be used in program evaluation and identifying priority areas for improvement in your local setting through the following suggested steps:

1. Select a Domain(s) and specific Dimension(s) outlined in the Quality Framework. For example, you may select 1 to 3 Dimensions across 1 to 3 Domains depending on your quality improvement plan and timeline.
2. Consider how these dimensions could be transformed into quality measures that are relevant and applicable to your identified target population and/or organizational processes. For example, what aspects of your Collaborative Care service are you trying to improve? Is it structural? Procedural? Outcome-oriented? Where possible, use existing validated measures and scales.
3. Implement the measure through a process of data and information gathering, for example, using electronic databases and records, and from different stakeholder perspectives (e.g. clients, staff, collaborators, etc.).
4. Apply the results from your quality measurement exercise by conducting targeted quality improvement initiatives until sustained improvement is achieved.

This Quality Framework is designed to be broad enough to be relevant to a diverse population of people experiencing mental health challenges and addictions across Canada . The Domains and Dimensions listed are also meant to be applicable to a variety of primary care settings, including Family Health Teams, Community Health Centers, nurse practitioner-led clinics, and other settings that offer Collaborative Care services. We invite groups interested in measurement and evaluation to approach the Quality Framework with specific goals in order to ensure its effective application to a target population, and with specific, measurable and realistic outcomes in mind.

Collaborative mental health care in action

The Quality Improvement for Collaborative Care (QI4CC) research team has developed a Mental Health Toolkit. The toolkit was developed through the meaningful involvement of service users to explore and make recommendations about how collaborative care could be improved in Ontario.

Click here to read: Introducing the Mental Health Toolkit: Improving collaborative mental health care in primary settings