(111) Scaling the Collaborative Care Model in Obstetrics: Multilevel Determinants to Guide Implementation

The Collaborative Care Model (CCM) is an evidence-based approach to care that improves health outcomes in primary care settings by integrating mental health into routine medical care. While recent adaptations have tailored the CCM for use in obstetric settings to address perinatal mental health (PMH) concerns, real-world implementation remains limited. Bridging this gap between research and practice requires an understanding of contextual factors influencing adoption and sustainment. Our objective was to identify key factors modifying the implementation of the perinatal Collaborative Care Model (pCCM).

Study Design:

We conducted a qualitative implementation study guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to evaluate facilitators and barriers of pCCM implementation. Using purposive sampling, we recruited clinical and administrative key informants from six obstetric clinics and one birthing hospital. Semi-structured interviews were designed to elicit determinants at multiple contextual levels. Data were analyzed using the Rapid Qualitative Analysis process. Emergent themes were mapped to the EPIS domains – Inner Context, Outer Context, Bridging Factors, and Innovation Characteristics.

Results:

A total of 20 individuals were interviewed prior to thematic saturation. Determinants influencing adoption and sustainability of the pCCM mapped across EPIS domains are summarized in Table 1. While several cross-cutting barriers emerged, participants also identified multiple facilitators that support integration of the CCM into obstetric settings. The need for site-level adaptation was an underlying theme, underscoring the opportunity to tailor implementation strategies to local contexts.

Conclusion:
The CCM is well suited to obstetric care but requires context-specific adaptation to support adoption and sustainability. Implementation strategies must address multilevel barriers and leverage existing facilitators to bridge the gap between research and practice.