The Three W’s of the IMPACT Model: Behavioral Health Integration

WHAT?

The IMPACT Model, which stands for “Improving Mood-Providing Access to Collaborative Treatment,” is a Collaborative Care model for depression treatment. It is important to recognize that not only is this model a good idea, it’s one that works! Depression is one of the most common mental diagnoses in the United States, roughly one in four adults suffer from depression (National Institute of Mental Health, 2014).  One in every ten Americans are taking an anti-depressant prescribed by their doctor (National Institute of Mental Health, 2014). Additionally, 27% of the population are seeing a mental health professional such as a psychotherapist, for therapy sessions and counseling (Howes, 2008).  Studies have supported collaborative care interventions for a plethora of mental health conditions, such as depression, anxiety disorders, schizophrenia and bipolar disorder. For the betterment of the patient, mental health clinicians and medical practitioners should be collaborating on patient treatment plans.  Integration of primary care and mental health is key to improving patient care and ultimately, lowering costs.

The IMPACT model of care was tested and led by a team of researchers who followed over 1,800 individuals across the nation for two years. The treatment trials were provided in several health clinics reaching a diverse population in states such as California, Texas, Indiana, Washington and North Carolina.  Half of the subjects were randomly assigned to receive the IMPACT model of depression care, whereas the other half received the care normally available in their primary care clinic. Collaborative Care teams include a primary care provider, care management staff and a psychiatric consultant. The half that received the IMPACT model of care experienced 100 additional depression free days over the two-year period in comparison to those treated with usual care. After the first 12 months, subjects receiving collaborative care were shown to have a 50% reduction in depressive symptoms as compared to only 19% who obtained typical care. In the years after the trial, numerous health organizations across the country adapted the collaborative care model utilized in the IMPACT Study. On average, 20% of patients in the study showed significant improvement after one year.  This statistic matches national data for depression treatment in primary care. Overall, patients reported less physical pain, better social and physical interests and functioning as well as an overall better quality of life!

WHY?

 Depression is a common mental health disorder with high health care costs and many patients are not receiving effective care.  Depression alone has shown to increase overall health care costs by 50-100 percent (Olsen, 2014). After more than 70 randomized controlled trials across diverse populations and settings, results support collaborative care for common mental health disorders are more effective and cost effective than usual care. The Collaborative Care Model for depression is a team collaboration to a patient-centered approach. It allows for population based care management for all patients regardless of treatment modalities, medications or psychotherapy. Evidence based treatments such as Cognitive-Behavioral Therapy (CBT) are utilized and adjusted based on treatment needs. Other treatment specifics utilized include medication recommendations and medication augmentation, brief structured psychotherapy and electroconvulsive therapy are considered. The IMPACT model improved the treatment team by including two new members, a depression care manager and a consulting psychiatrist. The model promotes regular monitoring and proactive treatment reviews to target progress among all patients. The Collaborative Care Model allows for shared accountability for patient’s outcomes and progress, amongst an entire clinical team.

WHERE?

The Collaborative Care Model is an evidenced based approach and can be implemented within a primary care based Medicaid health home model, among other settings.  It includes care coordination and care management across a team of clinicians. The Collaborative Care team consists of a primary care provider, usually a family physician or physician assistant and care management staff, such as a nurses, psychologists or social workers, to provide behavioral interventions or psychotherapy. Finally, the team includes a psychiatric consultant who advises the treatment team on present diagnostic challenges.  This consultation can even be provided through the use of telemedicine. Implementing such a model requires substantial organizational changes, staff transitions and training, and can be a burdensome journey to embark upon. Trials of the collaborative team have been implemented in network and staff health systems, along with private and public providers, including both insured and safety-net populations. Large health care organizations in both low income/safety net populations and commercially insured have implemented collaborative care programs. Medicaid managed care organizations in Oregon and Washington have implemented collaborative care partnerships with community health and community mental health centers.

References

AIMS Center University of Washington (2016). Retrieved from: http://aims.uw.edu/impact-improving-mood-promoting-access-collaborative-treatment/

Howes, R. Fundamentals of Therapy #1: Who Goes? (April 2008). Retrieved from: https://www.psychologytoday.com/blog/in-therapy/200804/fundamentals-therapy-1-who-goes.

National Institute of Mental Health. (2014). Major Depression Among Adults. Retrieved from: http://www.nimh.nih.gov/health/statistics/prevalence/major-depression-among-adults.shtml.

Olsen, D. (May 2014). Integrating Primary Care and Mental Health Key to Improving Patient Care, Lowering Costs. Retrieved from: http://medicaleconomics.modernmedicine.com/medical-economics/content/tags/affordable-care-act/integrating-primary-care-and-mental-health-key-im?page=full

Unutzer, J., Harbin, H., Schoenbaum, M., Druss, B. (May 2013). The Collaboration Care Model:  An Approach for Integrating Physical and Mental Health Care in Medicaid Health Homes. Retrieved from: https://www.medicaid.gov/State-Resource-Center/MedicaidState-Technical-Assistance/Health-Homes-Technical-Assistance/Downloads/HH-IRCCollaborative-5-13.pdf

Unutzer, J., Wayne, K. Callahan, C., Williams, J., Hunkeler, E., Harpole, L. (December 2002).       Collaborative Care Management of Care Life Depression in the Primary Care Setting. Retrieved from: http://jama.jamanetwork.com/article.aspx?articleid=195599.

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