A Mixed Method Environmental Scan of Collaborative Mental Health Care in Saskatchewan Province, Canada Journal: BMC Health Service Research

A Mixed Method Environmental Scan of Collaborative Mental Health Care in Saskatchewan Province, Canada Journal: BMC Health Service Research | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Mixed Method Environmental Scan of Collaborative Mental Health Care in Saskatchewan Province, Canada Journal: BMC Health Service Research Shazia Durrani, Mariam Alaverdashvili, Cameron Bye, Kirat Shukla, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9247526/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background: Collaborative care models (CCMs) are among the most evidence-supported approaches for integrating mental health services into primary care. Despite strong evidence, implementation across Canadian jurisdictions remains uneven. Saskatchewan’s geographically dispersed population and variable service infrastructure present challenges for equitable delivery. This study aimed to conduct a province-wide environmental scan of collaborative mental health care in Saskatchewan to examine model utilization, regional variation, and implementation of strengths and gaps. Methods: A convergent mixed-methods design was used. A cross-sectional online survey was distributed to healthcare providers, administrators, and system leaders involved in adult mental health service delivery. The survey captured clinic characteristics, collaborative care model type, availability of core components, and perceived effectiveness. Quantitative data were analyzed descriptively and clustered by clinics. Semi-structured interviews were conducted with a purposive sample of healthcare providers (n = 11) and analyzed using reflexive thematic analysis. Qualitative themes were subsequently organized using a Strengths, Weaknesses, Opportunities, and Threats (SWOT) framework. Integration occurred during interpretation. Results: A total of 155 survey responses were analyzed, identifying 38 clinics reporting the presence of collaborative mental health care. Coordinated care was the most commonly reported model in practice, while Integrated care was most frequently perceived as the most effective. Integrated and multi-model clinics demonstrated greater availability of core collaborative care components, including team-based structures, shared information systems, and quality improvement processes. Qualitative findings highlighted the value of informal collaboration and capacity-building while also identifying persistent system-level barriers, including workforce shortages, fragmented information systems, unstable funding, and inequities between urban and non-urban settings. Conclusions: Collaborative mental health care is widely valued and present across Saskatchewan but is often implemented in lower-intensity forms that diverge from evidence-based Integrated models. Persistent system-level constraints appear to drive this implementation gap. Strengthening infrastructure, workforce support, financing mechanisms, and information-sharing systems will be essential to support more equitable and sustainable implementation of high-fidelity collaborative care across diverse contexts. Collaborative Care Models Mental Health Primary care Introduction The growing burden of mental-health conditions in Canada has intensified pressure on primary-care systems, where most individuals first seek help for common mental health concerns such as depression and anxiety. Nearly 80% of Canadians with these conditions receive care from a family physician, underscoring the central role of primary care in mental-health service delivery ( 1 ). Yet despite this reliance, significant gaps persist. Many primary-care providers report limited mental-health training, heavy clinical workloads, and challenges accessing timely psychiatric consultation, all of which contribute to delays in diagnosis, fragmented treatment pathways, and unmet patient needs ( 2 – 4 ). These longstanding challenges highlight the need for structured, scalable models that can strengthen primary-care's capacity while improving the quality and consistency of mental health care. Collaborative Care Models (CCMs) are among the most evidence-supported approaches for integrating mental health services into primary care to improve equitable and timely access to care, quality of care and outcomes. Rooted in interprofessional teamwork, CCMs are defined by four core components: systematic screening and measurement-based care, a designated care manager who coordinates follow-up, regular psychiatric case consultation, and stepped treatment adjustments based on clinical outcomes ( 5 – 8 ). Randomized controlled trials, meta-analyses, and large-scale implementation initiatives have consistently shown that CCMs outperform standard clinical practice, leading to better symptom improvement, higher treatment adherence, increased patient satisfaction, and more efficient use of health-care resources ( 8 – 12 ). These benefits are particularly relevant in settings where access to specialized psychiatric care is limited and where primary-care providers shoulder the majority of mental-health management responsibilities. Despite their demonstrated effectiveness, the adoption and implementation of CCMs in Canada remain uneven. Variation in funding models, workforce capacity, and local health system priorities contributes to inconsistent integration of CCM components across provinces and territories ( 6 , 13 ). Many primary-care clinicians continue to report difficulty accessing psychiatric consultation and a lack of standardized processes to support ongoing collaboration between primary and specialty care ( 14 , 15 ). Even where collaborative models exist, they vary widely in their level of integration, ranging from informal co-location of services to fully Integrated team-based care ( 6 ). The diversity of these models, while reflective of local needs, also makes it difficult to assess accuracy to evidence-based principles or to scale effective approaches across jurisdictions. Moreover, many CCM initiatives have been developed and evaluated in resource-intensive or highly motivated practice settings, where participating clinicians are committed to the model and adequate infrastructure is available, raising concerns about generalizability to routine, real-world primary care environments. Saskatchewan represents a critical context in this landscape. The province’s geographically dispersed population, variable primary-care infrastructure, and limited psychiatric workforce create unique challenges for delivering timely and Coordinated mental health services. Furthermore, there have been efforts to improve or standardize CCM’s. Previous research in this area has documented substantial regional (even provincial) variation in how collaborative mental health care is organized and delivered ( 16 – 18 ). These inconsistencies limit system-level efforts to strengthen primary-care capacity, reduce psychiatric wait times, and align practice with evidence-based collaborative-care principles. The objective of this study was to conduct an environmental scan of CCMs currently in Saskatchewan to address these gaps. Specifically, we aimed to ( 1 ) identify the current utilization of collaborative mental health care across Saskatchewan, ( 2 ) examine regional variation in CCMs, and ( 3 ) identify common or effective model components that may inform a more tailored provincial approach. A mixed-methods design was employed to achieve these objectives, integrating quantitative and qualitative data to capture both the structural features of CCMs and the perspectives of healthcare providers on implementation, effectiveness, barriers, and facilitators. By identifying gaps, strengths, and areas for improvement in existing models, this project aims to generate evidence to support the development of a patient-centered, evidence-informed collaborative mental health care framework adaptable across diverse regional contexts in Saskatchewan. Such work has the potential to improve access, efficiency, and quality of mental health care, consistent with prior evidence demonstrating the effectiveness of collaborative care in improving patient outcomes and health-system performance. To our knowledge, this is the first province-wide mixed-methods environmental scan of CCM implementation in Saskatchewan, combining provider perceptions with clinic-level structural characteristics. Methods Study Design and Setting This study employed a convergent mixed methods ( 19 ) design to conduct an environmental scan ( 20 ) of CCMs across Saskatchewan, Canada. Quantitative and qualitative data were collected in parallel and integrated during interpretation to provide a comprehensive understanding of the utilization, implementation, and perceived effectiveness of collaborative care in primary and secondary care settings serving adults aged 18 years and older. Participants and Recruitment Participants were health care providers involved in the delivery of health care services in Saskatchewan. Eligible participants comprised of primary care and mental health providers (including family physicians and psychiatrists), administrative staff, and individuals in leadership roles such as directors, managers, and provincial area leaders. All participants were involved in services provided to adults with mental health disorders across Saskatchewan. For the quantitative component, a director-guided purposive snowball sampling strategy was used because no comprehensive registry of collaborative care clinics or providers exists and relevant roles are often distributed across formal and informal networks. Survey invitations were sent to 12 provincial area leaders, provincial department heads, the Saskatchewan nursing association who then distributed the survey invitations via email to leadership, healthcare providers, and administrative staff within their respective areas. Participation was voluntary, and informed consent was obtained prior to survey completion. Participants for the qualitative interviews were drawn from survey respondents who indicated willingness to participate in follow-up interviews. Purposive sampling was used to ensure representation across geographic regions, with 11 healthcare workers interviews conducted. Sampling continued until no new themes emerged and thematic saturation was achieved. Data collection and Definition of terms The survey was developed using the online data capture platform REDCap. Demographic and career information was collected to describe the sample of collaborative care users. This included job title and position, the clinic where they work, years worked in healthcare and at that particular clinic, health region and location, and involvement in collaborative care. Descriptions of the collaborative care used included model type, years present at the clinic in question, most common mental health conditions served, and several checklists of the types of services, functions, and supports available at that location. Personal opinions regarding the quality and frequency of various services present in CCMs was also asked. The choice of services, functions, and supports by which to examine CCMs was guided by Kates et al. and Sunderji et al. ( 7 , 13 ). The survey was piloted with one to two physicians to evaluate clarity and relevance, and their feedback informed further refinement of the instrument. Survey data collection occurred between August 2024 – December 2024. The survey can be found in Supplementary Materials 1. During the survey, participants were presented with the following definitions of location type in the Saskatchewan province, a map of Saskatchewan as seen in Supplementary Materials 2 was also provided for clarification: Urban Regina, Saskatoon, Prince Albert, Moose Jaw, Yorkton, North Battleford, Swift Current, Estevan, Weyburn, and Lloydminster. Rural All communities outside those listed above. Remote Health care facilities located a minimum of four hours away from hospital services by ground transportation. During the survey, participants were presented with the following definitions of CCMs from the Mental Health Commission of Canada: Coordinated care - Referral-triggered periodic exchange of information between clinicians in separate medical and behavioral settings, with minimally shared care plan or clinic culture. In this model, primary and specialist providers maintain separate office structures (21). Co-located care - Behavioral and medical clinicians in same space, with regular communication, usually separate systems, but some shared care plans and clinic culture. This model maintains separate administrative arrangements for primary and specialist providers. Integrated care - Shared space and systems with regular communications, mostly unified rather than separate care plans, and largely shared culture and collaborative routines. Providers in this model use the same offices and administrative arrangements. Qualitative Data Collection Qualitative data was collected through semi-structured interviews by an experienced interviewer conducted either virtually (via Zoom) or in person to accommodate geographic dispersion and scheduling constraints. The interview guide was developed by the research team based on the study objectives and relevant literature and is provided in Supplementary Materials 3. The interview guide was piloted with one physician to assess clarity and relevance, and feedback was used to inform subsequent revisions. Interviews explored participants’ experiences with collaborative care, perceived strengths and weaknesses of current models, barriers and facilitators to implementation, and perspectives on optimal collaborative care design. Interviews ranged in length from 30 to 45 minutes, were audio-recorded with participants’ consent, and transcribed for analysis. Data Analysis Quantitative data was exported from REDCap, cleaned in Microsoft Excel, and analyzed using SPSS (31.0.0.0). Descriptions of the study sample are reported as counts (n) and proportion of total sample (%). We present data on the study sample both as individual participants, as well as individual clinics/hospitals where collaborative care was identified as present. The frequency of services and functions were calculated with an arithmetic average for each CCM type. Clustering Much of the data is clustered within clinics, i.e., several participants contribute data about the same location. Answers about the type of care model present (objective 1) or the presence of services and functions (objective 3) were determined in an affirmative matter, similar to how individual participant per location responses are treated. This assumes that all positive responses were true. For example, if participant 1 at clinic x says Coordinated care is present, but participant 2 at that same clinic says that Co-located care is present but not Coordinated care; both models are considered to be present, as both were positively reported. Due to this decision, results specific to a CCM are presented both as “clinics where this model is present (and potentially other models)” and “clinics were only this model is present (excluding other models)”, for distinction. Ratings of service frequency were averaged across participants within the same location. Qualitative data were analysed using thematic approach following the six-phase approach described by Braun and Clarke (2006). An inductive analytic strategy was adopted to allow themes to emerge from the data rather than imposing a predefined coding framework. Interview transcripts were read repeatedly to ensure familiarity with the data. Two researchers (AV and CB) independently generated initial codes using Microsoft Word and Excel. Codes were then compared and discussed with a third researcher (SD), and discrepancies were resolved through team discussion. A shared coding framework was developed iteratively, and themes and subthemes were refined through ongoing review and reflexive discussion within the research team. This was done to support rigor and credibility. The prevalence of themes was summarized descriptively, and illustrative quotations were selected to reflect the range of perspectives across participants. Although coding was inductive, themes were subsequently organized within a Strengths, Weaknesses, Opportunities, and Threats (SWOT) framework ( 22 , 23 ) during the interpretive phase to support structured integration with the quantitative findings and to facilitate interpretation of system-level facilitators and barriers. SWOT was applied only during interpretive integration. SWOT is a strategic analytic framework used to identify internal and external factors that influence the success of a project or intervention. Strengths and weaknesses refer to internal characteristics that respectively support or hinder effectiveness, while opportunities and threats reflect external conditions that may facilitate or impede success. SWOT has been widely used in implementation and health systems research to inform planning and policy development ( 24 ). In this study, the SWOT framework was applied to organize qualitative themes, clarify implementation gaps, and guide future planning and policy related to CCMs across Saskatchewan. To enhance rigor, analytic decisions were documented throughout the process, and themes were reviewed by the broader research team to support reflexivity and credibility. The prevalence of themes was summarized descriptively, and illustrative quotations were selected to reflect the range of perspectives across participants. Mixed-methods integration Integration occurred at the interpretation stage through triangulation of quantitative and qualitative findings. Qualitative themes were used to contextualize, explain, and elaborate quantitative patterns, particularly in relation to variation in model implementation, perceived effectiveness, and regional inequities. Ethics Approval and Consent The study was approved by the Saskatchewan Health Authority (SHA) Research Ethics Board (REB-23-51). All participants received a letter of information. For the survey, all participants provided informed written consent before completion. For qualitative interviews, written or verbal informed consent was obtained. All data was de-identified prior to analysis and stored securely in accordance with SHA data security policies. Results The findings are presented in two main sections, each with accompanying subsections. The first section reports the quantitative results and integrates them with relevant qualitative themes in relation to the three study objectives: (i) utilization of collaborative mental health care models, (ii) regional variations in collaborative care, and (iii) identification of key components and gaps in implementation. The second section presents the qualitative findings in greater depth to further contextualize and explain the quantitative patterns. Utilization of Collaborative Mental Health Care Two-hundred and fourteen survey entries were collected (Table 1 ). Fifty-nine were removed for being empty or non-consenting, leaving a final sample size of N = 155. Sample demographics can be found in Tables 1 a and 1 b. The majority of participants are physicians, clinic staff, or allied professions (66.5%), the remainder making up leadership roles (26.5%) and a variety of self-described others (12.5%). The majority are female (73.5%), and working at urban centres (73.5%), namely Saskatoon (23.2%) and Regina (40.0%). Participants reported substantial professional experience, with over half indicating more than 10 years working in healthcare, supporting the credibility of responses regarding service organization and delivery. Table 1 a. Participant demographics of study sample Demographics (respondents) Count % (Total sample) Gender Female Male Not disclosed Missing 154 114 34 6 1 99.4% 73.5% 21.9% 3.9% 0.6% How long have you been working in healthcare ? 0–5 years 6–10 years 11–15 years 16–20 years 21 + years Missing 154 22 27 34 16 55 1 99.4% 14.2% 17.4% 21.9% 10.3% 35.5% 0.6% Position/Job title 155 Leadership/Director Clinician Manager Director Coordinator Other CEO Clinical Nurse Educator ED 32 1 16 9 3 3 1 1 1 20.6% 0.6% 10.3% 5.8% 1.9% 1.9% 0.6% 0.6% 0.6% Physician/Clinic staff/Allied profession Family doctor Psychiatrist Pharmacist Nurse Therapist/ counsellor Social work/counsellor/occupational Other: Administrator Assessor Coordinator Confidential Administrative Assistant Nurse Practitioner Occupational Therapist Psychologist Missing Other (non-allied staff) 103 19 4 0 11 2 6 8 1 1 1 3 1 1 53 20 66.5% 12.3% 2.6% 0.0% 7.1% 1.3% 3.9% 5.2% 0.6% 0.6% 0.6% 1.9% 0.6% 0.6% 34.2% 12.5% Specialty Family Medicine Nursing Psychiatry Psychology Social Work Other Mental health/Addictions Administration Occupational health Primary care Sexual health Geriatric medicine Emergency medicine Palliative care Missing Missing 154 49 29 32 1 13 30 9 3 3 5 1 1 1 2 5 1 99.4% 31.6% 18.7% 20.6% 0.6% 8.4% 19.4% 5.8% 1.9% 1.9% 3.2% 0.6% 0.6% 0.6% 1.3% 3.2% 0.6% Table 1 b: Geographical distribution of study sample Demographics (respondents) Count % (Total sample) Health area Saskatoon Regina South East South West South Central North East North West North Central Central East Central West Far North East Far North West Athabasca Missing 154 36 62 13 9 3 2 10 5 3 1 0 10 0 1 99.4% 23.2% 40.0% 8.4% 5.8% 1.9% 1.3% 6.5% 3.2% 1.9% 0.6% 0.0% 6.5% 0.0% 0.6% Location Urban Rural Remote Both I don’t know Missing 154 114 27 7 5 1 1 99.4% 73.5% 17.4% 4.5% 3.2% 0.6% 0.6% [Insert Table 1 a. and 1b. here] Table 2 summarizes the mental health conditions most commonly managed at clinics with CCMs. Across all clinics (N = 38), major depression (81.6%), substance dependence (76.3%), and anxiety disorders (73.7%) were most frequently reported and were consistent across model types and clinic configurations. Attention-deficit/hyperactivity disorder was also commonly identified (42.1%). In contrast, severe or specialized conditions including personality disorders (21.1%), psychotic disorders (15.8%), and schizophrenia (10.5%) were less frequently reported, while bipolar affective disorder, autism spectrum disorder, and eating disorders were rarely identified. Table 2 Clinical Populations Served in Collaborative Care Clinic By Clinic Single model only at clinic Multi-Model present at clinic Model All Coordinated Co-located Integrated Coordinated Co-located Integrated N = 38 N = 11 N = 7 N = 9 N = 20 N = 14 N = 19 Mental Disorder Substance dependence Major depression Panic Disorder Schizophrenia Anxiety disorder BPAD Personality disorder ADHD Autism Spectrum disorder Psychotic disorders Eating disorders Other (not listed above) 29 (76.3) 31 (81.6 1 (2.6) 4 (10.5) 28 (73.7) 0 (0.0) 8 (21.1) 16 (42.1) 0 (0.0) 6 (15.8) 1 (2.6) 5 (13.2) 9 (81.8) 9 (81.8) 0 (0.0) 0 (0.0) 10 (90.0) 0 (0.0) 2 (18.2) 1 (9.1) 0 (0.0) 1 (9.1) 0 (0.0) 2 (18.2) 4 (57.1) 6 (85.7) 0 (0.0) 0 (0.0) 5 (71.4) 0 (0.0) 0 (0.0) 5 (71.4) 0 (0.0) 1 (14.3) 1 (14.3) 0 (0.0) 7 (77.8) 7 (77.8) 0 (0.0) 2 (22.2) 6 (66.7) 0 (0.0) 1 (11.1) 3 (33.3) 0 (0.0) 2 (22.2) 0 (0.0) 2 (22.2) 16 (80.0) 17 (85.0) 1 (5.0) 2 (10.0) 17 (85.0) 0 (0.0) 6 (30.0) 7 (35.0) 0 (0.0) 2 (10.0) 0 (0.0) 3 (15.0) 11 (78.6) 12 (85.7) 0 (0.0) 2 (14.2) 9 (64.3) 0 (0.0) 4 (28.6) 9 (64.3) 0 (0.0) 3 (21.4) 1 (7.1) 0 (0.0) 15 (78.9) 15 (78.9) 1 (5.3) 4 (21.1) 12 (63.2) 0 (0.0) 6 (31.6) 10 (52.6) 0 (0.0) 4 (21.1) 0 (0.0) 3 (15.8) Note: Values are presented as n (%). [Insert Table 2 here] . Overall, collaborative care in Saskatchewan is primarily utilized for the management of common, high-prevalence mental health conditions typically addressed in primary care settings. Interview participants described collaborative care as supporting primary care clinicians in managing both common and complex presentations rather than transferring care to specialty services. Participants emphasized the value of timely consultation for clinical decision-making. However, much of this collaboration was described as occurring informally rather than through structured systems. One participant reflected that while ad hoc “hallway” consultations were common, they were suboptimal for quality and continuity of care: “Those are happening a lot in the hallway… I don’t love the hallway for that because… it doesn’t allow us sort of documentation… it relies on memory.” Q02 Regional Variation in Collaborative Care Models Table 3 depicts the CCMs present in Saskatchewan. Eleven of 32 (34.4%) leadership respondents report overseeing a CCMs where they work and 54.8% of all respondents claim to work at a clinic where a CCM is used. Of these 11 leadership participants, 7 (63.6%) oversee Coordinated models, 6 (54.5%) Integrated models, and only 2 (18.2%) Co-located models. The most common model of collaborative care seen in respondents is Coordinated (51.5%), followed by Integrated (40.0%) and then Co-located (29.4%). Many respondents report multiple model types being present where they work. Table 3 Collaborative Care Models by respondent Leadership – Do you oversee a Collaborative Care clinic? Yes No I’m not sure Count % (Total, N = 155) % (Sub-category) 32 11 16 5 20.6% 7.1% 10.3% 3.2% 100.0% 34.4% 50.0% 15.6% Leadership – Do you oversee a Collaborative Care clinic? (yes) Coordinated Co-located Integrated 11 7 2 6 7.1% 4.5% 1.3% 3.9% 100.0% 63.6% 18.2% 54.5% Is there a Collaborative Care model currently in use at the clinic where you work? Yes No I don’t know Missing 133 85 25 23 22 85.8% 54.8% 16.1% 14.8% 14.2% 100.0% 63.9% 18.8% 17.3% - What type of Collaborative Care model is present where you work? Coordinated Co-located Integrated Coordinated only Co-located only Integrated only Coordinated + Co-located Coordinated + Integrated Co-located + Integrated Coordinated + Co-located+ Integrated 85 44 25 34 32 14 24 5 4 3 3 54.8% 28.4% 16.1% 21.9% 20.6% 9.0% 15.5% 3.2% 2.6% 1.9% 1.9% 100.0% 51.8% 29.4% 40.0% 37.6% 16.5% 28.2% 5.9% 4.7% 3.5% 3.5% Some numbers may overlap due to respondents claiming multiple models at the same location [Insert Table 3 here] After clustering respondent data by location, 38 clinics were identified as using collaborative care. Only 2 out of the 25 respondents who said that no CCM was not present at the clinic they worked actually named the clinic, and so comparison results between collaborative and non-collaborative clinics (or estimate collaborative care prevalence) is not possible (Supplementary Materials 4). Due to the small workforce at many of these clinics, particularly in rural locations, clinics are not named to ensure the anonymity of our survey respondents. Table 4 contains the areas and regions of these individual clinics, along with the types of CCMs reported there and an estimation of how long it has been in use (Supplementary 4). Following the trends seen in individual participant responses, Saskatoon and Regina, the two largest cities in Saskatchewan, have the most clinics identified with 10 (26.3%) and 12 (31.6%) respectively. Across the province, various model types and combinations are seen, with Coordinated being the most common followed by Integrated and then Co-located. In clinics that use multiple models of CCMs, a breakdown of model types shows that 20 clinics use Coordinated care in some capacity, 19 use Integrated care, and 14 Co-located care as shown in Table 4 . Table 4 Collaborative care clinics location per health region By Clinic Single model only at clinic Multi-Model present at clinic All N = 38 Coordinated N = 11 Co-located N = 7 Integrated N = 9 Coordinated N = 20 Co-located N = 14 Integrated N = 19 Area Saskatoon Regina South East South West South Central North East North West North Central Central East Central West Far North East Far North West Athabasca 38 10 (26.3) 12 (31.6) 3 (7.9) 5 (13.2) 1 (2.6) 0 (0.0) 3 (7.9) 0 (0.0) 0 (0.0) 1 (2.6) 0 (0.0) 3 (7.9) 0 (0.0) 2 (18.5) 5 (45.5) 1 (9.1) 1 (9.1) 1 (9.1) 1 (9.1) 3 (42.9) 1 (14.3) 2 (28.6) 1 (14.3) 2 (22.2) 2 (22.2) 2 (22.2) 1 (11.1) 1 (11.1) 1 11.1) 4 (20.0) 9 (45.0) 2 (10.0) 1 (5.0) 2 (10.0) 1 (5.0) 1 (5.0) 4 (28.6) 4 (28.6) 1 (7.1) 3 (21.4) 1 (7.1) 1 (7.1) 5 (26.3) 7 (36.8) 2 (10.5) 2 (10.5) 2 (10.5) 1 (5.3) Note: Values are presented as n (%). [Insert Table 4 here] No trends or differences are found in the years a model has been in use by model type or area. When examining possible differences in model types between urban and rural regions, very little difference is seen in the relative number and type of clinic models (Supplementary Table 4). Regarding complexity of model usage, 1of 10 (10.0%) rural collaborative care clinics have more than 1 model present while 10 of 27 (37.0%) of urban clinics have more than 1 model type. During interviews, participants consistently emphasized that CCMs must be adapted to local context and that infrastructure, staffing, and resources varied substantially across settings. Several described inequitable access to collaborative supports in rural areas, noting the absence of local mental health professionals: “ We don’t have any mental health care providers, like social workers, counsellors, psychologists. We have none of that .” (Q07) Identify effective collaborative care components, implementation gaps and system-level needs Table 5 summarizes respondents’ perceptions of the collaborative care model that works best. Overall, Coordinated collaborative care was most frequently endorsed (60.6%), followed by Integrated (12.9%) and Co-located care (10.9%), while 15.9% of respondents reported no opinion. Table 5 Perceived Effectiveness of Collaborative Mental Health Care Model Survey question Which model do you think works best? Respondents (n) Total 132 (100) Coordinated 17 (12.9) Co-located 14 (10.9) Integrated 80 (60.6) No opinion 21 (15.9) Collaborative Care Clinic where you work? Yes No I don’t know 84 25 23 11 (13.1) 4 (16.0) 2 (8.7) 10 (11.9) 4 (16.0) 0 (0.0) 54 (64.3) 14 (56.0) 12 (52.2) 9 (10.7) 3 (12.0) 9 (39.1) Position/Title Physician/staff Leadership Other 94 20 18 11 (11.7) 2 (10.0) 4 (22.2) 10 (10.6) 1 (5.0) 3 (16.7) 57 (60.6) 16 (80.0) 7 (38.9) 16 (17.0) 1 (5.0) 4 (22.2) Specialty Family Medicine Nursing Psychiatry Psychology Social Work Other 43 26 29 01 11 22 3 (7.0) 3 (11.5) 4 (13.8) 0 (0.0) 3 (27.3) 4 (18.3) 5 (11.6) 2 (7.7) 3 (10.3) 0 (0.0) 2 (18.2) 2 (9.1) 29 (67.4) 18 (69.2) 13 (44.8) 1 (100.0) 5 (45.5) 14 (63.6) 6 (14.0) 3 (11.5) 9 (31.0) 0 (0.0) 1 (9.1) 2 (9.1) Note: Values are presented as n (%), with percentages calculated within each subgroup. Missing responses (n = 23) are included in the overall denominator Among respondents working in clinics with an established collaborative care clinic, 64.3% identified Integrated care as most effective, compared with 56.0% among those without a collaborative care clinic and 52.2% among those unsure whether a collaborative care clinic existed. Respondents uncertain about the presence of a collaborative care clinic were more likely to report no opinion (39.1%) than those working in clinics with (10.7%) or without (12.0%) collaborative care. By position, endorsement of Integrated care was highest among leadership respondents (80.0%), followed by physician and clinic staff (60.6%) and respondents in other roles (38.9%). Across clinical specialties, Integrated care was most frequently endorsed by psychology (100.0%), nursing (69.2%), family medicine (67.4%), and other disciplines (63.6%), while endorsement was lower among psychiatrists (44.8%). [ Insert Table 5 here ] Qualitative data clarified why integrated approaches were valued. Participants described improved efficiency, increased clinical confidence, and better patient outcomes when access to team-based consultation was available and functioned well. These accounts help explain the high perceived effectiveness of Integrated care observed in the survey. “ Having like, access to a psychologist who can do those cognitive assessments… makes things so much easier, because then you can [create a] treatment plan appropriately… the benefits of it have been outstanding. ” (Q09) “ All of that maneuvering is happening behind the scenes… so the client is just getting the care at the right time, at the right place so there’s no wrong door” (Q04) Across all clinics, patient education (84.2%) and education between services or providers (73.7%) were the most frequently reported functions, regardless of model type (Table 6 ). In contrast, data collection for quality improvement (44.7%) and formal billing methods specific to collaborative care (23.7%) were least commonly reported, indicating gaps in system-level infrastructure. Participants described structural and funding limitations as barriers to sustainability and consistency of collaborative care. One participant noted the fragility of existing supports: Table 6 Availability of Collaborative Care Services, Supports, and Functions by Model Type Model type Single model only at clinic Multi-Model present at clinic All Clinics N = 38 Coordinated N = 7 Co-located N = 7 Integrated N = 9 Coordinated N = 20 Co-located N = 14 Integrated N = 19 Services/Supports/Functions Patient education Education between services/providers Quality improvement data collection Proactive patient follow-up Enhanced patient care Access to tools (telehealth, e-health) Shared access to a medical database Tools for standardized assessment Triage Decision support Team-based structure to CC Billing method 32 (84.2) 28 (73.7) 17 (44.7) 20 (52.6) 21 (55.3) 20 (52.6) 22 (57.9) 23 (60.5) 20 (52.6) 18 (47.4) 21 (55.3) 9 (23.7) 9 (81.8) 6 (54.5) 4 (36.4) 5 (45.5) 4 (36.4) 2 (18.2) 4 (36.4) 6 (54.5) 6 (54.5) 5 (45.5) 3 (27.3) 1 (9.1) 7 (100.0) 7 (100.0) 4 (57.1) 3 (42.9) 4 (57.1) 3 (42.9) 4 (57.1) 4 (57.1) 4 (57.1) 3 (42.9) 4 (57.1) 0 (0.0) 7 (77.8) 6 (66.7) 2 (22.2) 5 (55.6) 3 (33.3) 4 (44.4) 6 (66.7) 5 (55.6) 3 (33.3) 3 (33.3) 5 (55.6) 3 (33.3) 16 (80.0) 13 (65.0) 9 (45.0) 11 (55.0) 12 (60.0) 11 (55.0) 11 (55.0) 13 (65.0) 11 (55.0) 11 (55.0) 10 (50.0) 4 (20.0) 13 (92.9) 13 (92.9) 9 (64.3) 7 (50.0) 11 (78.6) 10 (71.4) 9 (64.3) 9 (64.3) 10 (71.4) 7 (50.0) 10 (71.4) 3 (21.4) 15 (78.9) 14 (73.7) 9 (47.4) 11 (57.9) 12 (63.2) 14 (73.7) 13 (68.4) 12 (63.2) 9 (47.4) 9 (47.4) 14 (73.7) 8 (42.1) Note: Values are presented as n (%). Counts and percentages are based on the number of clinics where a participant who works there responds “yes” to the presence of the services, supports, or functions listed. *CC =Collaborative Care “Part of the money that we raised through the grant was to pay for overhead in the clinic that wouldn’t otherwise have been covered.” (Q11) Clinics operating Integrated models demonstrated a broader and more consistent presence of core collaborative care functions compared with Coordinated and Co-located models. Integrated models most frequently reported patient education and inter-provider education (both 100.0%), as well as shared data systems, standardized assessment tools, and team-based structures. In contrast, clinics operating Coordinated-only models reported lower availability of key functions, particularly telehealth tools, shared databases, and formal decision support. Clinics reporting multiple collaborative care models showed higher overall availability of services and supports across all model types. Integrated models within multi-model clinics reported the highest prevalence of key components, including education between services or providers (92.9%), data collection for quality improvement (64.3%), enhanced patient care (78.6%), telehealth or e-health tools (71.4%), and team-based collaborative care structures (71.4%). Coordinated and Co-located models within multi-model clinics also demonstrated greater functional breadth than their single-model counterparts but continued to lag behind Integrated models on system-level supports such as quality improvement infrastructure and billing mechanisms. [ Insert Table 6 here ] Table 7 shows that most processes were reported as present often to almost always (means 4.2–4.7). Patient involvement in decision making (mean = 4.7) and clarity of team roles (mean = 4.6) were rated highest, while wait times between services were lowest (mean = 4.2). Integrated and multi-model clinics (50.0%) reported consistently higher mean scores for data sharing, referral efficiency, and care management, whereas Coordinated-only clinics (28.9%) reported lower scores, particularly for data accessibility and wait times, indicating more limited operational integration. Table 7 Frequency of Core Collaborative Care Processes Across Clinics Model Single model only at clinic Multi-Model present at clinic Survey questions on clinic process All Coordinated Co-located Integrated Coordinated Co-located Integrated N = 38 N = 11 N = 7 N = 9 N = 20 N = 14 N = 19 1. Client data/information is shared and easily accessible 2. Patients referral between care providers are efficient and streamlined 3. Discharge of patients is done easily 4. The roles and responsibilities of each team member are clear 5. The wait times between services are reasonable 6. Collaborative care at the clinic is being well managed 7. Patients are involved in decision making 4.4 4.5 4.6 4.6 4.2 4.4 4.7 3.7 3.6 4.4 4.3 3.6 3.6 4.0 4.4 4.6 4.7 4.6 4.3 4.5 5.0 4.9 4.9 4.3 4.5 4.5 4.4 5.0 4.4 4.3 4.7 4.6 4.0 4.3 4.4 4.5 4.8 4.7 4.7 4.4 4.7 5.0 5.0 5.2 4.7 4.8 4.6 4.9 5.1 Response scale is 1–6 Likert scale ranging from never ( 1 ) to Always ( 6 ). Values in the table are averages of the coded responses across clinics. [ Insert Table 7 here ] Together, Tables 6 and 7 demonstrate that Integrated and multi-model type clinics have a broader range of collaborative care components, reporting more consistently implemented and higher-functioning collaborative care processes. Expanded Qualitative Findings (SWOT Analysis of Healthcare Worker Perspectives) . Qualitative findings are summarized in Supplementary Materials 5 and are organized within a Strengths, Weaknesses, Opportunities, and Threats (SWOT) framework. Rather than representing discrete categories, the findings illustrate how collaborative care is currently functioning in practice and reveal important tensions and contradictions within existing models. In particular, many themes reflected paradoxes as the same features were described as both enabling and constraining care highlighting that collaborative care in Saskatchewan is often sustained through adaptation and improvisation rather than formalized systems. Strengths of Existing Collaborative Practices Participants described multiple forms of collaboration currently in practice, including inpatient and outpatient models, as well as both direct and indirect consultation. Informal consultation (e.g., “hallway conversations,” quick phone advice) was frequently described as accessible and clinically valuable, supporting real-time decision-making and enhancing continuity of care. These accounts suggest that informal collaboration functions as an important compensatory mechanism within constrained systems, enabling clinicians to maintain care quality despite limited formal structures. Participants also emphasized the role of collaborative care in building primary care capacity, with access to specialist input improving clinician confidence, knowledge, and clinical management over time. Team-based approaches and exposure to multiple professional perspectives were perceived to contribute to more comprehensive and holistic patient care. However, taken together, these strengths also reveal that effective collaboration is often person-dependent rather than system-embedded, raising questions about sustainability and consistency across settings. Weaknesses in Current Implementation Despite these strengths, participants identified substantial limitations in how collaborative care is currently operationalized. Staffing shortages, in non-urban settings were described as shaping not only service availability but also the form collaboration could take. For example, limited workforce capacity was often cited as the reason why collaborative care remained informal rather than structured. Participants also described outdated referral processes, administrative complexity, and incompatible electronic medical record (EMR) systems as barriers that actively constrained collaboration rather than simply creating inconvenience. Fragmented information systems were interpreted as undermining shared care planning and reinforcing reliance on informal communication. Importantly, several participants explicitly recognized the double-edged nature of informal collaboration. While pragmatically useful, reliance on undocumented communication was seen as suboptimal for patient safety, continuity, and accountability. This tension reinforces the broader analytic finding that collaborative care is frequently sustained through goodwill and individual effort rather than through reliable system design. Opportunities for System Improvement Participants consistently articulated that collaborative care could be strengthened through system-level redesign rather than individual-level effort. Calls for greater standardization across the province were not framed as a desire for rigid uniformity but as a mechanism to ensure that core components are consistently available across settings. Participants conceptualized standardization as a tool for equity, particularly to reduce disparities between urban and rural contexts. Many also identified opportunities to improve efficiency, communication, and clinical effectiveness through better-designed workflows, stronger interprofessional relationships, and expanded resources. These insights demonstrate that participants were not only describing problems but also articulating sophisticated understandings of how collaborative systems could be improved. Threats to Sustainable Implementation Participants identified several structural threats to sustainability, including workforce shortages, unstable funding, and restrictive policies related to specialist roles and responsibilities. These were not viewed as external challenges but as systemic conditions that actively shape the feasibility of high-fidelity collaborative care. Geographic inequities were a persistent concern, with participants emphasizing that access to collaborative resources differed substantially between urban, rural, and remote regions. Technological limitations were similarly viewed as undermining the potential for effective integration. Together, these threats reinforce the interpretation that current models are fragile and highly contingent on local context, rather than supported by durable system infrastructure. Integration with Quantitative Findings Overall, the qualitative findings explain the quantitative patterns by clarifying why Coordinated and hybrid models predominate despite strong endorsement of Integrated care. Survey results showed that Coordinated care was most common in practice, whereas Integrated care was perceived as most effective. Qualitative accounts reconcile this gap: participants described relying on informal consultation and workarounds in response to limited infrastructure, staffing, and system supports. This suggests that model variation reflects pragmatic adaptation to structural constraints rather than weak commitment to collaborative care principles. Quantitative data also showed that Integrated and multi-model clinics reported more consistent implementation of core components, including shared information systems, team-based structures, and quality improvement processes. Participants linked these features to improved efficiency, clearer roles, and stronger continuity of care. Together, these findings indicate that implementation fidelity depends on system-level conditions, underscoring the need for sustained investment in infrastructure, workforce capacity, financing, and information systems to support equitable and effective collaborative care across the province. Discussion This mixed-methods study provides a provincial snapshot of how collaborative mental health care clinics are configured and experienced across Saskatchewan. Three key findings emerge. First, collaborative care is primarily oriented toward more prevalent mental health conditions managed in primary care. Second, despite strong endorsement of Integrated care as the most effective model, Coordinated care remains the most implemented configuration. Third, both quantitative and qualitative findings identify persistent system-level gaps related to infrastructure, workforce, financing, and data systems that limit consistent implementation across settings. Collectively, these findings extend national literature by offering empirically grounded, region-specific insight into the gap between collaborative care evidence and real-world delivery. 1. Collaborative Care is Appropriately Oriented Toward Common Mental Health Conditions Across clinics, collaborative care services were most frequently directed toward depression, anxiety, and substance use disorders. The prominence of depression and anxiety aligns with the existing evidence, as much of the collaborative care research has focused on common mood and anxiety disorders in primary care, with strong evidence that high-fidelity implementation improves symptoms, functioning, and quality of life ( 8 , 11 , 25 – 27 ). Notably, the high prevalence of substance use services observed in our study extends beyond the traditional focus of the collaborative care literature. This suggests that collaborative care can be successfully adapted for substance use conditions. Brackett and colleagues ( 28 ) demonstrated improved treatment initiation and favourable clinical outcomes when collaborative care was applied to opioid use disorder in primary care. Our findings contribute practice-based evidence that collaborative care in Saskatchewan is already being used to address substance use concerns, highlighting its potential to support a broader range of complex behavioural health needs than is typically reflected in the literature. However, care must be taken to that ensure that CCMs are operationalized, evaluated and adapted for the population they serve within their local health system ( 29 , 30 ) for effective service delivery. 2. Perceived Effectiveness of Integrated Care Contrasts with Real-World Implementation Although collaborative mental health care appears widely present across Saskatchewan, full implementation of evidence-based Integrated models remains limited. Most clinics appear to operate at earlier points along the collaborative care continuum, where consultation and informal collaboration are common but fully integrated, team-based care is less consistently observed. This implementation gap is further underscored by the divergence between perceived effectiveness and actual practice. While most respondents endorsed Integrated care as the most effective model, Coordinated care was most commonly reported in practice, often within single-model configurations. Qualitative findings help explain this discrepancy: participants described collaboration as occurring primarily through informal consultations, phone advice, and ad hoc interactions rather than through structured interprofessional teams. Interviews also revealed role-based differences in perception. Participants in leadership or management positions generally expressed satisfaction with current collaboration, whereas frontline clinicians more frequently described practical limitations in day-to-day functioning. This divergence is consistent with prior implementation research, which suggests that leaders often assess collaborative care based on the existence of structures and programs, while clinicians evaluate it based on whether these structures function meaningfully in practice ( 31 , 32 ). Similar patterns have been documented elsewhere, where managers perceive models as established, while clinicians experience them as fragile, informal, or overly dependent on personal relationships rather than systems ( 7 ). If collaborative care is to function as an effective provincial model of care, greater alignment is needed between aspirations for integration and the operational conditions required to support it, including shared planning, goal setting, resourcing, and accountability. 3. System-Level Barriers Limit Consistency and Equity of Implementation Approximately one-third of clinics reported using more than one CCM, suggesting hybrid or transitional approaches rather than stable implementation. These patterns indicate that the predominance of Coordinated models likely reflects limitations in infrastructure, workforce, funding, and organizational support—particularly outside urban settings—rather than resistance to Integrated care. This interpretation aligns with Canadian literature describing the pragmatic evolution of collaborative care in response to local context and constraints ( 7 ). McMahan and Ly ( 33 ) demonstrated that rural programs often rely on adapted models using alternative workforce configurations to overcome shortages, highlighting how Coordinated or hybrid approaches may reflect adaptation rather than deliberate model choice. Rugkåsa et al. ( 31 ) similarly describe collaborative care as often evolving through local negotiation rather than standardized design. A tailored approach grounded in shared core principles, rather than rigid standardization, may therefore be more appropriate for Saskatchewan. However, such flexibility must be supported by equitable access to collaborative care resources across regions. These constraints were reflected in persistent system-level barriers across sites. These findings align with national analyses emphasizing that sustainable collaborative care requires enabling infrastructure, financing reform, workforce planning, and integrated information systems ( 7 , 13 , 34 ). In this study, limited information sharing and weak system supports were associated with lower implementation of key collaborative care components, underscoring the importance of implementation fidelity. In this context, fidelity refers to the extent to which core components of collaborative care such as, structured care coordination, regular interprofessional communication, psychiatric consultation, and measurement-based care, are delivered as intended ( 5 , 13 ). Meta-analyses demonstrate that lower-fidelity or partially implemented collaborative care models are associated with weaker outcomes ( 26 , 27 ), whereas more integrated models yield superior outcomes for complex populations ( 35 ). Implementation research further indicates that inadequate system-level supports limit effectiveness in real-world settings ( 15 , 34 ). Importantly, these findings carry equity implications. Clinics outside major urban centres reported fewer models, fewer supports, and greater reliance on Coordinated care. This mirrors broader Canadian evidence that collaborative care remains unevenly distributed and difficult to scale in rural and remote contexts without targeted structural investment ( 2 ). Participants’ calls for standardization were framed not as rigidity, but as a mechanism to promote fairness, consistency, and timely access across regions. Crowley and Kirschner ( 36 ) similarly argue that system-level integration is essential for equitable access and sustainable primary care-based mental health services. Implications for Policy, Practice, and Research Policy: Findings support the need for a provincial framework for collaborative mental health care that prioritizes equitable access across urban, rural, and remote regions. Policy efforts should focus on sustainable funding models, standardized role definitions, and infrastructure investments (e.g., interoperable EMRs, telepsychiatry capacity) to enable broader implementation of Integrated care rather than reliance on informal or Coordinated-only models. Practice: Health systems and clinical leaders may use these findings to strengthen team-based structures, clarify care pathways, and invest in capacity-building supports such as regular psychiatric consultation and shared decision-making processes. Emphasizing core components of evidence-based collaborative care may improve consistency and effectiveness across settings. Research: Future research should examine implementation strategies that support scale-up of Integrated collaborative care in non-urban settings, evaluate patient outcomes associated with different model configurations, and include the perspectives of individuals with lived experience. Longitudinal and realist-informed studies may be particularly useful for understanding how contextual factors influence the success of CCMs across diverse health system environments. Limitations: This study has several limitations that should be considered when interpreting the findings. First, the quantitative survey used a purposive, snowball sampling strategy distributed through leadership networks. As a result, the sample might not representative of all healthcare providers or clinics in Saskatchewan, and the findings should be used cautiously as an estimate of the true prevalence of collaborative care models across the province. Relatedly, participation relied on self-report, which introduces the possibility of response bias and variation in how respondents interpreted collaborative care models and components. Second, classification of collaborative care models at the clinic level was based on aggregated participant responses. Where multiple respondents from the same clinic reported different models, all positively identified models were retained. This approach was chosen to avoid under-identifying collaborative practices but may have resulted in some overclassification of model presence in clinics with more responders. The findings should therefore be interpreted as reflecting perceived rather than objectively verified model structures. Conclusion The first province-wide examination of collaborative mental health care models across Saskatchewan, Canada, integrating clinic-level structural characteristics with healthcare provider perspectives demonstrate that collaborative care is widely valued and primarily oriented toward the management of common mental health conditions within primary care settings. However, despite strong endorsement of Integrated care as the most effective model, most clinics continue to operate using Coordinated or hybrid configurations, reflecting pragmatic adaptation to system constraints. Across both quantitative and qualitative findings, persistent system level barriers emerged as key factors limiting consistent and equitable implementation. These gaps were most evident in rural and remote settings underscoring the need for targeted structural investment. Collectively, the findings suggest that advancing collaborative mental health care in Saskatchewan will require more than local innovation or goodwill. Sustainable progress will depend on coordinated system-level strategies, including investment in infrastructure, tailored yet flexible models, stable funding mechanisms, and policies that enable team-based, measurement-informed care. By providing empirically grounded insight into how collaborative care is currently experienced and implemented across diverse settings, this study offers critical evidence to inform the development of a more effective and scalable provincial approach to collaborative mental health care. Declarations All manuscripts must contain the following sections under the heading 'Declarations': Ethics approval and consent to participate The study was approved by the Saskatchewan Health Authority (SHA) Research Ethics Board (REB-23-51) on 22-Feb-24. Consent for publication: Not applicable Availability of data and materials The datasets generated and/or analyzed during the current study are not publicly available because making the data public was not a consideration in the participant consent form, but are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests. Funding: This project was funded by the Department of Psychiatry at the University of Saskatchewan through Alfred G. Molstad Trust and Laura E Chapman Award (2023). Authors' contributions SD was the Principal Investigator who developed the study and secured funding as well as wrote the manuscript. MA was involved in study coordination and manuscript writing. CB was responsible for the creation and management of data collection tools, data analysis, and manuscript writing. AE was involved in participant recruitment. AV performed qualitative data analysis. KS managed both ethics and operational approvals and the creation of data collection tools. All authors read and approved the final manuscript. Acknowledgements The authors wish to thank the Canadian Hub for Applied and Social Research (CHASR) for their expert qualitative guidance throughout this project. We are also deeply appreciative of our grant partners, whose support and collaboration were essential to the completion of this work. Special thanks are extended to Monique Reboe Benjamin for her thoughtful contributions and dedicated assistance in the writing of this manuscript. Authors' information (optional) References Canadian Institute for Health Information. Health system resources for mental health and addictions care in Canada, July 2019 [Internet]. Ottawa (ON): CIHI. 2019. Available from: https://www.cihi.ca/sites/default/files/document/mental-health-chartbook-report-2019-en-web.pdf Mauer-Vakil D, Sunderji N, Webb D, Rudoler D. 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Supplementary Files SupplementaryMaterial2MapofSK.docx SupplementaryMaterial3InterviewGuide.docx SupplementaryMaterial4MappingCCM.docx SupplementaryMaterial5SWOTframework.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 07 May, 2026 Reviewers agreed at journal 26 Apr, 2026 Reviewers invited by journal 22 Apr, 2026 Editor invited by journal 30 Mar, 2026 Editor assigned by journal 28 Mar, 2026 Submission checks completed at journal 28 Mar, 2026 First submitted to journal 27 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9247526","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":631930522,"identity":"ea3fdf86-8274-4c30-832d-625f4cdba871","order_by":0,"name":"Shazia Durrani","email":"data:image/png;base64,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","orcid":"","institution":"University of Saskatchewan","correspondingAuthor":true,"prefix":"","firstName":"Shazia","middleName":"","lastName":"Durrani","suffix":""},{"id":631930523,"identity":"93e66867-e812-49c7-9d5d-36558a36a4fc","order_by":1,"name":"Mariam Alaverdashvili","email":"","orcid":"","institution":"University of Saskatchewan","correspondingAuthor":false,"prefix":"","firstName":"Mariam","middleName":"","lastName":"Alaverdashvili","suffix":""},{"id":631930524,"identity":"423b00b5-3a3e-41ac-aaa1-84f25c0f4eea","order_by":2,"name":"Cameron Bye","email":"","orcid":"","institution":"University of Saskatchewan","correspondingAuthor":false,"prefix":"","firstName":"Cameron","middleName":"","lastName":"Bye","suffix":""},{"id":631930525,"identity":"062fde9e-06bd-4710-9077-66bde096f0be","order_by":3,"name":"Kirat Shukla","email":"","orcid":"","institution":"Saskatchewan Health Authority","correspondingAuthor":false,"prefix":"","firstName":"Kirat","middleName":"","lastName":"Shukla","suffix":""},{"id":631930530,"identity":"a216191c-d675-4d62-9d2c-815ea74a63d2","order_by":4,"name":"Anicha Vickneaswaran","email":"","orcid":"","institution":"University of Saskatchewan","correspondingAuthor":false,"prefix":"","firstName":"Anicha","middleName":"","lastName":"Vickneaswaran","suffix":""},{"id":631930535,"identity":"d4baa8d7-7d84-4bfa-96b2-eb09692271fa","order_by":5,"name":"Ala Eisa","email":"","orcid":"","institution":"University of Saskatchewan","correspondingAuthor":false,"prefix":"","firstName":"Ala","middleName":"","lastName":"Eisa","suffix":""}],"badges":[],"createdAt":"2026-03-27 18:10:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9247526/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9247526/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108495247,"identity":"b858ef45-592e-4faf-93c8-40dead06627c","added_by":"auto","created_at":"2026-05-05 10:09:34","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":624944,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9247526/v1/e7528e10-14e8-4221-9c04-050a009c1487.pdf"},{"id":108241218,"identity":"a487bd68-f61e-47e0-acee-8640c8e304f6","added_by":"auto","created_at":"2026-04-30 20:50:43","extension":"docx","order_by":7,"title":"","display":"","copyAsset":false,"role":"supplement","size":160588,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterial2MapofSK.docx","url":"https://assets-eu.researchsquare.com/files/rs-9247526/v1/b102385a4e3af9a0b859f734.docx"},{"id":108491536,"identity":"8a1be8d3-9514-43cc-8beb-b37dbd68ac8e","added_by":"auto","created_at":"2026-05-05 09:54:25","extension":"docx","order_by":8,"title":"","display":"","copyAsset":false,"role":"supplement","size":17732,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterial3InterviewGuide.docx","url":"https://assets-eu.researchsquare.com/files/rs-9247526/v1/97d9cc9ec20dd85396410a49.docx"},{"id":108241220,"identity":"a9be44fc-2ad0-43cf-b350-a368a9304020","added_by":"auto","created_at":"2026-04-30 20:50:43","extension":"docx","order_by":9,"title":"","display":"","copyAsset":false,"role":"supplement","size":17934,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterial4MappingCCM.docx","url":"https://assets-eu.researchsquare.com/files/rs-9247526/v1/2b81110ac14edaff06f3cb4b.docx"},{"id":108491422,"identity":"b16fdb49-6bbd-4479-a421-d30f61b93c42","added_by":"auto","created_at":"2026-05-05 09:53:52","extension":"docx","order_by":10,"title":"","display":"","copyAsset":false,"role":"supplement","size":17477,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterial5SWOTframework.docx","url":"https://assets-eu.researchsquare.com/files/rs-9247526/v1/250c1a147889edab7adda16c.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Mixed Method Environmental Scan of Collaborative Mental Health Care in Saskatchewan Province, Canada Journal: BMC Health Service Research","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe growing burden of mental-health conditions in Canada has intensified pressure on primary-care systems, where most individuals first seek help for common mental health concerns such as depression and anxiety. Nearly 80% of Canadians with these conditions receive care from a family physician, underscoring the central role of primary care in mental-health service delivery (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Yet despite this reliance, significant gaps persist. Many primary-care providers report limited mental-health training, heavy clinical workloads, and challenges accessing timely psychiatric consultation, all of which contribute to delays in diagnosis, fragmented treatment pathways, and unmet patient needs (\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). These longstanding challenges highlight the need for structured, scalable models that can strengthen primary-care's capacity while improving the quality and consistency of mental health care.\u003c/p\u003e \u003cp\u003e Collaborative Care Models (CCMs) are among the most evidence-supported approaches for integrating mental health services into primary care to improve equitable and timely access to care, quality of care and outcomes. Rooted in interprofessional teamwork, CCMs are defined by four core components: systematic screening and measurement-based care, a designated care manager who coordinates follow-up, regular psychiatric case consultation, and stepped treatment adjustments based on clinical outcomes (\u003cspan additionalcitationids=\"CR6 CR7\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Randomized controlled trials, meta-analyses, and large-scale implementation initiatives have consistently shown that CCMs outperform standard clinical practice, leading to better symptom improvement, higher treatment adherence, increased patient satisfaction, and more efficient use of health-care resources (\u003cspan additionalcitationids=\"CR9 CR10 CR11\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). These benefits are particularly relevant in settings where access to specialized psychiatric care is limited and where primary-care providers shoulder the majority of mental-health management responsibilities.\u003c/p\u003e \u003cp\u003eDespite their demonstrated effectiveness, the adoption and implementation of CCMs in Canada remain uneven. Variation in funding models, workforce capacity, and local health system priorities contributes to inconsistent integration of CCM components across provinces and territories (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Many primary-care clinicians continue to report difficulty accessing psychiatric consultation and a lack of standardized processes to support ongoing collaboration between primary and specialty care (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Even where collaborative models exist, they vary widely in their level of integration, ranging from informal co-location of services to fully Integrated team-based care (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The diversity of these models, while reflective of local needs, also makes it difficult to assess accuracy to evidence-based principles or to scale effective approaches across jurisdictions. Moreover, many CCM initiatives have been developed and evaluated in resource-intensive or highly motivated practice settings, where participating clinicians are committed to the model and adequate infrastructure is available, raising concerns about generalizability to routine, real-world primary care environments.\u003c/p\u003e \u003cp\u003eSaskatchewan represents a critical context in this landscape. The province\u0026rsquo;s geographically dispersed population, variable primary-care infrastructure, and limited psychiatric workforce create unique challenges for delivering timely and Coordinated mental health services. Furthermore, there have been efforts to improve or standardize CCM\u0026rsquo;s. Previous research in this area has documented substantial regional (even provincial) variation in how collaborative mental health care is organized and delivered (\u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). These inconsistencies limit system-level efforts to strengthen primary-care capacity, reduce psychiatric wait times, and align practice with evidence-based collaborative-care principles.\u003c/p\u003e \u003cp\u003eThe objective of this study was to conduct an environmental scan of CCMs currently in Saskatchewan to address these gaps. Specifically, we aimed to (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) identify the current utilization of collaborative mental health care across Saskatchewan, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) examine regional variation in CCMs, and (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) identify common or effective model components that may inform a more tailored provincial approach. A mixed-methods design was employed to achieve these objectives, integrating quantitative and qualitative data to capture both the structural features of CCMs and the perspectives of healthcare providers on implementation, effectiveness, barriers, and facilitators. By identifying gaps, strengths, and areas for improvement in existing models, this project aims to generate evidence to support the development of a patient-centered, evidence-informed collaborative mental health care framework adaptable across diverse regional contexts in Saskatchewan. Such work has the potential to improve access, efficiency, and quality of mental health care, consistent with prior evidence demonstrating the effectiveness of collaborative care in improving patient outcomes and health-system performance. To our knowledge, this is the first province-wide mixed-methods environmental scan of CCM implementation in Saskatchewan, combining provider perceptions with clinic-level structural characteristics.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Setting\u003c/h2\u003e \u003cp\u003eThis study employed a convergent mixed methods (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) design to conduct an environmental scan (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) of CCMs across Saskatchewan, Canada. Quantitative and qualitative data were collected in parallel and integrated during interpretation to provide a comprehensive understanding of the utilization, implementation, and perceived effectiveness of collaborative care in primary and secondary care settings serving adults aged 18 years and older.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipants and Recruitment\u003c/h3\u003e\n\u003cp\u003eParticipants were health care providers involved in the delivery of health care services in Saskatchewan. Eligible participants comprised of primary care and mental health providers (including family physicians and psychiatrists), administrative staff, and individuals in leadership roles such as directors, managers, and provincial area leaders. All participants were involved in services provided to adults with mental health disorders across Saskatchewan.\u003c/p\u003e \u003cp\u003eFor the quantitative component, a director-guided purposive snowball sampling strategy was used because no comprehensive registry of collaborative care clinics or providers exists and relevant roles are often distributed across formal and informal networks. Survey invitations were sent to 12 provincial area leaders, provincial department heads, the Saskatchewan nursing association who then distributed the survey invitations via email to leadership, healthcare providers, and administrative staff within their respective areas. Participation was voluntary, and informed consent was obtained prior to survey completion.\u003c/p\u003e \u003cp\u003eParticipants for the qualitative interviews were drawn from survey respondents who indicated willingness to participate in follow-up interviews. Purposive sampling was used to ensure representation across geographic regions, with 11 healthcare workers interviews conducted.\u003c/p\u003e \u003cp\u003eSampling continued until no new themes emerged and thematic saturation was achieved.\u003c/p\u003e\n\u003ch3\u003eData collection and Definition of terms\u003c/h3\u003e\n\u003cp\u003eThe survey was developed using the online data capture platform REDCap. Demographic and career information was collected to describe the sample of collaborative care users. This included job title and position, the clinic where they work, years worked in healthcare and at that particular clinic, health region and location, and involvement in collaborative care. Descriptions of the collaborative care used included model type, years present at the clinic in question, most common mental health conditions served, and several checklists of the types of services, functions, and supports available at that location. Personal opinions regarding the quality and frequency of various services present in CCMs was also asked. The choice of services, functions, and supports by which to examine CCMs was guided by Kates et al. and Sunderji et al. (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The survey was piloted with one to two physicians to evaluate clarity and relevance, and their feedback informed further refinement of the instrument. Survey data collection occurred between August 2024 \u0026ndash; December 2024. The survey can be found in Supplementary Materials 1.\u003c/p\u003e \u003cp\u003eDuring the survey, participants were presented with the following definitions of location type in the Saskatchewan province, a map of Saskatchewan as seen in Supplementary Materials 2 was also provided for clarification:\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eUrban\u003c/strong\u003e \u003cp\u003eRegina, Saskatoon, Prince Albert, Moose Jaw, Yorkton, North Battleford, Swift Current, Estevan, Weyburn, and Lloydminster.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eRural\u003c/strong\u003e \u003cp\u003eAll communities outside those listed above.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eRemote\u003c/strong\u003e \u003cp\u003eHealth care facilities located a minimum of four hours away from hospital services by ground transportation.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eDuring the survey, participants were presented with the following definitions of CCMs from the Mental Health Commission of Canada:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eCoordinated care\u003c/em\u003e - Referral-triggered periodic exchange of information between clinicians in separate medical and behavioral settings, with minimally shared care plan or clinic culture. In this model, primary and specialist providers maintain separate office structures (21).\u003c/p\u003e\u003cp\u003e \u003cem\u003eCo-located care\u003c/em\u003e - Behavioral and medical clinicians in same space, with regular communication, usually separate systems, but some shared care plans and clinic culture. This model maintains separate administrative arrangements for primary and specialist providers.\u003c/p\u003e\u003cp\u003e \u003cem\u003eIntegrated care\u003c/em\u003e - Shared space and systems with regular communications, mostly unified rather than separate care plans, and largely shared culture and collaborative routines. Providers in this model use the same offices and administrative arrangements.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\n\u003ch3\u003eQualitative Data Collection\u003c/h3\u003e\n\u003cp\u003eQualitative data was collected through semi-structured interviews by an experienced interviewer conducted either virtually (via Zoom) or in person to accommodate geographic dispersion and scheduling constraints. The interview guide was developed by the research team based on the study objectives and relevant literature and is provided in Supplementary Materials 3. The interview guide was piloted with one physician to assess clarity and relevance, and feedback was used to inform subsequent revisions. Interviews explored participants\u0026rsquo; experiences with collaborative care, perceived strengths and weaknesses of current models, barriers and facilitators to implementation, and perspectives on optimal collaborative care design. Interviews ranged in length from 30 to 45 minutes, were audio-recorded with participants\u0026rsquo; consent, and transcribed for analysis.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eQuantitative data was exported from REDCap, cleaned in Microsoft Excel, and analyzed using SPSS (31.0.0.0). Descriptions of the study sample are reported as counts (n) and proportion of total sample (%). We present data on the study sample both as individual participants, as well as individual clinics/hospitals where collaborative care was identified as present. The frequency of services and functions were calculated with an arithmetic average for each CCM type.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eClustering\u003c/h2\u003e \u003cp\u003eMuch of the data is clustered within clinics, i.e., several participants contribute data about the same location. Answers about the type of care model present (objective 1) or the presence of services and functions (objective 3) were determined in an affirmative matter, similar to how individual participant per location responses are treated. This assumes that all positive responses were true. For example, if participant 1 at clinic x says Coordinated care is present, but participant 2 at that same clinic says that Co-located care is present but not Coordinated care; both models are considered to be present, as both were positively reported. Due to this decision, results specific to a CCM are presented both as \u0026ldquo;clinics where this model is present (and potentially other models)\u0026rdquo; and \u0026ldquo;clinics were \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eonly\u003c/span\u003e this model is present (excluding other models)\u0026rdquo;, for distinction. Ratings of service frequency were averaged across participants within the same location.\u003c/p\u003e \u003cp\u003eQualitative data were analysed using thematic approach following the six-phase approach described by Braun and Clarke (2006). An inductive analytic strategy was adopted to allow themes to emerge from the data rather than imposing a predefined coding framework.\u003c/p\u003e \u003cp\u003eInterview transcripts were read repeatedly to ensure familiarity with the data. Two researchers (AV and CB) independently generated initial codes using Microsoft Word and Excel. Codes were then compared and discussed with a third researcher (SD), and discrepancies were resolved through team discussion. A shared coding framework was developed iteratively, and themes and subthemes were refined through ongoing review and reflexive discussion within the research team. This was done to support rigor and credibility. The prevalence of themes was summarized descriptively, and illustrative quotations were selected to reflect the range of perspectives across participants.\u003c/p\u003e \u003cp\u003eAlthough coding was inductive, themes were subsequently organized within a Strengths, Weaknesses, Opportunities, and Threats (SWOT) framework (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e) during the interpretive phase to support structured integration with the quantitative findings and to facilitate interpretation of system-level facilitators and barriers. SWOT was applied only during interpretive integration.\u003c/p\u003e \u003cp\u003eSWOT is a strategic analytic framework used to identify internal and external factors that influence the success of a project or intervention. Strengths and weaknesses refer to internal characteristics that respectively support or hinder effectiveness, while opportunities and threats reflect external conditions that may facilitate or impede success. SWOT has been widely used in implementation and health systems research to inform planning and policy development (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). In this study, the SWOT framework was applied to organize qualitative themes, clarify implementation gaps, and guide future planning and policy related to CCMs across Saskatchewan.\u003c/p\u003e \u003cp\u003eTo enhance rigor, analytic decisions were documented throughout the process, and themes were reviewed by the broader research team to support reflexivity and credibility. The prevalence of themes was summarized descriptively, and illustrative quotations were selected to reflect the range of perspectives across participants.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMixed-methods integration\u003c/h3\u003e\n\u003cp\u003eIntegration occurred at the interpretation stage through triangulation of quantitative and qualitative findings. Qualitative themes were used to contextualize, explain, and elaborate quantitative patterns, particularly in relation to variation in model implementation, perceived effectiveness, and regional inequities.\u003c/p\u003e\n\u003ch3\u003eEthics Approval and Consent\u003c/h3\u003e\n\u003cp\u003e The study was approved by the Saskatchewan Health Authority (SHA) Research Ethics Board (REB-23-51). All participants received a letter of information. For the survey, all participants provided informed written consent before completion. For qualitative interviews, written or verbal informed consent was obtained. All data was de-identified prior to analysis and stored securely in accordance with SHA data security policies.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe findings are presented in two main sections, each with accompanying subsections. The first section reports the quantitative results and integrates them with relevant qualitative themes in relation to the three study objectives: (i) utilization of collaborative mental health care models, (ii) regional variations in collaborative care, and (iii) identification of key components and gaps in implementation. The second section presents the qualitative findings in greater depth to further contextualize and explain the quantitative patterns.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eUtilization of Collaborative Mental Health Care\u003c/h2\u003e \u003cp\u003eTwo-hundred and fourteen survey entries were collected (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Fifty-nine were removed for being empty or non-consenting, leaving a final sample size of N\u0026thinsp;=\u0026thinsp;155. Sample demographics can be found in Tables \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003ea and \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003eb. The majority of participants are physicians, clinic staff, or allied professions (66.5%), the remainder making up leadership roles (26.5%) and a variety of self-described others (12.5%). The majority are female (73.5%), and working at urban centres (73.5%), namely Saskatoon (23.2%) and Regina (40.0%). Participants reported substantial professional experience, with over half indicating more than 10 years working in healthcare, supporting the credibility of responses regarding service organization and delivery.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ea. \u003cb\u003eParticipant demographics of study sample\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDemographics (respondents)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCount\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e% (Total sample)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003eNot disclosed\u003c/p\u003e \u003cp\u003eMissing\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e154\u003c/p\u003e \u003cp\u003e114\u003c/p\u003e \u003cp\u003e34\u003c/p\u003e \u003cp\u003e6\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e99.4%\u003c/p\u003e \u003cp\u003e73.5%\u003c/p\u003e \u003cp\u003e21.9%\u003c/p\u003e \u003cp\u003e3.9%\u003c/p\u003e \u003cp\u003e0.6%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHow long have you been working in healthcare\u003c/b\u003e?\u003c/p\u003e \u003cp\u003e0\u0026ndash;5 years\u003c/p\u003e \u003cp\u003e6\u0026ndash;10 years\u003c/p\u003e \u003cp\u003e11\u0026ndash;15 years\u003c/p\u003e \u003cp\u003e16\u0026ndash;20 years\u003c/p\u003e \u003cp\u003e21\u0026thinsp;+\u0026thinsp;years\u003c/p\u003e \u003cp\u003eMissing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e154\u003c/b\u003e\u003c/p\u003e \u003cp\u003e22\u003c/p\u003e \u003cp\u003e27\u003c/p\u003e \u003cp\u003e34\u003c/p\u003e \u003cp\u003e16\u003c/p\u003e \u003cp\u003e55\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e99.4%\u003c/b\u003e\u003c/p\u003e \u003cp\u003e14.2%\u003c/p\u003e \u003cp\u003e17.4%\u003c/p\u003e \u003cp\u003e21.9%\u003c/p\u003e \u003cp\u003e10.3%\u003c/p\u003e \u003cp\u003e35.5%\u003c/p\u003e \u003cp\u003e0.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePosition/Job title\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e155\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLeadership/Director\u003c/b\u003e\u003c/p\u003e \u003cp\u003eClinician\u003c/p\u003e \u003cp\u003eManager\u003c/p\u003e \u003cp\u003eDirector\u003c/p\u003e \u003cp\u003eCoordinator\u003c/p\u003e \u003cp\u003eOther\u003c/p\u003e \u003cp\u003eCEO\u003c/p\u003e \u003cp\u003eClinical Nurse Educator\u003c/p\u003e \u003cp\u003eED\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e32\u003c/b\u003e\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e16\u003c/p\u003e \u003cp\u003e9\u003c/p\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.6%\u003c/p\u003e \u003cp\u003e0.6%\u003c/p\u003e \u003cp\u003e10.3%\u003c/p\u003e \u003cp\u003e5.8%\u003c/p\u003e \u003cp\u003e1.9%\u003c/p\u003e \u003cp\u003e1.9%\u003c/p\u003e \u003cp\u003e0.6%\u003c/p\u003e \u003cp\u003e0.6%\u003c/p\u003e \u003cp\u003e0.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePhysician/Clinic staff/Allied profession\u003c/b\u003e\u003c/p\u003e \u003cp\u003eFamily doctor\u003c/p\u003e \u003cp\u003ePsychiatrist\u003c/p\u003e \u003cp\u003ePharmacist\u003c/p\u003e \u003cp\u003eNurse\u003c/p\u003e \u003cp\u003eTherapist/ counsellor\u003c/p\u003e \u003cp\u003eSocial work/counsellor/occupational\u003c/p\u003e \u003cp\u003eOther:\u003c/p\u003e \u003cp\u003eAdministrator\u003c/p\u003e \u003cp\u003eAssessor Coordinator\u003c/p\u003e \u003cp\u003eConfidential Administrative Assistant\u003c/p\u003e \u003cp\u003eNurse Practitioner\u003c/p\u003e \u003cp\u003eOccupational Therapist\u003c/p\u003e \u003cp\u003ePsychologist\u003c/p\u003e \u003cp\u003eMissing\u003c/p\u003e \u003cp\u003e\u003cb\u003eOther (non-allied staff)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e103\u003c/b\u003e\u003c/p\u003e \u003cp\u003e19\u003c/p\u003e \u003cp\u003e4\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e11\u003c/p\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e6\u003c/p\u003e \u003cp\u003e8\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e53\u003c/p\u003e \u003cp\u003e\u003cb\u003e20\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e66.5%\u003c/b\u003e\u003c/p\u003e \u003cp\u003e12.3%\u003c/p\u003e \u003cp\u003e2.6%\u003c/p\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003cp\u003e7.1%\u003c/p\u003e \u003cp\u003e1.3%\u003c/p\u003e \u003cp\u003e3.9%\u003c/p\u003e \u003cp\u003e5.2%\u003c/p\u003e \u003cp\u003e0.6%\u003c/p\u003e \u003cp\u003e0.6%\u003c/p\u003e \u003cp\u003e0.6%\u003c/p\u003e \u003cp\u003e1.9%\u003c/p\u003e \u003cp\u003e0.6%\u003c/p\u003e \u003cp\u003e0.6%\u003c/p\u003e \u003cp\u003e34.2%\u003c/p\u003e \u003cp\u003e12.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSpecialty\u003c/b\u003e\u003c/p\u003e \u003cp\u003eFamily Medicine\u003c/p\u003e \u003cp\u003eNursing\u003c/p\u003e \u003cp\u003ePsychiatry\u003c/p\u003e \u003cp\u003ePsychology\u003c/p\u003e \u003cp\u003eSocial Work\u003c/p\u003e \u003cp\u003eOther\u003c/p\u003e \u003cp\u003eMental health/Addictions\u003c/p\u003e \u003cp\u003eAdministration\u003c/p\u003e \u003cp\u003eOccupational health\u003c/p\u003e \u003cp\u003ePrimary care\u003c/p\u003e \u003cp\u003eSexual health\u003c/p\u003e \u003cp\u003eGeriatric medicine\u003c/p\u003e \u003cp\u003eEmergency medicine\u003c/p\u003e \u003cp\u003ePalliative care\u003c/p\u003e \u003cp\u003eMissing\u003c/p\u003e \u003cp\u003eMissing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e154\u003c/b\u003e\u003c/p\u003e \u003cp\u003e49\u003c/p\u003e \u003cp\u003e29\u003c/p\u003e \u003cp\u003e32\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e13\u003c/p\u003e \u003cp\u003e30\u003c/p\u003e \u003cp\u003e9\u003c/p\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e5\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e5\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e99.4%\u003c/b\u003e\u003c/p\u003e \u003cp\u003e31.6%\u003c/p\u003e \u003cp\u003e18.7%\u003c/p\u003e \u003cp\u003e20.6%\u003c/p\u003e \u003cp\u003e0.6%\u003c/p\u003e \u003cp\u003e8.4%\u003c/p\u003e \u003cp\u003e19.4%\u003c/p\u003e \u003cp\u003e5.8%\u003c/p\u003e \u003cp\u003e1.9%\u003c/p\u003e \u003cp\u003e1.9%\u003c/p\u003e \u003cp\u003e3.2%\u003c/p\u003e \u003cp\u003e0.6%\u003c/p\u003e \u003cp\u003e0.6%\u003c/p\u003e \u003cp\u003e0.6%\u003c/p\u003e \u003cp\u003e1.3%\u003c/p\u003e \u003cp\u003e3.2%\u003c/p\u003e \u003cp\u003e0.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eb: Geographical distribution of study sample\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDemographics (respondents)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCount\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e% (Total sample)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHealth area\u003c/b\u003e\u003c/p\u003e \u003cp\u003eSaskatoon\u003c/p\u003e \u003cp\u003eRegina\u003c/p\u003e \u003cp\u003eSouth East\u003c/p\u003e \u003cp\u003eSouth West\u003c/p\u003e \u003cp\u003eSouth Central\u003c/p\u003e \u003cp\u003eNorth East\u003c/p\u003e \u003cp\u003eNorth West\u003c/p\u003e \u003cp\u003eNorth Central\u003c/p\u003e \u003cp\u003eCentral East\u003c/p\u003e \u003cp\u003eCentral West\u003c/p\u003e \u003cp\u003eFar North East\u003c/p\u003e \u003cp\u003eFar North West\u003c/p\u003e \u003cp\u003eAthabasca\u003c/p\u003e \u003cp\u003eMissing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e154\u003c/b\u003e\u003c/p\u003e \u003cp\u003e36\u003c/p\u003e \u003cp\u003e62\u003c/p\u003e \u003cp\u003e13\u003c/p\u003e \u003cp\u003e9\u003c/p\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e10\u003c/p\u003e \u003cp\u003e5\u003c/p\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e10\u003c/p\u003e \u003cp\u003e0\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e99.4%\u003c/b\u003e\u003c/p\u003e \u003cp\u003e23.2%\u003c/p\u003e \u003cp\u003e40.0%\u003c/p\u003e \u003cp\u003e8.4%\u003c/p\u003e \u003cp\u003e5.8%\u003c/p\u003e \u003cp\u003e1.9%\u003c/p\u003e \u003cp\u003e1.3%\u003c/p\u003e \u003cp\u003e6.5%\u003c/p\u003e \u003cp\u003e3.2%\u003c/p\u003e \u003cp\u003e1.9%\u003c/p\u003e \u003cp\u003e0.6%\u003c/p\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003cp\u003e6.5%\u003c/p\u003e \u003cp\u003e0.0%\u003c/p\u003e \u003cp\u003e0.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLocation\u003c/b\u003e\u003c/p\u003e \u003cp\u003eUrban\u003c/p\u003e \u003cp\u003eRural\u003c/p\u003e \u003cp\u003eRemote\u003c/p\u003e \u003cp\u003eBoth\u003c/p\u003e \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e \u003cp\u003eMissing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e154\u003c/b\u003e\u003c/p\u003e \u003cp\u003e114\u003c/p\u003e \u003cp\u003e27\u003c/p\u003e \u003cp\u003e7\u003c/p\u003e \u003cp\u003e5\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e99.4%\u003c/b\u003e\u003c/p\u003e \u003cp\u003e73.5%\u003c/p\u003e \u003cp\u003e17.4%\u003c/p\u003e \u003cp\u003e4.5%\u003c/p\u003e \u003cp\u003e3.2%\u003c/p\u003e \u003cp\u003e0.6%\u003c/p\u003e \u003cp\u003e0.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e[Insert Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003ea. and 1b. here]\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e summarizes the mental health conditions most commonly managed at clinics with CCMs. Across all clinics (N\u0026thinsp;=\u0026thinsp;38), major depression (81.6%), substance dependence (76.3%), and anxiety disorders (73.7%) were most frequently reported and were consistent across model types and clinic configurations. Attention-deficit/hyperactivity disorder was also commonly identified (42.1%). In contrast, severe or specialized conditions including personality disorders (21.1%), psychotic disorders (15.8%), and schizophrenia (10.5%) were less frequently reported, while bipolar affective disorder, autism spectrum disorder, and eating disorders were rarely identified.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinical Populations Served in Collaborative Care Clinic\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBy Clinic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eSingle model only at clinic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eMulti-Model present at clinic\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCoordinated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCo-located\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIntegrated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCoordinated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCo-located\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eIntegrated\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMental Disorder\u003c/b\u003e\u003c/p\u003e \u003cp\u003eSubstance dependence\u003c/p\u003e \u003cp\u003eMajor depression\u003c/p\u003e \u003cp\u003ePanic Disorder\u003c/p\u003e \u003cp\u003eSchizophrenia\u003c/p\u003e \u003cp\u003eAnxiety disorder\u003c/p\u003e \u003cp\u003eBPAD\u003c/p\u003e \u003cp\u003ePersonality disorder\u003c/p\u003e \u003cp\u003eADHD\u003c/p\u003e \u003cp\u003eAutism Spectrum disorder\u003c/p\u003e \u003cp\u003ePsychotic disorders\u003c/p\u003e \u003cp\u003eEating disorders\u003c/p\u003e \u003cp\u003eOther (not listed above)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29 (76.3)\u003c/p\u003e \u003cp\u003e31 (81.6\u003c/p\u003e \u003cp\u003e1 (2.6)\u003c/p\u003e \u003cp\u003e4 (10.5)\u003c/p\u003e \u003cp\u003e28 (73.7)\u003c/p\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003cp\u003e8 (21.1)\u003c/p\u003e \u003cp\u003e16 (42.1)\u003c/p\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003cp\u003e6 (15.8)\u003c/p\u003e \u003cp\u003e1 (2.6)\u003c/p\u003e \u003cp\u003e5 (13.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (81.8)\u003c/p\u003e \u003cp\u003e9 (81.8)\u003c/p\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003cp\u003e10 (90.0)\u003c/p\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003cp\u003e2 (18.2)\u003c/p\u003e \u003cp\u003e1 (9.1)\u003c/p\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003cp\u003e1 (9.1)\u003c/p\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003cp\u003e2 (18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (57.1)\u003c/p\u003e \u003cp\u003e6 (85.7)\u003c/p\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003cp\u003e5 (71.4)\u003c/p\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003cp\u003e5 (71.4)\u003c/p\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003cp\u003e1 (14.3)\u003c/p\u003e \u003cp\u003e1 (14.3)\u003c/p\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (77.8)\u003c/p\u003e \u003cp\u003e7 (77.8)\u003c/p\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003cp\u003e2 (22.2)\u003c/p\u003e \u003cp\u003e6 (66.7)\u003c/p\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003cp\u003e1 (11.1)\u003c/p\u003e \u003cp\u003e3 (33.3)\u003c/p\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003cp\u003e2 (22.2)\u003c/p\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003cp\u003e2 (22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16 (80.0)\u003c/p\u003e \u003cp\u003e17 (85.0)\u003c/p\u003e \u003cp\u003e1 (5.0)\u003c/p\u003e \u003cp\u003e2 (10.0)\u003c/p\u003e \u003cp\u003e17 (85.0)\u003c/p\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003cp\u003e6 (30.0)\u003c/p\u003e \u003cp\u003e7 (35.0)\u003c/p\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003cp\u003e2 (10.0)\u003c/p\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003cp\u003e3 (15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e11 (78.6)\u003c/p\u003e \u003cp\u003e12 (85.7)\u003c/p\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003cp\u003e2 (14.2)\u003c/p\u003e \u003cp\u003e9 (64.3)\u003c/p\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003cp\u003e4 (28.6)\u003c/p\u003e \u003cp\u003e9 (64.3)\u003c/p\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003cp\u003e3 (21.4)\u003c/p\u003e \u003cp\u003e1 (7.1)\u003c/p\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e15 (78.9)\u003c/p\u003e \u003cp\u003e15 (78.9)\u003c/p\u003e \u003cp\u003e1 (5.3)\u003c/p\u003e \u003cp\u003e4 (21.1)\u003c/p\u003e \u003cp\u003e12 (63.2)\u003c/p\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003cp\u003e6 (31.6)\u003c/p\u003e \u003cp\u003e10 (52.6)\u003c/p\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003cp\u003e4 (21.1)\u003c/p\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003cp\u003e3 (15.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eNote: Values are presented as n (%).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e[Insert\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e \u003cem\u003ehere]\u003c/em\u003e.\u003c/p\u003e \u003cp\u003eOverall, collaborative care in Saskatchewan is primarily utilized for the management of common, high-prevalence mental health conditions typically addressed in primary care settings. Interview participants described collaborative care as supporting primary care clinicians in managing both common and complex presentations rather than transferring care to specialty services. Participants emphasized the value of timely consultation for clinical decision-making. However, much of this collaboration was described as occurring informally rather than through structured systems. One participant reflected that while ad hoc \u0026ldquo;hallway\u0026rdquo; consultations were common, they were suboptimal for quality and continuity of care:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Those are happening a lot in the hallway\u0026hellip; I don\u0026rsquo;t love the hallway for that because\u0026hellip; it doesn\u0026rsquo;t allow us sort of documentation\u0026hellip; it relies on memory.\u0026rdquo;\u003c/em\u003e Q02\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eRegional Variation in Collaborative Care Models\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e depicts the CCMs present in Saskatchewan. Eleven of 32 (34.4%) leadership respondents report overseeing a CCMs where they work and 54.8% of all respondents claim to work at a clinic where a CCM is used. Of these 11 leadership participants, 7 (63.6%) oversee Coordinated models, 6 (54.5%) Integrated models, and only 2 (18.2%) Co-located models. The most common model of collaborative care seen in respondents is Coordinated (51.5%), followed by Integrated (40.0%) and then Co-located (29.4%). Many respondents report multiple model types being present where they work.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCollaborative Care Models by respondent\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eLeadership \u0026ndash; Do you oversee a Collaborative Care clinic?\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eI\u0026rsquo;m not sure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCount\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e% (Total, N\u0026thinsp;=\u0026thinsp;155)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e% (Sub-category)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003cp\u003e11\u003c/p\u003e \u003cp\u003e16\u003c/p\u003e \u003cp\u003e5\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.6%\u003c/p\u003e \u003cp\u003e7.1%\u003c/p\u003e \u003cp\u003e10.3%\u003c/p\u003e \u003cp\u003e3.2%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100.0%\u003c/p\u003e \u003cp\u003e34.4%\u003c/p\u003e \u003cp\u003e50.0%\u003c/p\u003e \u003cp\u003e15.6%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLeadership \u0026ndash; Do you oversee a Collaborative Care clinic? (yes)\u003c/p\u003e \u003cp\u003eCoordinated\u003c/p\u003e \u003cp\u003eCo-located\u003c/p\u003e \u003cp\u003eIntegrated\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003cp\u003e7\u003c/p\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e6\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.1%\u003c/p\u003e \u003cp\u003e4.5%\u003c/p\u003e \u003cp\u003e1.3%\u003c/p\u003e \u003cp\u003e3.9%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e100.0%\u003c/p\u003e \u003cp\u003e63.6%\u003c/p\u003e \u003cp\u003e18.2%\u003c/p\u003e \u003cp\u003e54.5%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIs there a Collaborative Care model currently in use at the clinic where you work?\u003c/b\u003e\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e \u003cp\u003eMissing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e133\u003c/b\u003e\u003c/p\u003e \u003cp\u003e85\u003c/p\u003e \u003cp\u003e25\u003c/p\u003e \u003cp\u003e23\u003c/p\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e85.8%\u003c/b\u003e\u003c/p\u003e \u003cp\u003e54.8%\u003c/p\u003e \u003cp\u003e16.1%\u003c/p\u003e \u003cp\u003e14.8%\u003c/p\u003e \u003cp\u003e14.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e100.0%\u003c/b\u003e\u003c/p\u003e \u003cp\u003e63.9%\u003c/p\u003e \u003cp\u003e18.8%\u003c/p\u003e \u003cp\u003e17.3%\u003c/p\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhat type of Collaborative Care model is present where you work?\u003c/b\u003e\u003c/p\u003e \u003cp\u003eCoordinated\u003c/p\u003e \u003cp\u003eCo-located\u003c/p\u003e \u003cp\u003eIntegrated\u003c/p\u003e \u003cp\u003eCoordinated only\u003c/p\u003e \u003cp\u003eCo-located only\u003c/p\u003e \u003cp\u003eIntegrated only\u003c/p\u003e \u003cp\u003eCoordinated\u0026thinsp;+\u0026thinsp;Co-located\u003c/p\u003e \u003cp\u003eCoordinated\u0026thinsp;+\u0026thinsp;Integrated\u003c/p\u003e \u003cp\u003eCo-located\u0026thinsp;+\u0026thinsp;Integrated\u003c/p\u003e \u003cp\u003eCoordinated\u0026thinsp;+\u0026thinsp;Co-located+\u003c/p\u003e \u003cp\u003eIntegrated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e85\u003c/b\u003e\u003c/p\u003e \u003cp\u003e44\u003c/p\u003e \u003cp\u003e25\u003c/p\u003e \u003cp\u003e34\u003c/p\u003e \u003cp\u003e32\u003c/p\u003e \u003cp\u003e14\u003c/p\u003e \u003cp\u003e24\u003c/p\u003e \u003cp\u003e5\u003c/p\u003e \u003cp\u003e4\u003c/p\u003e \u003cp\u003e3\u003c/p\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e54.8%\u003c/b\u003e\u003c/p\u003e \u003cp\u003e28.4%\u003c/p\u003e \u003cp\u003e16.1%\u003c/p\u003e \u003cp\u003e21.9%\u003c/p\u003e \u003cp\u003e20.6%\u003c/p\u003e \u003cp\u003e9.0%\u003c/p\u003e \u003cp\u003e15.5%\u003c/p\u003e \u003cp\u003e3.2%\u003c/p\u003e \u003cp\u003e2.6%\u003c/p\u003e \u003cp\u003e1.9%\u003c/p\u003e \u003cp\u003e1.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e100.0%\u003c/b\u003e\u003c/p\u003e \u003cp\u003e51.8%\u003c/p\u003e \u003cp\u003e29.4%\u003c/p\u003e \u003cp\u003e40.0%\u003c/p\u003e \u003cp\u003e37.6%\u003c/p\u003e \u003cp\u003e16.5%\u003c/p\u003e \u003cp\u003e28.2%\u003c/p\u003e \u003cp\u003e5.9%\u003c/p\u003e \u003cp\u003e4.7%\u003c/p\u003e \u003cp\u003e3.5%\u003c/p\u003e \u003cp\u003e3.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eSome numbers may overlap due to respondents claiming multiple models at the same location\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e[Insert\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e \u003cem\u003ehere]\u003c/em\u003e\u003c/p\u003e \u003cp\u003eAfter clustering respondent data by location, 38 clinics were identified as using collaborative care. Only 2 out of the 25 respondents who said that no CCM was not present at the clinic they worked actually named the clinic, and so comparison results between collaborative and non-collaborative clinics (or estimate collaborative care prevalence) is not possible (Supplementary Materials 4). Due to the small workforce at many of these clinics, particularly in rural locations, clinics are not named to ensure the anonymity of our survey respondents.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e4\u003c/span\u003e contains the areas and regions of these individual clinics, along with the types of CCMs reported there and an estimation of how long it has been in use (Supplementary 4). Following the trends seen in individual participant responses, Saskatoon and Regina, the two largest cities in Saskatchewan, have the most clinics identified with 10 (26.3%) and 12 (31.6%) respectively. Across the province, various model types and combinations are seen, with Coordinated being the most common followed by Integrated and then Co-located. In clinics that use multiple models of CCMs, a breakdown of model types shows that 20 clinics use Coordinated care in some capacity, 19 use Integrated care, and 14 Co-located care as shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCollaborative care clinics location per health region\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBy Clinic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eSingle model only at clinic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eMulti-Model present at clinic\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;38\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCoordinated\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;11\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCo-located\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;7\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIntegrated\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;9\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCoordinated\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;20\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCo-located\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;14\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eIntegrated\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;19\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eArea\u003c/b\u003e\u003c/p\u003e \u003cp\u003eSaskatoon\u003c/p\u003e \u003cp\u003eRegina\u003c/p\u003e \u003cp\u003eSouth East\u003c/p\u003e \u003cp\u003eSouth West\u003c/p\u003e \u003cp\u003eSouth Central\u003c/p\u003e \u003cp\u003eNorth East\u003c/p\u003e \u003cp\u003eNorth West\u003c/p\u003e \u003cp\u003eNorth Central\u003c/p\u003e \u003cp\u003eCentral East\u003c/p\u003e \u003cp\u003eCentral West\u003c/p\u003e \u003cp\u003eFar North East\u003c/p\u003e \u003cp\u003eFar North West\u003c/p\u003e \u003cp\u003eAthabasca\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e38\u003c/b\u003e\u003c/p\u003e \u003cp\u003e10 (26.3)\u003c/p\u003e \u003cp\u003e12 (31.6)\u003c/p\u003e \u003cp\u003e3 (7.9)\u003c/p\u003e \u003cp\u003e5 (13.2)\u003c/p\u003e \u003cp\u003e1 (2.6)\u003c/p\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003cp\u003e3 (7.9)\u003c/p\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003cp\u003e1 (2.6)\u003c/p\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003cp\u003e3 (7.9)\u003c/p\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (18.5)\u003c/p\u003e \u003cp\u003e5 (45.5)\u003c/p\u003e \u003cp\u003e1 (9.1)\u003c/p\u003e \u003cp\u003e1 (9.1)\u003c/p\u003e \u003cp\u003e1 (9.1)\u003c/p\u003e \u003cp\u003e1 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (42.9)\u003c/p\u003e \u003cp\u003e1 (14.3)\u003c/p\u003e \u003cp\u003e2 (28.6)\u003c/p\u003e \u003cp\u003e1 (14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2 (22.2)\u003c/p\u003e \u003cp\u003e2 (22.2)\u003c/p\u003e \u003cp\u003e2 (22.2)\u003c/p\u003e \u003cp\u003e1 (11.1)\u003c/p\u003e \u003cp\u003e1 (11.1)\u003c/p\u003e \u003cp\u003e1 11.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4 (20.0)\u003c/p\u003e \u003cp\u003e9 (45.0)\u003c/p\u003e \u003cp\u003e2 (10.0)\u003c/p\u003e \u003cp\u003e1 (5.0)\u003c/p\u003e \u003cp\u003e2 (10.0)\u003c/p\u003e \u003cp\u003e1 (5.0)\u003c/p\u003e \u003cp\u003e1 (5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4 (28.6)\u003c/p\u003e \u003cp\u003e4 (28.6)\u003c/p\u003e \u003cp\u003e1 (7.1)\u003c/p\u003e \u003cp\u003e3 (21.4)\u003c/p\u003e \u003cp\u003e1 (7.1)\u003c/p\u003e \u003cp\u003e1 (7.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5 (26.3)\u003c/p\u003e \u003cp\u003e7 (36.8)\u003c/p\u003e \u003cp\u003e2 (10.5)\u003c/p\u003e \u003cp\u003e2 (10.5)\u003c/p\u003e \u003cp\u003e2 (10.5)\u003c/p\u003e \u003cp\u003e1 (5.3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eNote: Values are presented as n (%).\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e[Insert\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e4\u003c/span\u003e \u003cem\u003ehere]\u003c/em\u003e\u003c/p\u003e \u003cp\u003eNo trends or differences are found in the years a model has been in use by model type or area. When examining possible differences in model types between urban and rural regions, very little difference is seen in the relative number and type of clinic models (Supplementary Table\u0026nbsp;4). Regarding complexity of model usage, 1of 10 (10.0%) rural collaborative care clinics have more than 1 model present while 10 of 27 (37.0%) of urban clinics have more than 1 model type.\u003c/p\u003e \u003cp\u003e During interviews, participants consistently emphasized that CCMs must be adapted to local context and that infrastructure, staffing, and resources varied substantially across settings. Several described inequitable access to collaborative supports in rural areas, noting the absence of local mental health professionals:\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eWe don\u0026rsquo;t have any mental health care providers, like social workers, counsellors, psychologists. We have none of that\u003c/em\u003e.\u0026rdquo; (Q07)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eIdentify effective collaborative care components, implementation gaps and system-level needs\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e5\u003c/span\u003e summarizes respondents\u0026rsquo; perceptions of the collaborative care model that works best. Overall, Coordinated collaborative care was most frequently endorsed (60.6%), followed by Integrated (12.9%) and Co-located care (10.9%), while 15.9% of respondents reported no opinion.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePerceived Effectiveness of Collaborative Mental Health Care Model\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurvey question\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c6\" namest=\"c2\"\u003e \u003cp\u003eWhich model do you think works best?\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRespondents (n)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003cp\u003e132 (100)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCoordinated 17 (12.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCo-located\u003c/p\u003e \u003cp\u003e14 (10.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIntegrated\u003c/p\u003e \u003cp\u003e80 (60.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNo opinion\u003c/p\u003e \u003cp\u003e21 (15.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCollaborative Care Clinic where you work?\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003cp\u003eI don\u0026rsquo;t know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84\u003c/p\u003e \u003cp\u003e25\u003c/p\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (13.1)\u003c/p\u003e \u003cp\u003e4 (16.0)\u003c/p\u003e \u003cp\u003e2 (8.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (11.9)\u003c/p\u003e \u003cp\u003e4 (16.0)\u003c/p\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e54 (64.3)\u003c/p\u003e \u003cp\u003e14 (56.0)\u003c/p\u003e \u003cp\u003e12 (52.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9 (10.7)\u003c/p\u003e \u003cp\u003e3 (12.0)\u003c/p\u003e \u003cp\u003e9 (39.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePosition/Title\u003c/p\u003e \u003cp\u003ePhysician/staff\u003c/p\u003e \u003cp\u003eLeadership\u003c/p\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e94\u003c/p\u003e \u003cp\u003e20\u003c/p\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (11.7)\u003c/p\u003e \u003cp\u003e2 (10.0)\u003c/p\u003e \u003cp\u003e4 (22.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (10.6)\u003c/p\u003e \u003cp\u003e1 (5.0)\u003c/p\u003e \u003cp\u003e3 (16.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e57 (60.6)\u003c/p\u003e \u003cp\u003e16 (80.0)\u003c/p\u003e \u003cp\u003e7 (38.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16 (17.0)\u003c/p\u003e \u003cp\u003e1 (5.0)\u003c/p\u003e \u003cp\u003e4 (22.2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpecialty\u003c/p\u003e \u003cp\u003eFamily Medicine\u003c/p\u003e \u003cp\u003eNursing\u003c/p\u003e \u003cp\u003ePsychiatry\u003c/p\u003e \u003cp\u003ePsychology\u003c/p\u003e \u003cp\u003eSocial Work\u003c/p\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003cp\u003e26\u003c/p\u003e \u003cp\u003e29\u003c/p\u003e \u003cp\u003e01\u003c/p\u003e \u003cp\u003e11\u003c/p\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (7.0)\u003c/p\u003e \u003cp\u003e3 (11.5)\u003c/p\u003e \u003cp\u003e4 (13.8)\u003c/p\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003cp\u003e3 (27.3)\u003c/p\u003e \u003cp\u003e4 (18.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (11.6)\u003c/p\u003e \u003cp\u003e2 (7.7)\u003c/p\u003e \u003cp\u003e3 (10.3)\u003c/p\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003cp\u003e2 (18.2)\u003c/p\u003e \u003cp\u003e2 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29 (67.4)\u003c/p\u003e \u003cp\u003e18 (69.2)\u003c/p\u003e \u003cp\u003e13 (44.8)\u003c/p\u003e \u003cp\u003e1 (100.0)\u003c/p\u003e \u003cp\u003e5 (45.5)\u003c/p\u003e \u003cp\u003e14 (63.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6 (14.0)\u003c/p\u003e \u003cp\u003e3 (11.5)\u003c/p\u003e \u003cp\u003e9 (31.0)\u003c/p\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003cp\u003e1 (9.1)\u003c/p\u003e \u003cp\u003e2 (9.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eNote: Values are presented as n (%), with percentages calculated within each subgroup. Missing responses (n\u0026thinsp;=\u0026thinsp;23) are included in the overall denominator\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAmong respondents working in clinics with an established collaborative care clinic, 64.3% identified Integrated care as most effective, compared with 56.0% among those without a collaborative care clinic and 52.2% among those unsure whether a collaborative care clinic existed. Respondents uncertain about the presence of a collaborative care clinic were more likely to report no opinion (39.1%) than those working in clinics with (10.7%) or without (12.0%) collaborative care.\u003c/p\u003e \u003cp\u003eBy position, endorsement of Integrated care was highest among leadership respondents (80.0%), followed by physician and clinic staff (60.6%) and respondents in other roles (38.9%). Across clinical specialties, Integrated care was most frequently endorsed by psychology (100.0%), nursing (69.2%), family medicine (67.4%), and other disciplines (63.6%), while endorsement was lower among psychiatrists (44.8%).\u003c/p\u003e \u003cp\u003e[\u003cem\u003eInsert\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e5\u003c/span\u003e \u003cem\u003ehere\u003c/em\u003e]\u003c/p\u003e \u003cp\u003eQualitative data clarified why integrated approaches were valued. Participants described improved efficiency, increased clinical confidence, and better patient outcomes when access to team-based consultation was available and functioned well. These accounts help explain the high perceived effectiveness of Integrated care observed in the survey.\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eHaving like, access to a psychologist who can do those cognitive assessments\u0026hellip; makes things so much easier, because then you can [create a] treatment plan appropriately\u0026hellip; the benefits of it have been outstanding.\u003c/em\u003e\u0026rdquo; (Q09)\u003c/p\u003e \u003cp\u003e\u0026ldquo;\u003cem\u003eAll of that maneuvering is happening behind the scenes\u0026hellip; so the client is just getting the care at the right time, at the right place so there\u0026rsquo;s no wrong door\u0026rdquo;\u003c/em\u003e (Q04)\u003c/p\u003e \u003cp\u003eAcross all clinics, patient education (84.2%) and education between services or providers (73.7%) were the most frequently reported functions, regardless of model type (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e6\u003c/span\u003e). In contrast, data collection for quality improvement (44.7%) and formal billing methods specific to collaborative care (23.7%) were least commonly reported, indicating gaps in system-level infrastructure. Participants described structural and funding limitations as barriers to sustainability and consistency of collaborative care. One participant noted the fragility of existing supports:\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAvailability of Collaborative Care Services, Supports, and Functions by Model Type\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eModel type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eSingle model only at clinic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eMulti-Model present at clinic\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll Clinics\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;38\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCoordinated\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;7\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCo-located\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;7\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIntegrated N\u0026thinsp;=\u0026thinsp;9\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCoordinated N\u0026thinsp;=\u0026thinsp;20\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCo-located\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;14\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eIntegrated\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;19\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eServices/Supports/Functions\u003c/p\u003e \u003cp\u003ePatient education\u003c/p\u003e \u003cp\u003eEducation between services/providers\u003c/p\u003e \u003cp\u003eQuality improvement data collection\u003c/p\u003e \u003cp\u003eProactive patient follow-up\u003c/p\u003e \u003cp\u003eEnhanced patient care\u003c/p\u003e \u003cp\u003eAccess to tools (telehealth, e-health)\u003c/p\u003e \u003cp\u003eShared access to a medical database\u003c/p\u003e \u003cp\u003eTools for standardized assessment\u003c/p\u003e \u003cp\u003eTriage\u003c/p\u003e \u003cp\u003eDecision support\u003c/p\u003e \u003cp\u003eTeam-based structure to CC\u003c/p\u003e \u003cp\u003eBilling method\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (84.2)\u003c/p\u003e \u003cp\u003e28 (73.7)\u003c/p\u003e \u003cp\u003e17 (44.7)\u003c/p\u003e \u003cp\u003e20 (52.6)\u003c/p\u003e \u003cp\u003e21 (55.3)\u003c/p\u003e \u003cp\u003e20 (52.6)\u003c/p\u003e \u003cp\u003e22 (57.9)\u003c/p\u003e \u003cp\u003e23 (60.5)\u003c/p\u003e \u003cp\u003e20 (52.6)\u003c/p\u003e \u003cp\u003e18 (47.4)\u003c/p\u003e \u003cp\u003e21 (55.3)\u003c/p\u003e \u003cp\u003e9 (23.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (81.8)\u003c/p\u003e \u003cp\u003e6 (54.5)\u003c/p\u003e \u003cp\u003e4 (36.4)\u003c/p\u003e \u003cp\u003e5 (45.5)\u003c/p\u003e \u003cp\u003e4 (36.4)\u003c/p\u003e \u003cp\u003e2 (18.2)\u003c/p\u003e \u003cp\u003e4 (36.4)\u003c/p\u003e \u003cp\u003e6 (54.5)\u003c/p\u003e \u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e6\u003c/span\u003e (54.5)\u003c/p\u003e \u003cp\u003e5 (45.5)\u003c/p\u003e \u003cp\u003e3 (27.3)\u003c/p\u003e \u003cp\u003e1 (9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (100.0)\u003c/p\u003e \u003cp\u003e7 (100.0)\u003c/p\u003e \u003cp\u003e4 (57.1)\u003c/p\u003e \u003cp\u003e3 (42.9)\u003c/p\u003e \u003cp\u003e4 (57.1)\u003c/p\u003e \u003cp\u003e3 (42.9)\u003c/p\u003e \u003cp\u003e4 (57.1)\u003c/p\u003e \u003cp\u003e4 (57.1)\u003c/p\u003e \u003cp\u003e4 (57.1)\u003c/p\u003e \u003cp\u003e3 (42.9)\u003c/p\u003e \u003cp\u003e4 (57.1)\u003c/p\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (77.8)\u003c/p\u003e \u003cp\u003e6 (66.7)\u003c/p\u003e \u003cp\u003e2 (22.2)\u003c/p\u003e \u003cp\u003e5 (55.6)\u003c/p\u003e \u003cp\u003e3 (33.3)\u003c/p\u003e \u003cp\u003e4 (44.4)\u003c/p\u003e \u003cp\u003e6 (66.7)\u003c/p\u003e \u003cp\u003e5 (55.6)\u003c/p\u003e \u003cp\u003e3 (33.3)\u003c/p\u003e \u003cp\u003e3 (33.3)\u003c/p\u003e \u003cp\u003e5 (55.6)\u003c/p\u003e \u003cp\u003e3 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16 (80.0)\u003c/p\u003e \u003cp\u003e13 (65.0)\u003c/p\u003e \u003cp\u003e9 (45.0)\u003c/p\u003e \u003cp\u003e11 (55.0)\u003c/p\u003e \u003cp\u003e12 (60.0)\u003c/p\u003e \u003cp\u003e11 (55.0)\u003c/p\u003e \u003cp\u003e11 (55.0)\u003c/p\u003e \u003cp\u003e13 (65.0)\u003c/p\u003e \u003cp\u003e11 (55.0)\u003c/p\u003e \u003cp\u003e11 (55.0)\u003c/p\u003e \u003cp\u003e10 (50.0)\u003c/p\u003e \u003cp\u003e4 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e13 (92.9)\u003c/p\u003e \u003cp\u003e13 (92.9)\u003c/p\u003e \u003cp\u003e9 (64.3)\u003c/p\u003e \u003cp\u003e7 (50.0)\u003c/p\u003e \u003cp\u003e11 (78.6)\u003c/p\u003e \u003cp\u003e10 (71.4)\u003c/p\u003e \u003cp\u003e9 (64.3)\u003c/p\u003e \u003cp\u003e9 (64.3)\u003c/p\u003e \u003cp\u003e10 (71.4)\u003c/p\u003e \u003cp\u003e7 (50.0)\u003c/p\u003e \u003cp\u003e10 (71.4)\u003c/p\u003e \u003cp\u003e3 (21.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e15 (78.9)\u003c/p\u003e \u003cp\u003e14 (73.7)\u003c/p\u003e \u003cp\u003e9 (47.4)\u003c/p\u003e \u003cp\u003e11 (57.9)\u003c/p\u003e \u003cp\u003e12 (63.2)\u003c/p\u003e \u003cp\u003e14 (73.7)\u003c/p\u003e \u003cp\u003e13 (68.4)\u003c/p\u003e \u003cp\u003e12 (63.2)\u003c/p\u003e \u003cp\u003e9 (47.4)\u003c/p\u003e \u003cp\u003e9 (47.4)\u003c/p\u003e \u003cp\u003e14 (73.7)\u003c/p\u003e \u003cp\u003e8 (42.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eNote: Values are presented as n (%). Counts and percentages are based on the number of clinics where a participant who works there responds \u0026ldquo;yes\u0026rdquo; to the presence of the services, supports, or functions listed. *CC =Collaborative Care\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Part of the money that we raised through the grant was to pay for overhead in the clinic that wouldn\u0026rsquo;t otherwise have been covered.\u0026rdquo;\u003c/em\u003e (Q11)\u003c/p\u003e \u003cp\u003e Clinics operating Integrated models demonstrated a broader and more consistent presence of core collaborative care functions compared with Coordinated and Co-located models. Integrated models most frequently reported patient education and inter-provider education (both 100.0%), as well as shared data systems, standardized assessment tools, and team-based structures. In contrast, clinics operating Coordinated-only models reported lower availability of key functions, particularly telehealth tools, shared databases, and formal decision support.\u003c/p\u003e \u003cp\u003e Clinics reporting multiple collaborative care models showed higher overall availability of services and supports across all model types. Integrated models within multi-model clinics reported the highest prevalence of key components, including education between services or providers (92.9%), data collection for quality improvement (64.3%), enhanced patient care (78.6%), telehealth or e-health tools (71.4%), and team-based collaborative care structures (71.4%). Coordinated and Co-located models within multi-model clinics also demonstrated greater functional breadth than their single-model counterparts but continued to lag behind Integrated models on system-level supports such as quality improvement infrastructure and billing mechanisms.\u003c/p\u003e \u003cp\u003e[\u003cem\u003eInsert\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e6\u003c/span\u003e \u003cem\u003ehere\u003c/em\u003e]\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e7\u003c/span\u003e shows that most processes were reported as present often to almost always (means 4.2\u0026ndash;4.7). Patient involvement in decision making (mean\u0026thinsp;=\u0026thinsp;4.7) and clarity of team roles (mean\u0026thinsp;=\u0026thinsp;4.6) were rated highest, while wait times between services were lowest (mean\u0026thinsp;=\u0026thinsp;4.2). Integrated and multi-model clinics (50.0%) reported consistently higher mean scores for data sharing, referral efficiency, and care management, whereas Coordinated-only clinics (28.9%) reported lower scores, particularly for data accessibility and wait times, indicating more limited operational integration.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFrequency of Core Collaborative Care Processes Across Clinics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModel\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003eSingle model only at clinic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c8\" namest=\"c6\"\u003e \u003cp\u003eMulti-Model present at clinic\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eSurvey questions on clinic process\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAll\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCoordinated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eCo-located\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIntegrated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCoordinated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eCo-located\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eIntegrated\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Client data/information is shared and easily accessible\u003c/p\u003e \u003cp\u003e2. Patients referral between care providers are efficient and streamlined\u003c/p\u003e \u003cp\u003e3. Discharge of patients is done easily\u003c/p\u003e \u003cp\u003e4. The roles and responsibilities of each team member are clear\u003c/p\u003e \u003cp\u003e5. The wait times between services are reasonable\u003c/p\u003e \u003cp\u003e6. Collaborative care at the clinic is being well managed\u003c/p\u003e \u003cp\u003e7. Patients are involved in decision making\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.4\u003c/p\u003e \u003cp\u003e4.5\u003c/p\u003e \u003cp\u003e4.6\u003c/p\u003e \u003cp\u003e4.6\u003c/p\u003e \u003cp\u003e4.2\u003c/p\u003e \u003cp\u003e4.4\u003c/p\u003e \u003cp\u003e4.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.7\u003c/p\u003e \u003cp\u003e3.6\u003c/p\u003e \u003cp\u003e4.4\u003c/p\u003e \u003cp\u003e4.3\u003c/p\u003e \u003cp\u003e3.6\u003c/p\u003e \u003cp\u003e3.6\u003c/p\u003e \u003cp\u003e4.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.4\u003c/p\u003e \u003cp\u003e4.6\u003c/p\u003e \u003cp\u003e4.7\u003c/p\u003e \u003cp\u003e4.6\u003c/p\u003e \u003cp\u003e4.3\u003c/p\u003e \u003cp\u003e4.5\u003c/p\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.9\u003c/p\u003e \u003cp\u003e4.9\u003c/p\u003e \u003cp\u003e4.3\u003c/p\u003e \u003cp\u003e4.5\u003c/p\u003e \u003cp\u003e4.5\u003c/p\u003e \u003cp\u003e4.4\u003c/p\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.4\u003c/p\u003e \u003cp\u003e4.3\u003c/p\u003e \u003cp\u003e4.7\u003c/p\u003e \u003cp\u003e4.6\u003c/p\u003e \u003cp\u003e4.0\u003c/p\u003e \u003cp\u003e4.3\u003c/p\u003e \u003cp\u003e4.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.5\u003c/p\u003e \u003cp\u003e4.8\u003c/p\u003e \u003cp\u003e4.7\u003c/p\u003e \u003cp\u003e4.7\u003c/p\u003e \u003cp\u003e4.4\u003c/p\u003e \u003cp\u003e4.7\u003c/p\u003e \u003cp\u003e5.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.0\u003c/p\u003e \u003cp\u003e5.2\u003c/p\u003e \u003cp\u003e4.7\u003c/p\u003e \u003cp\u003e4.8\u003c/p\u003e \u003cp\u003e4.6\u003c/p\u003e \u003cp\u003e4.9\u003c/p\u003e \u003cp\u003e5.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003eResponse scale is 1\u0026ndash;6 Likert scale ranging from never (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) to Always (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Values in the table are averages of the coded responses across clinics.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e[\u003cem\u003eInsert\u003c/em\u003e Table\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e7\u003c/span\u003e \u003cem\u003ehere\u003c/em\u003e]\u003c/p\u003e \u003cp\u003eTogether, Tables \u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e6\u003c/span\u003e and \u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e7\u003c/span\u003e demonstrate that Integrated and multi-model type clinics have a broader range of collaborative care components, reporting more consistently implemented and higher-functioning collaborative care processes.\u003c/p\u003e \u003cp\u003e \u003cb\u003eExpanded Qualitative Findings (SWOT Analysis of Healthcare Worker Perspectives)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003eQualitative findings are summarized in Supplementary Materials 5 and are organized within a Strengths, Weaknesses, Opportunities, and Threats (SWOT) framework. Rather than representing discrete categories, the findings illustrate how collaborative care is currently functioning in practice and reveal important tensions and contradictions within existing models. In particular, many themes reflected paradoxes as the same features were described as both enabling and constraining care highlighting that collaborative care in Saskatchewan is often sustained through adaptation and improvisation rather than formalized systems.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eStrengths of Existing Collaborative Practices\u003c/h2\u003e \u003cp\u003eParticipants described multiple forms of collaboration currently in practice, including inpatient and outpatient models, as well as both direct and indirect consultation. Informal consultation (e.g., \u0026ldquo;hallway conversations,\u0026rdquo; quick phone advice) was frequently described as accessible and clinically valuable, supporting real-time decision-making and enhancing continuity of care. These accounts suggest that informal collaboration functions as an important compensatory mechanism within constrained systems, enabling clinicians to maintain care quality despite limited formal structures.\u003c/p\u003e \u003cp\u003eParticipants also emphasized the role of collaborative care in building primary care capacity, with access to specialist input improving clinician confidence, knowledge, and clinical management over time. Team-based approaches and exposure to multiple professional perspectives were perceived to contribute to more comprehensive and holistic patient care. However, taken together, these strengths also reveal that effective collaboration is often person-dependent rather than system-embedded, raising questions about sustainability and consistency across settings.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eWeaknesses in Current Implementation\u003c/h2\u003e \u003cp\u003eDespite these strengths, participants identified substantial limitations in how collaborative care is currently operationalized. Staffing shortages, in non-urban settings were described as shaping not only service availability but also the form collaboration could take. For example, limited workforce capacity was often cited as the reason why collaborative care remained informal rather than structured.\u003c/p\u003e \u003cp\u003eParticipants also described outdated referral processes, administrative complexity, and incompatible electronic medical record (EMR) systems as barriers that actively constrained collaboration rather than simply creating inconvenience. Fragmented information systems were interpreted as undermining shared care planning and reinforcing reliance on informal communication.\u003c/p\u003e \u003cp\u003e Importantly, several participants explicitly recognized the double-edged nature of informal collaboration. While pragmatically useful, reliance on undocumented communication was seen as suboptimal for patient safety, continuity, and accountability. This tension reinforces the broader analytic finding that collaborative care is frequently sustained through goodwill and individual effort rather than through reliable system design.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eOpportunities for System Improvement\u003c/h2\u003e \u003cp\u003eParticipants consistently articulated that collaborative care could be strengthened through system-level redesign rather than individual-level effort. Calls for greater standardization across the province were not framed as a desire for rigid uniformity but as a mechanism to ensure that core components are consistently available across settings.\u003c/p\u003e \u003cp\u003eParticipants conceptualized standardization as a tool for equity, particularly to reduce disparities between urban and rural contexts. Many also identified opportunities to improve efficiency, communication, and clinical effectiveness through better-designed workflows, stronger interprofessional relationships, and expanded resources. These insights demonstrate that participants were not only describing problems but also articulating sophisticated understandings of how collaborative systems could be improved.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eThreats to Sustainable Implementation\u003c/h2\u003e \u003cp\u003eParticipants identified several structural threats to sustainability, including workforce shortages, unstable funding, and restrictive policies related to specialist roles and responsibilities. These were not viewed as external challenges but as systemic conditions that actively shape the feasibility of high-fidelity collaborative care.\u003c/p\u003e \u003cp\u003eGeographic inequities were a persistent concern, with participants emphasizing that access to collaborative resources differed substantially between urban, rural, and remote regions. Technological limitations were similarly viewed as undermining the potential for effective integration. Together, these threats reinforce the interpretation that current models are fragile and highly contingent on local context, rather than supported by durable system infrastructure.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eIntegration with Quantitative Findings\u003c/h2\u003e \u003cp\u003eOverall, the qualitative findings explain the quantitative patterns by clarifying why Coordinated and hybrid models predominate despite strong endorsement of Integrated care. Survey results showed that Coordinated care was most common in practice, whereas Integrated care was perceived as most effective. Qualitative accounts reconcile this gap: participants described relying on informal consultation and workarounds in response to limited infrastructure, staffing, and system supports. This suggests that model variation reflects pragmatic adaptation to structural constraints rather than weak commitment to collaborative care principles.\u003c/p\u003e \u003cp\u003eQuantitative data also showed that Integrated and multi-model clinics reported more consistent implementation of core components, including shared information systems, team-based structures, and quality improvement processes. Participants linked these features to improved efficiency, clearer roles, and stronger continuity of care. Together, these findings indicate that implementation fidelity depends on system-level conditions, underscoring the need for sustained investment in infrastructure, workforce capacity, financing, and information systems to support equitable and effective collaborative care across the province.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e This mixed-methods study provides a provincial snapshot of how collaborative mental health care clinics are configured and experienced across Saskatchewan. Three key findings emerge. First, collaborative care is primarily oriented toward more prevalent mental health conditions managed in primary care. Second, despite strong endorsement of Integrated care as the most effective model, Coordinated care remains the most implemented configuration. Third, both quantitative and qualitative findings identify persistent system-level gaps related to infrastructure, workforce, financing, and data systems that limit consistent implementation across settings. Collectively, these findings extend national literature by offering empirically grounded, region-specific insight into the gap between collaborative care evidence and real-world delivery.\u003c/p\u003e \u003cp\u003e1. \u003cem\u003eCollaborative Care is Appropriately Oriented Toward Common Mental Health Conditions\u003c/em\u003e\u003c/p\u003e \u003cp\u003eAcross clinics, collaborative care services were most frequently directed toward depression, anxiety, and substance use disorders. The prominence of depression and anxiety aligns with the existing evidence, as much of the collaborative care research has focused on common mood and anxiety disorders in primary care, with strong evidence that high-fidelity implementation improves symptoms, functioning, and quality of life (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNotably, the high prevalence of substance use services observed in our study extends beyond the traditional focus of the collaborative care literature. This suggests that collaborative care can be successfully adapted for substance use conditions. Brackett and colleagues (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) demonstrated improved treatment initiation and favourable clinical outcomes when collaborative care was applied to opioid use disorder in primary care. Our findings contribute practice-based evidence that collaborative care in Saskatchewan is already being used to address substance use concerns, highlighting its potential to support a broader range of complex behavioural health needs than is typically reflected in the literature. However, care must be taken to that ensure that CCMs are operationalized, evaluated and adapted for the population they serve within their local health system (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) for effective service delivery.\u003c/p\u003e \u003cp\u003e2. \u003cem\u003ePerceived Effectiveness of Integrated Care Contrasts with Real-World Implementation\u003c/em\u003e\u003c/p\u003e \u003cp\u003eAlthough collaborative mental health care appears widely present across Saskatchewan, full implementation of evidence-based Integrated models remains limited. Most clinics appear to operate at earlier points along the collaborative care continuum, where consultation and informal collaboration are common but fully integrated, team-based care is less consistently observed.\u003c/p\u003e \u003cp\u003eThis implementation gap is further underscored by the divergence between perceived effectiveness and actual practice. While most respondents endorsed Integrated care as the most effective model, Coordinated care was most commonly reported in practice, often within single-model configurations. Qualitative findings help explain this discrepancy: participants described collaboration as occurring primarily through informal consultations, phone advice, and ad hoc interactions rather than through structured interprofessional teams.\u003c/p\u003e \u003cp\u003eInterviews also revealed role-based differences in perception. Participants in leadership or management positions generally expressed satisfaction with current collaboration, whereas frontline clinicians more frequently described practical limitations in day-to-day functioning. This divergence is consistent with prior implementation research, which suggests that leaders often assess collaborative care based on the existence of structures and programs, while clinicians evaluate it based on whether these structures function meaningfully in practice (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Similar patterns have been documented elsewhere, where managers perceive models as established, while clinicians experience them as fragile, informal, or overly dependent on personal relationships rather than systems (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). If collaborative care is to function as an effective provincial model of care, greater alignment is needed between aspirations for integration and the operational conditions required to support it, including shared planning, goal setting, resourcing, and accountability.\u003c/p\u003e \u003cp\u003e3. \u003cem\u003eSystem-Level Barriers Limit Consistency and Equity of Implementation\u003c/em\u003e\u003c/p\u003e \u003cp\u003eApproximately one-third of clinics reported using more than one CCM, suggesting hybrid or transitional approaches rather than stable implementation. These patterns indicate that the predominance of Coordinated models likely reflects limitations in infrastructure, workforce, funding, and organizational support\u0026mdash;particularly outside urban settings\u0026mdash;rather than resistance to Integrated care. This interpretation aligns with Canadian literature describing the pragmatic evolution of collaborative care in response to local context and constraints (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). McMahan and Ly (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e) demonstrated that rural programs often rely on adapted models using alternative workforce configurations to overcome shortages, highlighting how Coordinated or hybrid approaches may reflect adaptation rather than deliberate model choice. Rugk\u0026aring;sa et al. (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e) similarly describe collaborative care as often evolving through local negotiation rather than standardized design. A tailored approach grounded in shared core principles, rather than rigid standardization, may therefore be more appropriate for Saskatchewan. However, such flexibility must be supported by equitable access to collaborative care resources across regions.\u003c/p\u003e \u003cp\u003eThese constraints were reflected in persistent system-level barriers across sites. These findings align with national analyses emphasizing that sustainable collaborative care requires enabling infrastructure, financing reform, workforce planning, and integrated information systems (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). In this study, limited information sharing and weak system supports were associated with lower implementation of key collaborative care components, underscoring the importance of implementation fidelity. In this context, fidelity refers to the extent to which core components of collaborative care such as, structured care coordination, regular interprofessional communication, psychiatric consultation, and measurement-based care, are delivered as intended (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Meta-analyses demonstrate that lower-fidelity or partially implemented collaborative care models are associated with weaker outcomes (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e), whereas more integrated models yield superior outcomes for complex populations (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Implementation research further indicates that inadequate system-level supports limit effectiveness in real-world settings (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eImportantly, these findings carry equity implications. Clinics outside major urban centres reported fewer models, fewer supports, and greater reliance on Coordinated care. This mirrors broader Canadian evidence that collaborative care remains unevenly distributed and difficult to scale in rural and remote contexts without targeted structural investment (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Participants\u0026rsquo; calls for standardization were framed not as rigidity, but as a mechanism to promote fairness, consistency, and timely access across regions. Crowley and Kirschner (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e) similarly argue that system-level integration is essential for equitable access and sustainable primary care-based mental health services.\u003c/p\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eImplications for Policy, Practice, and Research\u003c/h2\u003e \u003cp\u003ePolicy: Findings support the need for a provincial framework for collaborative mental health care that prioritizes equitable access across urban, rural, and remote regions. Policy efforts should focus on sustainable funding models, standardized role definitions, and infrastructure investments (e.g., interoperable EMRs, telepsychiatry capacity) to enable broader implementation of Integrated care rather than reliance on informal or Coordinated-only models.\u003c/p\u003e \u003cp\u003ePractice: Health systems and clinical leaders may use these findings to strengthen team-based structures, clarify care pathways, and invest in capacity-building supports such as regular psychiatric consultation and shared decision-making processes. Emphasizing core components of evidence-based collaborative care may improve consistency and effectiveness across settings.\u003c/p\u003e \u003cp\u003eResearch: Future research should examine implementation strategies that support scale-up of Integrated collaborative care in non-urban settings, evaluate patient outcomes associated with different model configurations, and include the perspectives of individuals with lived experience. Longitudinal and realist-informed studies may be particularly useful for understanding how contextual factors influence the success of CCMs across diverse health system environments.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eLimitations:\u003c/h2\u003e \u003cp\u003eThis study has several limitations that should be considered when interpreting the findings. First, the quantitative survey used a purposive, snowball sampling strategy distributed through leadership networks. As a result, the sample might not representative of all healthcare providers or clinics in Saskatchewan, and the findings should be used cautiously as an estimate of the true prevalence of collaborative care models across the province. Relatedly, participation relied on self-report, which introduces the possibility of response bias and variation in how respondents interpreted collaborative care models and components.\u003c/p\u003e \u003cp\u003eSecond, classification of collaborative care models at the clinic level was based on aggregated participant responses. Where multiple respondents from the same clinic reported different models, all positively identified models were retained. This approach was chosen to avoid under-identifying collaborative practices but may have resulted in some overclassification of model presence in clinics with more responders. The findings should therefore be interpreted as reflecting perceived rather than objectively verified model structures.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe first province-wide examination of collaborative mental health care models across Saskatchewan, Canada, integrating clinic-level structural characteristics with healthcare provider perspectives demonstrate that collaborative care is widely valued and primarily oriented toward the management of common mental health conditions within primary care settings. However, despite strong endorsement of Integrated care as the most effective model, most clinics continue to operate using Coordinated or hybrid configurations, reflecting pragmatic adaptation to system constraints.\u003c/p\u003e \u003cp\u003eAcross both quantitative and qualitative findings, persistent system level barriers emerged as key factors limiting consistent and equitable implementation. These gaps were most evident in rural and remote settings underscoring the need for targeted structural investment. Collectively, the findings suggest that advancing collaborative mental health care in Saskatchewan will require more than local innovation or goodwill. Sustainable progress will depend on coordinated system-level strategies, including investment in infrastructure, tailored yet flexible models, stable funding mechanisms, and policies that enable team-based, measurement-informed care. By providing empirically grounded insight into how collaborative care is currently experienced and implemented across diverse settings, this study offers critical evidence to inform the development of a more effective and scalable provincial approach to collaborative mental health care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAll manuscripts must contain the following sections under the heading \u0026apos;Declarations\u0026apos;:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the Saskatchewan Health Authority (SHA) Research Ethics Board (REB-23-51) on 22-Feb-24.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication: Not applicable\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available because making the data public was not a consideration in the participant consent form, but are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThis project was funded by the Department of Psychiatry at the University of Saskatchewan through Alfred G. Molstad Trust and Laura E Chapman Award (2023).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSD was the Principal Investigator who developed the study and secured funding as well as wrote the manuscript. MA was involved in study coordination and manuscript writing. CB was responsible for the creation and management of data collection tools, data analysis, and manuscript writing. AE was involved in participant recruitment. AV performed qualitative data analysis. KS managed both ethics and operational approvals and the creation of data collection tools. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors wish to thank the Canadian Hub for Applied and Social Research (CHASR) for their expert qualitative guidance throughout this project. We are also deeply appreciative of our grant partners, whose support and collaboration were essential to the completion of this work. Special thanks are extended to Monique Reboe Benjamin for her thoughtful contributions and dedicated assistance in the writing of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information (optional)\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCanadian Institute for Health Information. Health system resources for mental health and addictions care in Canada, July 2019 [Internet]. Ottawa (ON): CIHI. 2019. 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Barriers and facilitators to implementing a technology-enhanced psychiatric collaborative care model among rural primary care sites: a mixed-methods implementation case study. BMC Prim Care. 2025;26:17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStergiopoulos V, Schuler A, Nisenbaum R, deRuiter W, Guimond T, Wasylenki D, et al. The effectiveness of an integrated collaborative care model vs. a shifted outpatient collaborative care model on community functioning, residential stability, and health service use among homeless adults with mental illness: a quasi-experimental study. BMC Health Serv Res. 2015;15:348.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCrowley RA, Kirschner N, Health and Public Policy Committee of the American College of Physicians. The integration of care for mental health, substance abuse, and other behavioral health conditions into primary care: executive summary of an American College of Physicians position paper. Ann Intern Med. 2015;163(4):298\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7326/M15-0510\u003c/span\u003e\u003cspan address=\"10.7326/M15-0510\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Collaborative Care Models, Mental Health, Primary care","lastPublishedDoi":"10.21203/rs.3.rs-9247526/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9247526/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eCollaborative care models (CCMs) are among the most evidence-supported approaches for integrating mental health services into primary care. Despite strong evidence, implementation across Canadian jurisdictions remains uneven. Saskatchewan\u0026rsquo;s geographically dispersed population and variable service infrastructure present challenges for equitable delivery. This study aimed to conduct a province-wide environmental scan of collaborative mental health care in Saskatchewan to examine model utilization, regional variation, and implementation of strengths and gaps.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eA convergent mixed-methods design was used. A cross-sectional online survey was distributed to healthcare providers, administrators, and system leaders involved in adult mental health service delivery. The survey captured clinic characteristics, collaborative care model type, availability of core components, and perceived effectiveness. Quantitative data were analyzed descriptively and clustered by clinics. Semi-structured interviews were conducted with a purposive sample of healthcare providers (n\u0026thinsp;=\u0026thinsp;11) and analyzed using reflexive thematic analysis. Qualitative themes were subsequently organized using a Strengths, Weaknesses, Opportunities, and Threats (SWOT) framework. Integration occurred during interpretation.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eA total of 155 survey responses were analyzed, identifying 38 clinics reporting the presence of collaborative mental health care. Coordinated care was the most commonly reported model in practice, while Integrated care was most frequently perceived as the most effective. Integrated and multi-model clinics demonstrated greater availability of core collaborative care components, including team-based structures, shared information systems, and quality improvement processes. Qualitative findings highlighted the value of informal collaboration and capacity-building while also identifying persistent system-level barriers, including workforce shortages, fragmented information systems, unstable funding, and inequities between urban and non-urban settings.\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e \u003cp\u003eCollaborative mental health care is widely valued and present across Saskatchewan but is often implemented in lower-intensity forms that diverge from evidence-based Integrated models. Persistent system-level constraints appear to drive this implementation gap. Strengthening infrastructure, workforce support, financing mechanisms, and information-sharing systems will be essential to support more equitable and sustainable implementation of high-fidelity collaborative care across diverse contexts.\u003c/p\u003e","manuscriptTitle":"A Mixed Method Environmental Scan of Collaborative Mental Health Care in Saskatchewan Province, Canada Journal: BMC Health Service Research","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-30 20:50:38","doi":"10.21203/rs.3.rs-9247526/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-07T05:45:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"253253535802026385835017182041380508765","date":"2026-04-26T21:46:35+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-22T17:29:17+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-30T11:59:54+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-28T14:22:46+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-28T14:22:24+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2026-03-27T17:52:24+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2d34adb9-9e6b-4da9-a34d-309d825bb644","owner":[],"postedDate":"April 30th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-07T05:45:10+00:00","index":37,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-30T20:50:38+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-30 20:50:38","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9247526","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9247526","identity":"rs-9247526","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}