Positively IMPACTing a Patient’s Life: The IMPACT Model of Behavioral Health Integration

What do you envision when you think of the word, impact? Impact can be a strong or lasting effect that may be positive or negative. Some people believe that having a positive impact on others gives life meaning.  Alternatively, stress and depression negatively impact a person’s physical health due to the chemical reactions that they trigger in the body. Both of these meanings are relevant when it comes to healthcare, so it’s only fitting that a model designed to improve this process would be also be called “IMPACT”.

The Improving Mood – Providing Access to Collaborative Treatment (IMPACT) model of behavioral health integration is designed to substantially improve medical and mental health outcomes and functioning.  Furthermore, it is designed to be used with existing healthcare models, such as Medicare and Medicaid, and to reduce health care costs. This type of care plan, sometimes referred to as “Collaborative Care”, has been shown to be more effective than “usual care” in the treatment of depression, anxiety disorders, bipolar disorder, and even schizophrenia.  The IMPACT model centers around three core principles: care coordination, proactive monitoring, and individualized adjustment.

The first, and perhaps most fundamental aspect of the IMPACT model is the emphasis on collaboration and communication between the different healthcare providers involved in a patient’s care, which provides an eclectic perspective for treatment and diagnosis.  In addition to the Primary Care Provider (PCP), this team of healthcare providers in the IMPACT model includes a Psychiatric Consultant and care management staff. The care management staff can be nurses, clinical social workers, psychologists, or any combination of these. The combined expertise of all these different healthcare providers makes screening and diagnosis confirmation much easier and more efficient than it would be with any one of them alone.

Another key aspect of the IMPACT model is the regular and proactive approach to screening and monitoring patients throughout their treatment.  By using health questionnaires, such as the PHQ-9, healthcare providers are able to monitor the patient’s progress throughout treatment. In addition to clinical rating scales, the IMPACT model emphasizes the importance of educating the patient on effective self-management.  Patient education and therapy is centered around behavioral activation and problem- solving.

Lastly, the IMPACT model includes individualized adjustment in treatment.  If consistent monitoring indicates that the current treatment is not working, significant changes will be necessary. In the usual care model, primary care givers refer patients who are not responding to treatment to other specialists for consultation, which can be costly and very time-consuming.  When the IMPACT model is integrated into existing healthcare models, all of the specialists are working together throughout the process, so treatment adjustments can be made more efficiently.  This communication and collaboration provides a streamlined element to the system already in place that ultimately improves the final outcomes and cost of treatment for patients.

In 2002, a study was published in the Journal of the American Medical Association (JAMA) comparing the outcomes of traditional care models with the IMPACT model. The study used a sample of 1,801 depressed older adults from 18 different clinics across the U.S to find out what kind of difference this method had on outcomes as compared to usual care.  Over a 12-month period, half of the patients were given the usual care they received at their respective clinics (including medications and referrals to specialty mental health), while the other half were randomly assigned to receive the IMPACT model of depression care.  While 19% of patients who received the usual care reported a 50% or more reduction in depression symptoms, 45% of those who received the IMPACT care reported that same level of symptom reduction.  In other words, the effectiveness of care more than doubled with the implementation of the IMPACT model.  In addition to reduction in symptoms, patients in the IMPACT care group reported substantially higher quality of life than those who only received the usual care. Furthermore, the benefits of the IMPACT intervention (less functional impairment, greater quality of life, etc.) persisted for a  longer period of time than those patients who received usual care. In some cases, the benefits using the IMPACT model lasted over 100 days more than those in the traditional care group.

Finally, telebehavioral health (also called telemental health) can help further streamline the process of communication and collaboration, especially between patients and care providers.  By using technology to communicate across distances, one of the greatest barriers to getting mental health services (accessibility) is all but removed from the table. Whether it’s a lengthy commute to the therapist’s office or simply a complete lack of facilities in the patient’s home location, the use of remote communication allows nearly anyone in any socioeconomic situation to keep in close contact with their care providers throughout the treatment process.

In many areas of life, communication, collaboration, and innovation seem to be the keys to success, and the IMPACT model brings all three of these to the world of primary care. With more and more research demonstrating the benefits of this eclectic approach, the principles of the IMPACT model may one day be implemented in to all mental (and perhaps even physical) healthcare practices.

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