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Scaling the collaborative care model in obstetrics: Multilevel determinants to guide implementation
Alexandra Turco1, Andrea Chu2, Emily Feinberg2,3
1Warren Alpert School of Medicine at Brown University Providence Rhode Island USA.
Pregnancy (Hoboken, N.J.)
|August 14, 2026
Summary
Implementing the Collaborative Care Model (CCM) in obstetric settings requires adapting strategies to address barriers like stigma and space limitations. Facilitators include existing comfort with mental health integration and staff buy-in for better perinatal mental health outcomes.
Area of Science:
- Healthcare delivery research
- Mental health services research
- Implementation science
Background:
- The Collaborative Care Model (CCM) integrates mental health into primary care, improving outcomes.
- Perinatal mental health (PMH) adaptations of CCM exist, but real-world implementation is limited.
- Understanding contextual factors is crucial for adopting and sustaining PMH interventions.
Purpose of the Study:
- To identify key factors influencing the implementation of the perinatal CCM (pCCM).
- To explore facilitators and barriers to pCCM adoption and sustainability in obstetric settings.
Main Methods:
- Qualitative implementation study using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework.
- Semi-structured interviews with 20 clinical and administrative informants from five obstetric clinics and one birthing hospital.
- Thematic analysis guided by EPIS domains (inner context, outer context, bridging factors, innovation characteristics).
Main Results:
- Barriers included limited clinic space, workflow changes, and societal stigma regarding psychotropic medication use during pregnancy.
- Facilitators included increased medical touchpoints, staff/leadership buy-in, and existing comfort with mental health integration.
- Need for site-level adaptation to tailor implementation strategies to local contexts was a key theme.
Conclusions:
- The CCM is suitable for obstetric care but requires context-specific adaptation for successful adoption and sustainability.
- Implementation strategies must address multilevel barriers and leverage existing facilitators.
- Bridging the gap between research and practice necessitates tailored approaches for perinatal mental health integration.
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