Conclusions
The Bipolar Disorders Program intervention is a collaborative chronic care model with conceptual roots in lithium clinics and medical chronic care models. The program provides a highly specified, manual-based intervention. However, unlike typical efficacy interventions, which are designed for maximal effect in select samples with less regard for complexity or cost, this intervention was developed for eventual dissemination. The randomized controlled trial was designed from an effectiveness perspective to maximize the likelihood that trial results would resemble those seen when disseminated. This developmental strategy anticipated
subsequent arguments that interventions should be developed from the outset with consideration for their eventual dissemination (45). The intervention was then tested in a multisite trial that emphasized effectiveness aspects to maximize generalizability of results. The trial recruited a complex sample typical of the population treated in VAMCs and successfully assessed participants over a three-year period with a lowburden assessment battery. The companion article in this issue (76) reports the results of this clinical trial.