Co-location is Not Enough

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Collaborative care (and related measurement-based integrated care) is not simply co-locating a mental health professional into your clinic, nor is it simply adding new members to your team. What sets it apart from co-location and other integrated care efforts is a care team that draws upon shared knowledge, principles, and care plans as it works toward patient goals. The team provides proven treatments and takes a population-based approach, making sure no one who needs help is falling through the cracks.

Perhaps the most important difference between collaborative care and co-located care is that true collaborative care has been shown across dozens of research studies to be significantly more effective in treating conditions like depression and anxiety. The same cannot be said for co-located care, in which primary care and behavioral health clinicians provide services in the same location but practice independently using a traditional referral model.

The figure below shows the eight health care organizations that participated in the IMPACT study, a national study of collaborative care for depression and one of the largest depression treatment studies ever conducted in the United States. The organization circled had Masters-level co-located behavioral health clinicians in each participating primary care office. These providers practiced within the primary care clinic using a referral model in which the primary care providers referred patients to them and they provided care to these patients independently using a traditional approach (50 minute psychotherapy sessions). These clinicians did not collaborate closely with the primary care providers using a team approach and did not use the principles of measurement-based, stepped care treatment.

Patients participating in the IMPACT study at this clinic who were randomly assigned to the usual care group could be referred by their primary care provider to these co-located therapists for treatment, and many were. The graph shows that patients in this clinic who were randomly assigned to receive IMPACT care were almost twice as likely to have significant improvement in their depression as compared to patients receiving usual care (including referral to the co-located therapists).