Collaborative Care Management: E2i Toolkit

Collaborative Care Management (CoCM) is an evidence-based intervention that integrates behavioral health care with primary care in order to treat depression and other common psychiatric disorders. A team consisting of a primary care provider, a behavioral health care manager, and a psychiatric consultant work closely together to improve the behavioral health of a shared caseload of clients. In collaboration with HIV experts, CoCM experts, and community members, E2i adapted CoCM for the Ryan White HIV/AIDS Program (RWHAP) and produced a toolkit that provides the resources needed to implement CoCM within RWHAP settings and other HIV care organizations. 


  • To improve behavioral health outcomes and HIV health outcomes of people with HIV

Priority Population

  • People with HIV who have depression or other psychiatric disorders 

Core Elements

1. Client-Centered Team Care

  • CoCM is a team-based approach to care that includes the primary care provider, a behavioral health care manager, and a psychiatric consultant. The client is at the center of the care team and is encouraged to contribute their own values and personal goals to the treatment plan.

2. Population-Based Care  

  • CoCM care teams use a client registry to closely track client progress and clinical outcomes over time. 

3. Measurement-Based Care and Treatment to Target 

  • CoCM care teams routinely measure client symptoms with validated rating scales to inform treatment decisions and adjustments.

4. Evidence-Based Care

  • CoCM care teams use evidence-based medications and/or behavioral interventions to treat psychiatric disorders. 

5. Accountable Care

  • Accountable care means holding the care team (and the entire organization) responsible for conducting ongoing quality improvement based on the organization’s behavioral health integration goals and client outcome metrics. 


  • CoCM continues until a client’s symptoms of depression (or other psychiatric disorder) are improved and the patient is able to resume their normal daily activities.


  • Any organization that provides primary care for people with HIV can implement CoCM

Toolkit Components

This Guide includes:

  • How to plan and implement the intervention
  • Lessons learned during implementation in RWHAP settings
  • Outcomes from the E2i initiative

CoCM E2i Implementation Guide (PDF)

A Spanish version of the Implementation Guide is coming soon!

Watch an instructional dramatization of how to deliver CoCM to clients.

Download posters and a brochure that explain CoCM and its benefits for clients. You can add your organization's contact information to these materials and distribute them in your clinic. 

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