title: Stakeholder Experiences in a Stepped Collaborative Care Study Within U.S. Army Clinics.
abstract: This article examines stakeholder experiences with integrating treatment for posttraumatic stress disorder (PTSD) and depression within primary care clinics in the U.S. Army, the use-of-care facilitation to improve treatment, and the specific therapeutic tools used within the Stepped Treatment Enhanced PTSD Services Using Primary Care study.
  
  
  
  We conducted a series of qualitative interviews with health care providers, care facilitators, and patients within the context of a large randomized controlled trial being conducted across 18 Army primary care clinics at 6 military installations.
  
  
  
  Most of stakeholders' concerns clustered around the need to improve collaborative care tools and care facilitators and providers' comfort and abilities to treat behavioral health issues in the primary care setting.
  
  
  
  Although stakeholders generally recognize the value of collaborative care in overcoming barriers to care, their perspectives about the utility of different tools varied. The extent to which collaborative care mechanisms are well understood, navigated, and implemented by providers, care facilitators, and patients is critical to the success of the model. Improving the design of the web-based therapy tools, increasing the frequency of team meetings and case presentations, and expanding training for primary care providers on screening and treatment for PTSD and depression and the collaborative care model's structure, processes, and offerings may improve stakeholder perceptions and usage of collaborative care.
authors.affiliation: RAND Corporation, Arlington, VA.
authors.forename: Caroline
authors.initials: C
authors.lastname: Batka
authors.affiliation: RAND Corporation, Arlington, VA. Electronic address: territ@rand.org.
authors.forename: Terri
authors.initials: T
authors.lastname: Tanielian
authors.affiliation: RAND Corporation, Santa Monica, CA.
authors.forename: Mahlet A
authors.initials: MA
authors.lastname: Woldetsadik
authors.affiliation: RAND Corporation, Pittsburgh, PA.
authors.forename: Carrie
authors.initials: C
authors.lastname: Farmer
authors.affiliation: RAND Corporation, Arlington, VA.
authors.forename: Lisa H
authors.initials: LH
authors.lastname: Jaycox
mesh_terms: D003299:Cooperative Behavior; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008889:Military Personnel / Q000523:psychology*; D010348:Patient Care Team; D011320:Primary Health Care / Q000379:methods*; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology / Q000628:therapy*; D014481:United States
keywords: collaborative care; depression; mental health; posttraumatic stress; primary care