Integrating behavioral health care into a low-barrier HIV clinic using the Collaborative Care Model: a mixed methods evaluation of patient care cascade outcomes and determinants
Abstract Background Low-barrier HIV care is an evidence-based intervention to improve HIV outcomes among those who have complex barriers to care, but the walk-in model poses challenges to integrating behavioral health services. We evaluated the acceptability and feasibility of a Collaborative Care M...
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BMC
2025-05-01
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| Series: | Implementation Science Communications |
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| Online Access: | https://doi.org/10.1186/s43058-025-00738-5 |
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| author | Scott Halliday Lydia A. Chwastiak Kaitlin Zinsli Ramona Emerson Teagan Wood Meena S. Ramchandani Kenneth Sherr Judith I. Tsui Bradley H. Wagenaar Deepa Rao Julia C. Dombrowski |
| author_facet | Scott Halliday Lydia A. Chwastiak Kaitlin Zinsli Ramona Emerson Teagan Wood Meena S. Ramchandani Kenneth Sherr Judith I. Tsui Bradley H. Wagenaar Deepa Rao Julia C. Dombrowski |
| author_sort | Scott Halliday |
| collection | DOAJ |
| description | Abstract Background Low-barrier HIV care is an evidence-based intervention to improve HIV outcomes among those who have complex barriers to care, but the walk-in model poses challenges to integrating behavioral health services. We evaluated the acceptability and feasibility of a Collaborative Care Model (CoCM) for treatment of depression and opioid use disorder in a low-barrier clinic. Methods In a sequential explanatory mixed methods pilot study, we accessed data from patient records to generate a care cascade for the number of patients enrolled in the first six months of the program and conducted individual interviews with patients and staff to interpret the care cascade findings. Results Among 175 patients who visited the clinic, 36% were screened for, 24% were referred to, 15% completed an intake for, and 9% engaged in CoCM. The interviews revealed that screening was limited by a lack of clarity among staff about services offered in CoCM, staff forgetting the screening process, and limited time during patent visits. Referrals were limited by low buy-in among staff and patient complexity. Intakes were limited by time and space constraints in the care setting and competing acute patient needs. The care manager’s ability to embody the clinic’s culture facilitated engagement among patients who completed intakes. Conclusions Staff perceived CoCM to be acceptable and feasible to implement, but only in the context of multiple barriers to implementation and challenges to systematic screening and measurement-based care. Trial registration Not applicable. |
| format | Article |
| id | doaj-art-eee0499cff9642e8a3ee8631bfbdc7e2 |
| institution | OA Journals |
| issn | 2662-2211 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Implementation Science Communications |
| spelling | doaj-art-eee0499cff9642e8a3ee8631bfbdc7e22025-08-20T02:15:16ZengBMCImplementation Science Communications2662-22112025-05-016111010.1186/s43058-025-00738-5Integrating behavioral health care into a low-barrier HIV clinic using the Collaborative Care Model: a mixed methods evaluation of patient care cascade outcomes and determinantsScott Halliday0Lydia A. Chwastiak1Kaitlin Zinsli2Ramona Emerson3Teagan Wood4Meena S. Ramchandani5Kenneth Sherr6Judith I. Tsui7Bradley H. Wagenaar8Deepa Rao9Julia C. Dombrowski10Department of Global Health, University of WashingtonDepartment of Global Health, University of WashingtonDepartment of Epidemiology, University of WashingtonDepartment of Medicine, University of WashingtonDepartment of Medicine, University of WashingtonDepartment of Medicine, University of WashingtonDepartment of Global Health, University of WashingtonDepartment of Medicine, University of WashingtonDepartment of Global Health, University of WashingtonDepartment of Global Health, University of WashingtonDepartment of Epidemiology, University of WashingtonAbstract Background Low-barrier HIV care is an evidence-based intervention to improve HIV outcomes among those who have complex barriers to care, but the walk-in model poses challenges to integrating behavioral health services. We evaluated the acceptability and feasibility of a Collaborative Care Model (CoCM) for treatment of depression and opioid use disorder in a low-barrier clinic. Methods In a sequential explanatory mixed methods pilot study, we accessed data from patient records to generate a care cascade for the number of patients enrolled in the first six months of the program and conducted individual interviews with patients and staff to interpret the care cascade findings. Results Among 175 patients who visited the clinic, 36% were screened for, 24% were referred to, 15% completed an intake for, and 9% engaged in CoCM. The interviews revealed that screening was limited by a lack of clarity among staff about services offered in CoCM, staff forgetting the screening process, and limited time during patent visits. Referrals were limited by low buy-in among staff and patient complexity. Intakes were limited by time and space constraints in the care setting and competing acute patient needs. The care manager’s ability to embody the clinic’s culture facilitated engagement among patients who completed intakes. Conclusions Staff perceived CoCM to be acceptable and feasible to implement, but only in the context of multiple barriers to implementation and challenges to systematic screening and measurement-based care. Trial registration Not applicable.https://doi.org/10.1186/s43058-025-00738-5Collaborative care modelImplementation scienceHIVDepressionOpioid-use disorderDelivery of health care |
| spellingShingle | Scott Halliday Lydia A. Chwastiak Kaitlin Zinsli Ramona Emerson Teagan Wood Meena S. Ramchandani Kenneth Sherr Judith I. Tsui Bradley H. Wagenaar Deepa Rao Julia C. Dombrowski Integrating behavioral health care into a low-barrier HIV clinic using the Collaborative Care Model: a mixed methods evaluation of patient care cascade outcomes and determinants Implementation Science Communications Collaborative care model Implementation science HIV Depression Opioid-use disorder Delivery of health care |
| title | Integrating behavioral health care into a low-barrier HIV clinic using the Collaborative Care Model: a mixed methods evaluation of patient care cascade outcomes and determinants |
| title_full | Integrating behavioral health care into a low-barrier HIV clinic using the Collaborative Care Model: a mixed methods evaluation of patient care cascade outcomes and determinants |
| title_fullStr | Integrating behavioral health care into a low-barrier HIV clinic using the Collaborative Care Model: a mixed methods evaluation of patient care cascade outcomes and determinants |
| title_full_unstemmed | Integrating behavioral health care into a low-barrier HIV clinic using the Collaborative Care Model: a mixed methods evaluation of patient care cascade outcomes and determinants |
| title_short | Integrating behavioral health care into a low-barrier HIV clinic using the Collaborative Care Model: a mixed methods evaluation of patient care cascade outcomes and determinants |
| title_sort | integrating behavioral health care into a low barrier hiv clinic using the collaborative care model a mixed methods evaluation of patient care cascade outcomes and determinants |
| topic | Collaborative care model Implementation science HIV Depression Opioid-use disorder Delivery of health care |
| url | https://doi.org/10.1186/s43058-025-00738-5 |
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