Table 2 External facilitation model used to facilitate ICBT implementation within community mental health clinics

Online Therapy Unit (OUT) at the University of Regina facilitated ICBT in the community clinics

The OTU was founded to provide centralized assistance with implementation of ICBT in the community clinics. The OTU created a platform and website that allowed therapists to deliver ICBT; established policies and procedures for therapists to deliver ICBT; trained therapists in the provision of ICBT; provided ongoing supervision and consultation with cases; provided technical assistance; screened patients; matched patients to therapists; monitored the service and treatment outcomes; and identified and resolved barriers to implementation. Key actions of the OTU as an external facilitator of change are outlined below.

Accessed new funding

Research funding was obtained to support the operation of the OTU.

Developed resource sharing agreement

The OTU developed a partnership with Macquarie University in order to trial a previously developed ICBT Course in Saskatchewan.

Built a coalition between OTU and community mental health clinics

Partnerships were formed between OTU and seven community mental health clinics.

Educational meetings

The OTU educated and trained therapists in the provision of ICBT.

Developed tools for promoting ICBT

The OTU developed posters, letters for physicians, and an online video to inform the community about ICBT.

Consensus discussions

Tri-quarterly meetings were held between the OTU and the Directors of the community clinics. During these meetings, positive experiences with ICBT delivery were shared. Barriers to implementation were discussed, such as: 1) how to best educate patients about ICBT; 2) which patients should be included/excluded from ICBT; 3) how to assign therapists to work with ICBT patients; 4) how to provide supervision to therapists; and 5) how to manage health records related to ICBT.

Individuated pilot by community mental health clinics

Each clinic determined the number of therapists they would train in ICBT, and the number of patients who would receive ICBT.

Monthly updates

The OTU provided monthly updates to clinics on the number of patients screened, treated, and completing ICBT.

Audit and provide feedback

The OTU audited the provision of ICBT within each of the community clinics. Feedback was provided to the therapists on methods that could be employed to improve delivery of ICBT.

Email reminders

Therapists received email reminders periodically regarding important aspects of providing ICBT (e.g., reminding therapists to complete weekly check-ins with patients, to build supportive relationships with patients, to remind patients to complete the course, to assist patients in applying ICBT content to life circumstances).