Scaling Implementation of Collaborative Care for Depression: Adaptation of the Stages of Implementation Completion (SIC)


Tools to monitor implementation progress could facilitate scale-up of effective treatments. Most treatment for depression, a common and disabling condition, is provided in primary care settings. Collaborative Care Management (CoCM) is an evidence-based model for treating common mental health conditions, including depression, in this setting; yet, it is not widely implemented. The Stages of Implementation Completion (SIC) was adapted for CoCM and piloted in eight rural primary care clinics serving adults challenged by low-income status. The CoCM-SIC accurately assessed implementation effectiveness and detected site variations in performance, suggesting key implementation activities to aid future scale-ups of CoCM for diverse populations.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 99

This is the net price. Taxes to be calculated in checkout.

Fig. 1


  1. Areán, P.A., Ayalon, L., Hunkeler, E., Lin, E.H., Tang, L., Harpole, L., … Unützer, J. (2005). Improving depression care for older, minority patients in primary care. Medical Care, 43(4), 381–90.

  2. Areán, P. A., Gum, A. M., Tang, L., & Unützer, J. (2007). Service use and outcomes among elderly persons with low incomes being treated for depression. Psychiatric Services,58(8), 1057–1064.

  3. Bao, Y., Druss, B. G., Jung, H. Y., Chan, Y. F., & Unützer, J. (2016). Unpacking collaborative care for depression: examining two essential tasks for implementation. Psychiatric Services,67(4), 418–424.

  4. Bauer, A. M., Azzone, V., & Goldman, H. H. (2011). Implementation of collaborative depression management at community-based primary care clinics: an evaluation. Psychiatric Services,62, 1047–1053.

  5. Bauer, A. M., Chan, Y. F., Huang, H., Vannoy, S., & Unützer, J. (2013). Characteristics, management, and depression outcomes of primary care patients who endorse thoughts of death or suicide on the PHQ-9. Journal of General Internal Medicine,28, 363–369.

  6. Blasinsky, M., Goldman, H. H., & Unützer, J. (2006). Project IMPACT: a report on barriers and facilitators to sustainability. Administration and Policy in Mental Health and Mental Health Services Research,33, 718–729.

  7. Brown, C. H., Chamberlain, P., Saldana, L., Padgett, C., Wang, W., & Cruden, G. (2014). Evaluation of two implementation strategies in 51 child county public service systems in two states: results of a cluster randomized head-to-head implementation trial. Implementation Science,9, 134.

  8. Chamberlain, P., Saldana, L., Brown, C. H., & Leve, L. (2010). Implementation of multidimensional treatment foster care in California: a randomized control trial of an evidence-based practice. In M. Roberts-DeGennaro & S. Fogel (Eds.), Using evidence to inform practice for community and organizational change (pp. 218–234). Chicago: Lyceum Books.

  9. Coventry, P.A., Hudson, J.L., Kontopantelis, E., Archer, J., Richards, D.A., Gilbody, S., … Bower, P. (2014). Characteristics of effective collaborative care for treatment of depression: a systematic review and meta-regression of 74 randomised controlled trials. PLoS ONE 9, e108114.

  10. Cunningham, P. J. (2009). Beyond parity: primary care physicians’ perspectives on access to mental health care. Health Affairs,28(3), w490–w501.

  11. Gilbody, S., Bower, P., Fletcher, J., Richards, D., & Sutton, A. J. (2006a). Collaborative care for depression: a cumulative meta-analysis and review of longer-term outcomes. Archives of Internal Medicine,166, 2314–2321.

  12. Gilbody, S., Bower, P., & Whitty, P. (2006b). Costs and consequences of enhanced primary care for depression: systematic review of randomised economic evaluations. British Journal of Psychiatry,189, 297–308.

  13. Grumbach, K., Bainbridge, E., & Bodenheimer, T. (2012). Facilitating improvement in primary care: the promise of practice coaching. Washington: The Commonwealth Fund.

  14. Hansen, N. B., Lambert, M. J., & Forman, E. M. (2002). The psychotherapy dose-response effect and its implications for treatment delivery services. Clinical Psychology: Science and Practice,9(3), 329–343.

  15. Huang, H., Chan, Y.F., Katon, W., Tabb, K., Sieu, N., Bauer, A.M., … Unützer, J. (2012). Variations in depression care and outcomes among high-risk mothers from different racial/ethnic groups. Family Practice, 29(4), 394–400.

  16. Katon, W., Unützer, J., Wells, K., & Jones, L. (2010). Collaborative depression care: history, evolution and ways to enhance dissemination and sustainability. General Hospital Psychiatry,32, 456–464.

  17. Levine, S., Unützer, J., Yip, J.Y., Hoffing, M., Leung, M., Fan, M.Y., … Langston, C.A. (2005). Physicians’ satisfaction with a collaborative disease management program for late-life depression in primary care. General Hospital Psychiatry, 27(6), 383–391.

  18. Olfson, M., Marcus, S. C., Druss, B., Elinson, L., Tanielian, T., & Pincus, H. A. (2002). National trends in the outpatient treatment of depression. JAMA,287(2), 203–209.

  19. Regier, D. A., Narrow, W. E., Rae, D. S., Manderscheid, R. W., Locke, B. Z., & Goodwin, F. K. (1993). The de facto US mental and addictive disorders service system. Archives of General Psychiatry,50, 85–94.

  20. Rossom, R. C., Solberg, L. I., Magnan, S., Crain, A. L., Beck, A., Coleman, K. J., … Unützer, J. (2017). Impact of a national collaborative care initiative for patients with depression and diabetes or cardiovascular disease. General Hospital Psychiatry, 44, 77-85.

  21. Rush, A. J., Trivedi, M., Carmody, T. J., Biggs, M. M., Shores-Wilson, K., Ibrahim, H., et al. (2004). One-year clinical outcomes of depressed public sector outpatients: a benchmark for subsequent studies. Biological Psychiatry,56(1), 46–53.

  22. Saldana, L. (2014). The stages of implementation completion for evidence-based practice: protocol for a mixed methods study. Implementation Science,9, 43.

  23. Saldana, L., Chamberlain, P., Bradford, W. D., Campbell, M., & Landsverk, J. (2013). The cost of implementing new strategies (COINS): a method for mapping implementation resources using the stages of implementation completion. Children and Youth Services Review,39, 177–182.

  24. Saldana, L., Chamberlain, P., Wang, W., & Brown, H. (2011). Predicting program start-up using the stages of implementation measure. Administration and Policy in Mental Health and Mental Health Services Research,39, 419–425.

  25. Saldana, L., Schaper, H., Campbell, M., & Chapman, J. (2015). Standardized measurement of implementation: the Universal SIC. 7th Annual conference on the science of the dissemination and implementation in health. Implementation Science,10(S1), A73.

  26. Solberg, L. I. (2014). Impact of a learning health care network on depression care: the DIAMOND initiative. Paper presented at the the 22nd NIMH Conference on Mental Health Services Research, Bethesda.

  27. Solberg, L.I., Crain, A.L., Jaeckels, N., Ohnsorg, K.A., Margolis, K.L., Beck, A.,… Van de Ven, A.H. (2013). The DIAMOND initiative: implementing collaborative care for depression in 75 primary care clinics. Implementation Science, 8.

  28. Solberg, L.I., Crain, A.L., Maciosek, M.V., Unützer, J., Ohnsorg, K.A., Beck, A., … Glasgow, R.E. (2015). A stepped-wedge evaluation of an initiative to spread the collaborative care model for depression in primary care. The Annals of Family Medicine, 13(5), 412–420.

  29. Trivedi, M. H. (2009). Treating depression to full remission. The Journal of Clinical Psychiatry,70(1), e01.

  30. Unützer, J., Katon, W., Callahan, C.M., Williams Jr, J.W., Hunkeler, E., Harpole, L., … Areán, P.A. (2002). Collaborative care management of late-life depression in the primary care setting. JAMA, 288(22), 2836–2845.

  31. Vannoy, S.D., Mauer, B., Kern, J., Girn, K., Ingoglia, C., Campbell, J., … Unützer, J. (2011). A learning collaborative of CMHCs and CHCs to support integration of behavioral health and general medical care. Psychiatric Services, 62, 753-758.

  32. Von Korff, M., & Tiemens, B. (2000). Individualized stepped care of chronic illness. Western Journal of Medicine,172(2), 133–137.

  33. Wang, P. S., Demler, O., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2006). Changing profiles of service sectors used for mental health care in the United States. American Journal of Psychiatry,163(7), 1187–1198.

  34. Wang, P. S., Lane, M., Olfson, M., Pincus, H. A., Wells, K. B., & Kessler, R. C. (2005). Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Archives of General Psychiatry,62(6), 629–640.

  35. Wells, K. B., Miranda, J., Bauer, M. S., Bruce, M. L., Durham, M., Escobar, J., et al. (2002). Overcoming barriers to reducing the burden of affective disorders. Biological Psychiatry,52, 655–675.

  36. Whiteford, H.A., Degenhardt, L., Rehm, J., Baxter, A.J., Ferrari, A.J., Erskine, H.E., … Burstein, R. (2013). Global burden of disease attributable to mental and substance use disorders: findings from the global burden of disease study 2010. Lancet, 382(9904), 1575–1586.

Download references

Author information

Correspondence to Lisa Saldana.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This article does not contain any studies with human participants performed by any of the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Saldana, L., Bennett, I., Powers, D. et al. Scaling Implementation of Collaborative Care for Depression: Adaptation of the Stages of Implementation Completion (SIC). Adm Policy Ment Health (2019) doi:10.1007/s10488-019-00944-z

Download citation


  • Collaborative Care
  • CoCM
  • Depression
  • Adaptation
  • Implementation
  • SIC