Depression is one of the leading causes of disability worldwide and the number-two cause of disability in the United States after heart disease. Its damaging effects include reduced productivity, lower incomes, and overall poor health. Rural areas in the United States are especially susceptible to high rates of depression, primarily because of higher rates of social isolation, poverty, and economic distress.
The John A. Hartford Foundation, a 2012 Social Innovation Fund grantee, is bringing a proven model of depression treatment to eight health clinics in the Mountain West. Known as IMPACT (which stands for Improving Mood – Promoting Access to Collaborative Treatment), the model is based on close coordination between a patient’s primary care provider, an on-site depression “care manager,” and a psychiatric consultant. As reported in the Journal of the American Medical Association (JAMA) in 2002, the IMPACT model more than doubled the effectiveness of depression treatment for older adults in primary care settings.
“A lot of programs say they offer integrated behavioral health care, but that often means you go to the primary provider and then you are referred separately to a mental health counselor. They treat you in parallel but they don’t really work together,” explained Wally Patawaran, a Hartford Foundation program officer. Patawaran continued, “What’s different in this approach is there is a high degree of synchronization across the team, but the primary care provider is still in the driver’s seat with support from the care manager and the psychiatric consultant.”
The Hartford Foundation is supporting the implementation of the IMPACT model in eight clinics in the states of Washington, Wyoming, Alaska and Montana. The results at one of these clinics, the Community Health Center of Central Wyoming, show the promise of the model for improving access to high-quality depression treatment in underserved rural communities. In February 2014, the center had just 18 active patients in depression treatment. As of April 2015, the total was 135 active patients, and nearly 400 patients had received depression treatment in some form. This exceeded the center’s original goal of supporting 350 patients to access such treatment by June 2015.
Other clinics in the program are seeing similar results, according to Diane Powers, Associate Director of the AIMS Center at the University of Washington, which is the Hartford Foundation’s evaluation and technical assistance partner for the initiative. “Overall it is working really well,” Powers said, noting that the AIMS Center’s early evaluation efforts show that all but one of the eight sites are hitting targets for the number of patients served, as well as meeting benchmarks for quality of care.
Due to the lack of philanthropic resources in many of these communities, the Hartford Foundation has supported clinics to connect with outside funders to provide the matching funds required of SIF subgrantees. In addition, the AIMS Center, which has led adoption of the IMPACT model in hundreds of sites around the world, works closely with clinics to ensure that they get the training and technical assistance they need to implement the model successfully. A key priority for the AIMS Center in its work with the clinics is supporting them to find self-sustaining funding — in part, by maximizing their ability to collect revenues from Medicaid, Medicare and third-party insurers to support implementation of the IMPACT model.
Another focus for the AIMS Center consultants when it comes to sustainability is culture and systems change within the clinics. The consultants work closely with the clinics to help them implement the model as efficiently as possible through better scheduling and use of staff and technology. The focus is on supporting clinics to make this work an integral part of how they serve patients. To the extent that IMPACT becomes ingrained in these organizations, the chances increase that new behaviors and work processes will not disappear at the end of the grant period.
Additional information about the Hartford Foundation’s SIF project can be found online.