title: Implementing the Collaborative Care Model as Part of a Countywide Initiative.
abstract: This column describes the planning and implementation of an integrated behavioral health project which was facilitated and endorsed by a developing accountable health community, the Washtenaw Health Initiative (WHI). The WHI is a voluntary countywide coalition of academic, community, health system, and county government agencies dedicated to improving access to high-quality health care for low-income, uninsured, and Medicaid populations. When lack of access to mental health services was identified as a pressing concern, the WHI endorsed pilot testing of collaborative care, an evidence-based treatment model, in county safety-net clinics. Challenges, outcomes, and relevance of this initiative to other counties or regional entities are discussed.
authors.affiliation: Dr. Valenstein, Dr. Dalack, Ms. Simoncic, Ms. Metzger, Dr. Deneke, Dr. Miller, Ms. Cuson, Ms. McLaughlin, and Dr. LePlatte-Ogini are with the Department of Psychiatry, Dr. Richardson and Dr. Rion are with the Department of Family Medicine, and Dr. Williams is with the Department of Internal Medicine, all at the University of Michigan, Ann Arbor (e-mail: marciav@umich.edu ). Dr. Valenstein is also with the Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor. Dr. Rion is also with the Packard Health Center, Ann Arbor. Dr. Hopper is with the Department of Internal Medicine, Saint Joseph Mercy Hospital, Ypsilanti, Michigan. Dr. Ryan and Ms. Spangler are with Integrated Health Associates, Ann Arbor. Dr. Baum, Ms. Rheingans, and Ms. Udow-Phillips are with the Center for Healthcare Research and Transformation, Ann Arbor. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column.
authors.forename: Marcia
authors.initials: M
authors.lastname: Valenstein
authors.affiliation: Dr. Valenstein, Dr. Dalack, Ms. Simoncic, Ms. Metzger, Dr. Deneke, Dr. Miller, Ms. Cuson, Ms. McLaughlin, and Dr. LePlatte-Ogini are with the Department of Psychiatry, Dr. Richardson and Dr. Rion are with the Department of Family Medicine, and Dr. Williams is with the Department of Internal Medicine, all at the University of Michigan, Ann Arbor (e-mail: marciav@umich.edu ). Dr. Valenstein is also with the Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor. Dr. Rion is also with the Packard Health Center, Ann Arbor. Dr. Hopper is with the Department of Internal Medicine, Saint Joseph Mercy Hospital, Ypsilanti, Michigan. Dr. Ryan and Ms. Spangler are with Integrated Health Associates, Ann Arbor. Dr. Baum, Ms. Rheingans, and Ms. Udow-Phillips are with the Center for Healthcare Research and Transformation, Ann Arbor. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column.
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Dalack
authors.affiliation: Dr. Valenstein, Dr. Dalack, Ms. Simoncic, Ms. Metzger, Dr. Deneke, Dr. Miller, Ms. Cuson, Ms. McLaughlin, and Dr. LePlatte-Ogini are with the Department of Psychiatry, Dr. Richardson and Dr. Rion are with the Department of Family Medicine, and Dr. Williams is with the Department of Internal Medicine, all at the University of Michigan, Ann Arbor (e-mail: marciav@umich.edu ). Dr. Valenstein is also with the Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor. Dr. Rion is also with the Packard Health Center, Ann Arbor. Dr. Hopper is with the Department of Internal Medicine, Saint Joseph Mercy Hospital, Ypsilanti, Michigan. Dr. Ryan and Ms. Spangler are with Integrated Health Associates, Ann Arbor. Dr. Baum, Ms. Rheingans, and Ms. Udow-Phillips are with the Center for Healthcare Research and Transformation, Ann Arbor. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column.
authors.forename: Teague
authors.initials: T
authors.lastname: Simoncic
authors.affiliation: Dr. Valenstein, Dr. Dalack, Ms. Simoncic, Ms. Metzger, Dr. Deneke, Dr. Miller, Ms. Cuson, Ms. McLaughlin, and Dr. LePlatte-Ogini are with the Department of Psychiatry, Dr. Richardson and Dr. Rion are with the Department of Family Medicine, and Dr. Williams is with the Department of Internal Medicine, all at the University of Michigan, Ann Arbor (e-mail: marciav@umich.edu ). Dr. Valenstein is also with the Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor. Dr. Rion is also with the Packard Health Center, Ann Arbor. Dr. Hopper is with the Department of Internal Medicine, Saint Joseph Mercy Hospital, Ypsilanti, Michigan. Dr. Ryan and Ms. Spangler are with Integrated Health Associates, Ann Arbor. Dr. Baum, Ms. Rheingans, and Ms. Udow-Phillips are with the Center for Healthcare Research and Transformation, Ann Arbor. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column.
authors.forename: Karla
authors.initials: K
authors.lastname: Metzger
authors.affiliation: Dr. Valenstein, Dr. Dalack, Ms. Simoncic, Ms. Metzger, Dr. Deneke, Dr. Miller, Ms. Cuson, Ms. McLaughlin, and Dr. LePlatte-Ogini are with the Department of Psychiatry, Dr. Richardson and Dr. Rion are with the Department of Family Medicine, and Dr. Williams is with the Department of Internal Medicine, all at the University of Michigan, Ann Arbor (e-mail: marciav@umich.edu ). Dr. Valenstein is also with the Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor. Dr. Rion is also with the Packard Health Center, Ann Arbor. Dr. Hopper is with the Department of Internal Medicine, Saint Joseph Mercy Hospital, Ypsilanti, Michigan. Dr. Ryan and Ms. Spangler are with Integrated Health Associates, Ann Arbor. Dr. Baum, Ms. Rheingans, and Ms. Udow-Phillips are with the Center for Healthcare Research and Transformation, Ann Arbor. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column.
authors.forename: D Edward
authors.initials: DE
authors.lastname: Deneke
authors.affiliation: Dr. Valenstein, Dr. Dalack, Ms. Simoncic, Ms. Metzger, Dr. Deneke, Dr. Miller, Ms. Cuson, Ms. McLaughlin, and Dr. LePlatte-Ogini are with the Department of Psychiatry, Dr. Richardson and Dr. Rion are with the Department of Family Medicine, and Dr. Williams is with the Department of Internal Medicine, all at the University of Michigan, Ann Arbor (e-mail: marciav@umich.edu ). Dr. Valenstein is also with the Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor. Dr. Rion is also with the Packard Health Center, Ann Arbor. Dr. Hopper is with the Department of Internal Medicine, Saint Joseph Mercy Hospital, Ypsilanti, Michigan. Dr. Ryan and Ms. Spangler are with Integrated Health Associates, Ann Arbor. Dr. Baum, Ms. Rheingans, and Ms. Udow-Phillips are with the Center for Healthcare Research and Transformation, Ann Arbor. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column.
authors.forename: Caroline R
authors.initials: CR
authors.lastname: Richardson
authors.affiliation: Dr. Valenstein, Dr. Dalack, Ms. Simoncic, Ms. Metzger, Dr. Deneke, Dr. Miller, Ms. Cuson, Ms. McLaughlin, and Dr. LePlatte-Ogini are with the Department of Psychiatry, Dr. Richardson and Dr. Rion are with the Department of Family Medicine, and Dr. Williams is with the Department of Internal Medicine, all at the University of Michigan, Ann Arbor (e-mail: marciav@umich.edu ). Dr. Valenstein is also with the Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor. Dr. Rion is also with the Packard Health Center, Ann Arbor. Dr. Hopper is with the Department of Internal Medicine, Saint Joseph Mercy Hospital, Ypsilanti, Michigan. Dr. Ryan and Ms. Spangler are with Integrated Health Associates, Ann Arbor. Dr. Baum, Ms. Rheingans, and Ms. Udow-Phillips are with the Center for Healthcare Research and Transformation, Ann Arbor. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column.
authors.forename: John A
authors.initials: JA
authors.lastname: Hopper
authors.affiliation: Dr. Valenstein, Dr. Dalack, Ms. Simoncic, Ms. Metzger, Dr. Deneke, Dr. Miller, Ms. Cuson, Ms. McLaughlin, and Dr. LePlatte-Ogini are with the Department of Psychiatry, Dr. Richardson and Dr. Rion are with the Department of Family Medicine, and Dr. Williams is with the Department of Internal Medicine, all at the University of Michigan, Ann Arbor (e-mail: marciav@umich.edu ). Dr. Valenstein is also with the Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor. Dr. Rion is also with the Packard Health Center, Ann Arbor. Dr. Hopper is with the Department of Internal Medicine, Saint Joseph Mercy Hospital, Ypsilanti, Michigan. Dr. Ryan and Ms. Spangler are with Integrated Health Associates, Ann Arbor. Dr. Baum, Ms. Rheingans, and Ms. Udow-Phillips are with the Center for Healthcare Research and Transformation, Ann Arbor. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column.
authors.forename: Ray
authors.initials: R
authors.lastname: Rion
authors.affiliation: Dr. Valenstein, Dr. Dalack, Ms. Simoncic, Ms. Metzger, Dr. Deneke, Dr. Miller, Ms. Cuson, Ms. McLaughlin, and Dr. LePlatte-Ogini are with the Department of Psychiatry, Dr. Richardson and Dr. Rion are with the Department of Family Medicine, and Dr. Williams is with the Department of Internal Medicine, all at the University of Michigan, Ann Arbor (e-mail: marciav@umich.edu ). Dr. Valenstein is also with the Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor. Dr. Rion is also with the Packard Health Center, Ann Arbor. Dr. Hopper is with the Department of Internal Medicine, Saint Joseph Mercy Hospital, Ypsilanti, Michigan. Dr. Ryan and Ms. Spangler are with Integrated Health Associates, Ann Arbor. Dr. Baum, Ms. Rheingans, and Ms. Udow-Phillips are with the Center for Healthcare Research and Transformation, Ann Arbor. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column.
authors.forename: Brent C
authors.initials: BC
authors.lastname: Williams
authors.affiliation: Dr. Valenstein, Dr. Dalack, Ms. Simoncic, Ms. Metzger, Dr. Deneke, Dr. Miller, Ms. Cuson, Ms. McLaughlin, and Dr. LePlatte-Ogini are with the Department of Psychiatry, Dr. Richardson and Dr. Rion are with the Department of Family Medicine, and Dr. Williams is with the Department of Internal Medicine, all at the University of Michigan, Ann Arbor (e-mail: marciav@umich.edu ). Dr. Valenstein is also with the Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor. Dr. Rion is also with the Packard Health Center, Ann Arbor. Dr. Hopper is with the Department of Internal Medicine, Saint Joseph Mercy Hospital, Ypsilanti, Michigan. Dr. Ryan and Ms. Spangler are with Integrated Health Associates, Ann Arbor. Dr. Baum, Ms. Rheingans, and Ms. Udow-Phillips are with the Center for Healthcare Research and Transformation, Ann Arbor. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column.
authors.forename: Adam
authors.initials: A
authors.lastname: Miller
authors.affiliation: Dr. Valenstein, Dr. Dalack, Ms. Simoncic, Ms. Metzger, Dr. Deneke, Dr. Miller, Ms. Cuson, Ms. McLaughlin, and Dr. LePlatte-Ogini are with the Department of Psychiatry, Dr. Richardson and Dr. Rion are with the Department of Family Medicine, and Dr. Williams is with the Department of Internal Medicine, all at the University of Michigan, Ann Arbor (e-mail: marciav@umich.edu ). Dr. Valenstein is also with the Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor. Dr. Rion is also with the Packard Health Center, Ann Arbor. Dr. Hopper is with the Department of Internal Medicine, Saint Joseph Mercy Hospital, Ypsilanti, Michigan. Dr. Ryan and Ms. Spangler are with Integrated Health Associates, Ann Arbor. Dr. Baum, Ms. Rheingans, and Ms. Udow-Phillips are with the Center for Healthcare Research and Transformation, Ann Arbor. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column.
authors.forename: Patricia
authors.initials: P
authors.lastname: Ryan
authors.affiliation: Dr. Valenstein, Dr. Dalack, Ms. Simoncic, Ms. Metzger, Dr. Deneke, Dr. Miller, Ms. Cuson, Ms. McLaughlin, and Dr. LePlatte-Ogini are with the Department of Psychiatry, Dr. Richardson and Dr. Rion are with the Department of Family Medicine, and Dr. Williams is with the Department of Internal Medicine, all at the University of Michigan, Ann Arbor (e-mail: marciav@umich.edu ). Dr. Valenstein is also with the Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor. Dr. Rion is also with the Packard Health Center, Ann Arbor. Dr. Hopper is with the Department of Internal Medicine, Saint Joseph Mercy Hospital, Ypsilanti, Michigan. Dr. Ryan and Ms. Spangler are with Integrated Health Associates, Ann Arbor. Dr. Baum, Ms. Rheingans, and Ms. Udow-Phillips are with the Center for Healthcare Research and Transformation, Ann Arbor. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column.
authors.forename: Sara
authors.initials: S
authors.lastname: Cuson
authors.affiliation: Dr. Valenstein, Dr. Dalack, Ms. Simoncic, Ms. Metzger, Dr. Deneke, Dr. Miller, Ms. Cuson, Ms. McLaughlin, and Dr. LePlatte-Ogini are with the Department of Psychiatry, Dr. Richardson and Dr. Rion are with the Department of Family Medicine, and Dr. Williams is with the Department of Internal Medicine, all at the University of Michigan, Ann Arbor (e-mail: marciav@umich.edu ). Dr. Valenstein is also with the Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor. Dr. Rion is also with the Packard Health Center, Ann Arbor. Dr. Hopper is with the Department of Internal Medicine, Saint Joseph Mercy Hospital, Ypsilanti, Michigan. Dr. Ryan and Ms. Spangler are with Integrated Health Associates, Ann Arbor. Dr. Baum, Ms. Rheingans, and Ms. Udow-Phillips are with the Center for Healthcare Research and Transformation, Ann Arbor. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column.
authors.forename: Melissa
authors.initials: M
authors.lastname: McLaughlin
authors.affiliation: Dr. Valenstein, Dr. Dalack, Ms. Simoncic, Ms. Metzger, Dr. Deneke, Dr. Miller, Ms. Cuson, Ms. McLaughlin, and Dr. LePlatte-Ogini are with the Department of Psychiatry, Dr. Richardson and Dr. Rion are with the Department of Family Medicine, and Dr. Williams is with the Department of Internal Medicine, all at the University of Michigan, Ann Arbor (e-mail: marciav@umich.edu ). Dr. Valenstein is also with the Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor. Dr. Rion is also with the Packard Health Center, Ann Arbor. Dr. Hopper is with the Department of Internal Medicine, Saint Joseph Mercy Hospital, Ypsilanti, Michigan. Dr. Ryan and Ms. Spangler are with Integrated Health Associates, Ann Arbor. Dr. Baum, Ms. Rheingans, and Ms. Udow-Phillips are with the Center for Healthcare Research and Transformation, Ann Arbor. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column.
authors.forename: Kristyn
authors.initials: K
authors.lastname: Spangler
authors.affiliation: Dr. Valenstein, Dr. Dalack, Ms. Simoncic, Ms. Metzger, Dr. Deneke, Dr. Miller, Ms. Cuson, Ms. McLaughlin, and Dr. LePlatte-Ogini are with the Department of Psychiatry, Dr. Richardson and Dr. Rion are with the Department of Family Medicine, and Dr. Williams is with the Department of Internal Medicine, all at the University of Michigan, Ann Arbor (e-mail: marciav@umich.edu ). Dr. Valenstein is also with the Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor. Dr. Rion is also with the Packard Health Center, Ann Arbor. Dr. Hopper is with the Department of Internal Medicine, Saint Joseph Mercy Hospital, Ypsilanti, Michigan. Dr. Ryan and Ms. Spangler are with Integrated Health Associates, Ann Arbor. Dr. Baum, Ms. Rheingans, and Ms. Udow-Phillips are with the Center for Healthcare Research and Transformation, Ann Arbor. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column.
authors.forename: Dayna
authors.initials: D
authors.lastname: LePlatte-Ogini
authors.affiliation: Dr. Valenstein, Dr. Dalack, Ms. Simoncic, Ms. Metzger, Dr. Deneke, Dr. Miller, Ms. Cuson, Ms. McLaughlin, and Dr. LePlatte-Ogini are with the Department of Psychiatry, Dr. Richardson and Dr. Rion are with the Department of Family Medicine, and Dr. Williams is with the Department of Internal Medicine, all at the University of Michigan, Ann Arbor (e-mail: marciav@umich.edu ). Dr. Valenstein is also with the Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor. Dr. Rion is also with the Packard Health Center, Ann Arbor. Dr. Hopper is with the Department of Internal Medicine, Saint Joseph Mercy Hospital, Ypsilanti, Michigan. Dr. Ryan and Ms. Spangler are with Integrated Health Associates, Ann Arbor. Dr. Baum, Ms. Rheingans, and Ms. Udow-Phillips are with the Center for Healthcare Research and Transformation, Ann Arbor. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column.
authors.forename: Nancy
authors.initials: N
authors.lastname: Baum
authors.affiliation: Dr. Valenstein, Dr. Dalack, Ms. Simoncic, Ms. Metzger, Dr. Deneke, Dr. Miller, Ms. Cuson, Ms. McLaughlin, and Dr. LePlatte-Ogini are with the Department of Psychiatry, Dr. Richardson and Dr. Rion are with the Department of Family Medicine, and Dr. Williams is with the Department of Internal Medicine, all at the University of Michigan, Ann Arbor (e-mail: marciav@umich.edu ). Dr. Valenstein is also with the Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor. Dr. Rion is also with the Packard Health Center, Ann Arbor. Dr. Hopper is with the Department of Internal Medicine, Saint Joseph Mercy Hospital, Ypsilanti, Michigan. Dr. Ryan and Ms. Spangler are with Integrated Health Associates, Ann Arbor. Dr. Baum, Ms. Rheingans, and Ms. Udow-Phillips are with the Center for Healthcare Research and Transformation, Ann Arbor. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column.
authors.forename: Carrie
authors.initials: C
authors.lastname: Rheingans
authors.affiliation: Dr. Valenstein, Dr. Dalack, Ms. Simoncic, Ms. Metzger, Dr. Deneke, Dr. Miller, Ms. Cuson, Ms. McLaughlin, and Dr. LePlatte-Ogini are with the Department of Psychiatry, Dr. Richardson and Dr. Rion are with the Department of Family Medicine, and Dr. Williams is with the Department of Internal Medicine, all at the University of Michigan, Ann Arbor (e-mail: marciav@umich.edu ). Dr. Valenstein is also with the Center for Clinical Management Research, Department of Veterans Affairs, Ann Arbor. Dr. Rion is also with the Packard Health Center, Ann Arbor. Dr. Hopper is with the Department of Internal Medicine, Saint Joseph Mercy Hospital, Ypsilanti, Michigan. Dr. Ryan and Ms. Spangler are with Integrated Health Associates, Ann Arbor. Dr. Baum, Ms. Rheingans, and Ms. Udow-Phillips are with the Center for Healthcare Research and Transformation, Ann Arbor. Lisa B. Dixon, M.D., M.P.H., and Brian Hepburn, M.D., are editors of this column.
authors.forename: Marianne
authors.initials: M
authors.lastname: Udow-Phillips
mesh_terms: D014487:Centers for Medicare and Medicaid Services, U.S.; D003156:Community Mental Health Services / Q000191:economics*; D019033:Delivery of Health Care, Integrated / Q000191:economics* / Q000379:methods; D006801:Humans; D008329:Managed Care Programs / Q000458:organization & administration*; D017057:Medically Uninsured; D001523:Mental Disorders / Q000628:therapy*; D017146:Models, Organizational; D058991:Patient Protection and Affordable Care Act; D011203:Poverty; D014481:United States