The quality improvement intervention included (1) expert leader teams at each site that adapted and implemented the intervention; (2) care managers who supported primary care clinicians with patient evaluation, education, medication and
psychosocial treatment, and linkage with specialty mental health services; (3) training of care managers in
manualized CBT for depression; and (4) patient and clinician choice of
treatment modalities (CBT, medication, combined CBT and medication, care manager follow - up, or referral).