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
The objectives of this Quality Framework are to provide
teams and organizations with a framework for:
- Implementing evidence-informed
models of Collaborative Care; and
- 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
and identifying priority areas for improvement in
your local setting through the following suggested steps:
- 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.
- 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.
- 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.).
- 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
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