Collaborative Care is delivered by a team consisting of a primary care provider, care manager (nurse, clinical social worker, or psychologist), and psychiatric consultant.
The team cares for a defined group of patients and closely tracks each patient’s progress using validated clinical rating scales (e.g. PHQ-9 for depression). Treatment is systematically adjusted if patients are not improving as expected. Patients who don’t respond to treatment are referred to more intensive mental health specialist care.
Psychiatric consultations are largely conducted via phone with the care manager (and sometimes the primary care provider) with direct patient consultations focused on those patients who are presenting diagnostic or therapeutic challenges to the team. These consultations can be performed face-to-face or using televideo equipment. This systematic stepped care approach can help overcome the clinical inertia that is often responsible for patients continuing on ineffective treatment.