Highly integrated care requires a shift in structure.
Collaborative teams vary from rudimentary, such as developing a preferred referral relationship with a physician group, to complete integration which requires an operational, structural, and financial transformation of a clinic. Doherty, McDaniel, and Baird (1996) have offered a five-level continuum, describing levels of collaboration that can occur alongside varying degrees of integration. While this continuum does imply a certain hierarchy of values, it is one of the few models proposed which outline the different degrees of integration. Common characteristics of highly integrated clinics are those which have onsite full-time mental health staff, combined medical record and billing services, universal screening for depression and substance abuse, enhanced assessment of mental health issues, and focus on treatment approaches that encourage shared patient care. Thus there is a continuum of collaboration from none, referral relationships, co-location to highly integrated (SAHMSA).