What Is Collaborative Care? Reexamining the Principles of Collaborative Care Through Scaling to Complex Populations and Settings

The Collaborative Care Model (CoCM) is a principle-based, behavioral health integration model used in primary care to improve access and quality of behavioral health treatment. CoCM was originally developed and tested for the treatment of depression. This JGIM Perspective argues that when principle-based models are scaled to complex populations and settings beyond those for which they were originally developed, the boundaries of the principles are strained. In scaling CoCM for the treatment of opioid use disorder (OUD) co-occurring with PTSD and/or depression in a randomized trial, we found challenges with enacting the principles of CoCM for a complex population in low-resourced settings. Key considerations included understanding the scope of the care manager role while adapting practices for low-resourced settings (e.g., using community health workers (CHWs) in the role; delivery of psychotherapy by CHWs), understanding if and how to address patient social needs in CoCM care plans, overcoming lack of validated measures for OUD symptoms, and understanding the appropriate timeframe and supports needed to provide population-based care to complex patients with co-occurring disorders. Practitioners, researchers, and policymakers should collaborate to refine understanding of the CoCM principles to strengthen the foundation of CoCM and its application to various populations and settings.