Members of the Behavioral Health team at Valley View Health Center. Members of the Behavioral Health team at Valley View Health Center.

Editor’s Note: The Valley View Health Center in Chehalis, Washington, is one of eight primary care community clinics receiving funding through the federal Social Innovation Fund (SIF) initiative to spread the IMPACT program, also known as Collaborative Care, in the rural Pacific Northwest.

The John A. Hartford Foundation was one of just four new awardees chosen in 2012 to serve as an intermediary between SIF and subgrantees implementing innovative care models. As a result, a $3 million federal grant has been matched by $3 million from the John A. Hartford Foundation, with additional matching grants from the subgrantees, to spread the IMPACT/Collaborative Care model of depression treatment in Washington, Wyoming, Alaska, Montana, and Idaho.

From the Cascade foothills all the way to the Pacific Ocean, the great span of land served by Valley View Health Center encompasses more than 3,600 miles in the state of Washington. The communities in our service areas of Lewis and Pacific counties are characterized by economic challenges and are among the poorest counties in the state.

Current data from the U.S. Census Bureau indicates that 15.4 percent of Lewis County residents live below the poverty level. It should not come as a surprise, then, that there are many who suffer from depression. Additionally, homelessness and substance abuse are a problem for some our patients.

We have found that they may often experience a lack of hope, something we have coined as “chronic despair.” Given the lack of resources for treatment for mental health issues in this rural county, when we heard that there was a possibility to apply for a Social Innovation Fund (SIF) grant for collaborative depression treatment, we jumped at the opportunity.

VVHC_logo(new)_400pWe knew that a proven depression treatment program targeted for low-income people was a perfect fit for our organization. Steve Clark, the executive director of our organization, often talks about how Valley View Health Center’s growth over the past 11 years stems from a commitment to serve the community and being open to new opportunities to do so.

Steve likes to describe the growth of our federally qualified health center (FQHC) as “11 clinics in 11 years!” He is quick to tell you that 11 years ago, Lewis County residents responded positively to the idea of a “community located” health center for all, regardless of ability to pay.

In fact, the idea came from community leaders who were faced with an enormous demand for charity care, especially in the local emergency room.

The Onalaska clinic is one of three Valley View Health Center sites offering the IMPACT program. The Onalaska clinic is one of three Valley View Health Center sites offering the IMPACT program.

Since winning a SIF grant in 2013, we have been able to offer the evidence-based IMPACT model of depression treatment in our Lewis County clinics of Chehalis, Toledo, and Onalaska.

What have we learned in the year and a half that we have had the SIF program up and running? It would take more than a few pages to list all the ways that we have grown. I think the one organizational change of which I am truly most proud would be the depth of commitment to the collaborative care model that has come out of our implementation of the IMPACT program.

Through our work with the John A. Hartford Foundation and the University of Washington’s AIMS Center, we have realized the importance of sustaining all that we have created with this collaborative care program. And we have realized that commitment must come from the board down … to the executive director … to the clinical directors … to the care managers … to the medical providers ...and to everyone who works at Valley View.

We set out to highlight this point by changing our vision statement, and to do so, we involved all team players in the rewrite. We did this in an effort to ensure that the organization is, and will remain, fully committed to a model of care that is collaborative and patient centered.

As a result, we learned not only from each other, but from our work with our patients. Sometimes, the lessons were not those we expected. We have learned to gain the trust of patients who do not trust easily. We have learned about cultural differences in depression symptoms. We have learned that our patients often have more symptoms than those of a simple depressed episode. I offer a couple of success stories to illustrate the complexity and richness of our patient work.

The first success story is that of a 50-year-old veteran. He is someone who has “lived off the radar” in the very rural southern part of Lewis County for the past 20 years and wanted help with his depression, anxiety, and with what his wife called his verbally abusive outbursts. In addition to depression, and due to past trauma, this patient struggled with panic disorder, nightmares, significant impairment with emotional regulation, impulsive and sometimes violent behavior, and fairly paranoid thinking. He expressed distrust of all government agencies and stated that coming into the clinic for counseling was “the most difficult thing I’ve ever done.”

This patient found a connection with the medical team in one of our small clinics in the southern part of the county. He reported that he viewed his care manager and his nurse practitioner as the only two people, outside of his family, who have ever cared about him and who were “in his corner.” At the start of treatment, he was unable to identify any warning signs for his depression or violent outbursts, as he experienced a great deal of disconnect from his emotions. Since enrolling in the SIF program, he has made improvement in his ability to identify symptoms of a panic attack, differentiate panic from anger, and has not had an out-of-control outburst for several months. He has put in place several strategies for slowing down his reactivity, which has curbed his impulsive acting out. His symptom report fluctuated, but there was slow but steady improvement in both his mood and behaviors.

Another story of success is that of an undocumented, Spanish-speaking woman in her mid-40s, who is not literate in any language. She presented with severe vegetative symptoms of depression and was nearly hospitalized at the start of treatment. She reported cyclical episodes of major depression that began after the birth of her last child. As it was culturally appropriate, the family of the patient came in with her for several sessions. With this support and with education on her depression, she quickly experienced a lessening of her symptoms and began engaging in everyday life again. With continued help from her family, a neighbor, her primary care physician and care manager, this patient developed a verbal self-care and relapse prevention plan that involved family-based behavioral activation.

These are only two of the rewarding stories we have witnessed, stories of lives changed for the better by the collaborative care model. Seeing the difference that this program makes in real lives in our area only strengthens our commitment to providing collaborative care that puts our patients first.

For more information on the John A. Hartford Foundation’s SIF projects, visit our Social Innovation Fund page.

This is the fourth in an occasional series of Health AGEnda posts on the Hartford Foundation’s Social Innovation Fund projects. Read the previous posts:

For Missoula Clinic, SIF Program Support Is a Dream Come True

Innovative Depression Treatment Helps Sophie Enjoy Better Mental and Physical Health

Partnership Advances a Revolution in Mental Health Care