Implementation of the CALM intervention for anxiety disorders: a qualitative study

Table 2 Major Themes

Major Theme	Subtheme
Barriers to Implementation Provider attitudes/behaviors	Uneven physician "buy in"
	Enthusiasm could wane without continued intervention
	Feeling that prevalence of anxiety was low in their clinic
Clinic structure	Part-time primary care providers harder to reach
	Space concerns for ACS
Intervention characteristics	Part-time ACS
	Communication with ACSs sometime unsatisfactory
	Some nurses felt "out of the loop" and not consistent targets for education and marketing
Patient characteristics	Challenges of Low SES patients
	Hispanic patients resistant to CALM
	Drop-outs weaken enthusiasm among providers and staff
Facilitators to Implementation
Provider attitudes/behaviors	Interest in mental health increases uptake
	Buy-in/support from nurses/staff
Clinic structure	Presence of MH professional
	Reliable and appropriate space for ACS
Intervention characteristics	ACS in clinic full time (or close)
	"Face-time" with providers/relationships
	CALM not overly burdensome
	Providers appreciated referral source and additional care
	Positive feedback from/about patients
	Providers very positive about ACS
Patient Characteristics	Prefer coming to primary care
Barriers to Sustaining CALM
Clinic structure	Paying for ACS service
	Space for ACS and doing therapy
Facilitators to Sustaining CALM
-Provider attitudes	Providers high value of CALM
-Clinic structure	Already doing CC for other disorders
	Presence of MH person who could adopt

MH = mental health; ACS = anxiety clinical specialist; PCP = primary care physician; CALM = Coordinated Anxiety Learning and Management; SES = socioeconomic status; CBT = cognitive behavioral therapy; CC = collaborative care.

ISSN: 1748-5908