IMPACT is a team approach that integrates depression treatment into primary care and other medical settings. This model of care was tested in a randomized control trial in 8 healthcare systems across five states. Results from the study show that IMPACT is more than twice as effective as usual care for depression. It also improves physical and social functioning and patients’ quality of life while reducing overall health care costs over a four-year follow-up. The purpose of the IMPACT Implementation Center is to assist clinicians and organizations interested in bringing IMPACT depression care into their clinical practice. With support from the John A. Hartford Foundation, the Center provides materials, training and technical assistance to aid the adaptation and implementation of IMPACT in diverse practice settings. To date, the center has trained nearly 3,700 individuals and supported implementation of this evidence-based program in more than 240 clinic settings.

The purpose of MHIP is to integrate high quality mental health screening and treatment into primary care settings serving safety net populations. Patients needing more intensive mental health services are treated in community mental health centers that collaborate with the primary care clinic to provide person-centered integrated mental health care. More than 200 community health centers and community mental health centers in the state of Washington participate in this program funded by the state legislature with additional support for King County clinics provided by Public Health Seattle and King County. Over 18,000 individuals have received integrated mental health services through this program since its inception in January 2008.

DIAMOND is a collaborative effort of 9 health plans, 25 medical groups, and over 80 primary care clinics in Minnesota to implement and study the implementation of integrated care for depression based on the IMPACT model of depression care (see above). The initiative is funded and managed by the Institute for Clinical Systems Improvement (ICSI), which documents process and outcome measures as it evaluates the success of DIAMOND. In addition, the National Institute of Mental Health (NIMH) has awarded a $3 million grant to HealthPartners Research Foundation to study the DIAMOND initiative over five years. The study will evaluate all aspects of DIAMOND, including effects of the program on patient satisfaction, productivity, and program cost-effectiveness.

The Alaska Mental Health Trust Authority has provided pilot funding to a Federally Qualified Health Center in Anchorage to support implementation of IMPACT and two Alaska Native tribal health corporations to support implementation of IMPACT and SBIRT (Substance Brief Intervention and Referral to Treatment). The purpose of this pilot program is to determine if integrated mental health care can be effective given the unique challenges faced by primary care clinics in Alaska. Qualitative and quantitative information gathered will be used to determine what, if any, adaptations are necessary to implement integrated mental health care in Alaska. If implementation is successful, the Trust will present the findings to the state legislature and other health care payers to encourage policy changes that promote implementation.

The George Foundation funded two primary care clinics in Fort Bend County, Texas to implement IMPACT over the course of three years with training and technical assistance provided through the AIMS Center.

Dr. Unützer is consulting to the American Association of Retired Persons (AARP) to help implement and support comprehensive evidence-based depression care management in the context of its Health Improvement Initiatives.

CareOregon was started as a Community Benefit Organization to assure that the people of Oregon, regardless of income or social circumstance, have access to high-quality health care from a stable network of providers. Their goal is to provide access to high quality, cost-effective and culturally competent care. In 2010, CareOregon launched an integrated care initiative with five primary care organizations, representing eight clinic sites, in Portland, Oregon.

Ventura County Health Care Agency and Clinicas FQHC are implementing IMPACT in 11 clinics in Ventura County, CA as part of a larger initiative implementing evidence-based mental health treatment in primary care for children and adults.

With financial support from the Samuels Foundation, five CHCANYS clinics located in New York City are planning to launch an IMPACT implementation in June 2011.

The National Council’s Center for Integrated Health Solutions (CIHS) provides training and technical assistance regarding integrated care to 56 organizations that have been awarded SAMHSA grants as well as to community health centers and other primary care and behavioral health organizations. The purpose of the CIHS is to address the comprehensive health needs of clients with mental illnesses and/or substance use disorders by improving the coordination of healthcare services in publicly funded community settings. The Center is funded jointly by the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources Services Administration (HRSA). The AIMS Center is participating in this project as a subcontractor, supporting training and technical assistance activities, especially regarding the role of consulting psychiatrists in the provision of evidence-based integrated care services.

UCC is a community center and social service agency serving monolingual Spanish-speaking adults in Milwaukee, WI. Their programs include IMPACT for older adults.

This research study, funded by the National Institute of Mental Health, examines efforts to improve depression care in the context of disease management programs for Medicare recipients with multiple chronic medical disorders. The study design has two components 1) technical assistance and training for disease management companies that want to integrate depression care management into their existing chronic medical disease management programs, and 2) analysis of the effects of depression and inclusion of depression care management on the effective management of complex chronic medical conditions like diabetes and congestive heart failure.

This research study directed by Dr. Ladson Hinton at UC Davis and funded by the National Institute for Mental Health, examines barriers and facilitators to depression care for Mexican-American and non-Latino White older men in primary care. The study seeks to shed light on how these older men experience depression and its treatment. It will also explore the factors that impede or facilitate depression care from the perspectives of primary care physicians. Dr. Unützer and the AIMS program participate in this trial as experts in quality improvement for late-life depression.

This large multi-site research study, funded by the Department of Defense and led by Dr. Charles Engel seeks to evaluate the effectiveness of an integrated care program for soldiers with depression and posttraumatic stress disorder. The study will compare the integrated care program with optimized usual primary care for military personnel with PTSD. The evaluation will examine effects of the program on symptoms of PTSD, the soldiers’ experience of the program and cost effectiveness. Drs. Zatzick, Unützer, and Katon are participating in this study as experts in primary care-based interventions for depression and PTSD.

COPE-N, the Collaborative Opioid Prescribing Education for Nurses, a program led by Dr. Mark Sullivan at UW builds on the success of the original COPE resource for prescribing providers, but is tailored specifically to care managers, be they non-prescribing nurses, social workers, or psychologists. COPE taught a shared-decision-making strategy to opioid prescribers.

This contract with SRI International, an independent, non-profit research company, is funded by the National Library of Medicine to apply natural language processing to treatment data from the original IMPACT trial in an effort to develop models that can assist behavioral health providers in the best course of action when treatment changes are needed.

The AIMS Center held an invitation-only summit meeting that brought together thought leaders and experts from public and private sector health plans and health care organizations and researchers studying evidence-based integrated mental health programs. The purpose of this meeting was to examine the state of the art of integrated mental health care, review successful dissemination and implementation efforts, discuss opportunities to advance evidence-based integrated care programs in the context of the patient-centered medical home and to develop work groups that will collaborate to promote widespread implementation of integrated mental health care. The purpose of the work groups was to develop a detailed plan to translate existing knowledge about integrated mental health into action and to identify and pursue the most promising opportunities for such translation. Action plans focused on topics relevant to integrated mental health care (e.g. training and workforce development, health information technology, health disparities, health services and implementation research) were developed during the summit meeting and participants will continue to work together on these action plans for the next 12-24 months. To learn more about the Integration Roadmap and the action plans, click here.

Dr. Unützer serves as a member of a World Health Organization (WHO) sponsored multi-year effort to develop guidelines for essential mental health services in developing countries. MORE

This two-year Research Training Program, funded by the National Institute for Mental Health, provides postdoctoral training in health services research to psychiatrists, psychologists, and social/behavioral scientists who are committed to becoming independently supported mental health services researchers. The program is part of a three-site cooperative that brings together expert faculty from Dartmouth, Cornell, and the University of Washington.

The Pittsburgh Regional Health Initiative funded five community health clinics to implement an integrated care program for common chronic medical conditions (e.g. diabetes), depression and substance abuse with the goal of reducing hospital readmission rates among this high risk population. Training and technical assistance regarding integrated care for depression is provided through the AIMS Center.

The Hogg Foundation for Mental Health funded five primary care organizations in Texas to implement integrated care for the mental health conditions most commonly encountered in primary care: depression, anxiety and childhood ADHD (Attention Deficit Hyperactivity Disorder) with training and technical assistance provided through the AIMS Center.

This research project combined IMPACT depression care management with an existing diabetes care management program for low income predominantly Spanish-speaking Latinos in San Diego, demonstrating that this kind of combined approach is both effective and cost-effective with this population. Citation for the publication describing this study and its outcomes: Gilmer TP, Walker C, Johnson ED, Philis-Tsimikas A, Unützer J. (2008) Improving treatment of depression among Latinos with diabetes using project Dulce and IMPACT. Diabetes Care; Jul;31(7):1324-6.

MHIT is a program designed to enhance the availability of evidence-based mental health services offered through REACH-NOLA’s non-profit partners and other agencies to uninsured, disadvantaged, and minority community members in the Greater New Orleans area. The project supports development of post-Katrina infrastructure necessary for the delivery of evidence-based services and, ultimately, contributes to adoption of evidence-based systems-level models of coordinated care for depression and post-traumatic stress disorder (PTSD). UW-AIMS team members (Vannoy, Bentham, Unützer, Powers) supported training and capacity building activities in evidence-based mental health services in primary care.