In 1998, a gallon of gas cost $1.15, the last episode of Seinfeld aired on TV, and the John A. Hartford Foundation quietly helped start a revolution in mental health care. That was the year Dr. Jürgen Unützer, then an early-career psychiatrist at UCLA, convinced the Hartford Foundation of the worthiness of a radical idea—bringing mental health care into primary care.
The idea of having a primary care provider treat patients for common mental health conditions was so different that Unützer and Wayne Katon, Unützer’s mentor and an established psychiatrist at the University of Washington, were having difficulty finding a funder to test it.
It wasn’t until a young program officer named Chris Langston at the Hartford Foundation saw their vision and agreed to fund what would become the largest treatment trial for depression to date, the IMPACT (Improving Mood—Promoting Access to Collaborative Treatment) study.
Fast forward to 2015, when a gallon of gas costs $2.64, Mad Men is in its last season, and integrated behavioral health has grown from a foreign concept to a highly sought after practice. Numerous integrated care models have sprung up over the past 17 years, but none have as much evidence behind them as the Collaborative Care model first tested in the IMPACT trial, where it doubled the effectiveness of depression treatment for older adults in primary care.
In Collaborative Care, teams consisting of a primary care provider, care manager, and a psychiatric consultant work closely together to treat a population of patients with common mental health conditions. The team uses a single treatment plan and such established principles of chronic illness care as treating to target, meaning that a patient’s treatment plan is regularly monitored and changed until the patient is better.
During the past 17 years, the partnership between the Hartford Foundation and the University of Washington has been a major driver in pushing the Collaborative Care model forward. In 2004, Hartford gave the university $2.4 million over five years to fund the UW AIMS (Advancing Integrated Mental Health Solutions) Center—formerly called the IMPACT Implementation Center—to help organizations put Collaborative Care into place. As additional research studies validated the effectiveness of Collaborative Care, the AIMS Center helped clinics implement the model across the country and around the world.
Today, more than 80 randomized controlled trials have shown that Collaborative Care consistently leads to better patient outcomes, better patient and provider satisfaction, and lower health care costs, achieving the Triple Aim of health care reform. Collaborative Care has been proven effective for all ages, including for adolescent depression, and for a broad range of mental health problems (depression, anxiety disorders, PTSD, and ADHD) and co-morbid medical conditions (heart disease, diabetes and cancer).
Most of the evidence demonstrates the effectiveness of Collaborative Care in medical settings such as primary care and specialty medical care, but researchers are exploring other settings as well such as OB/GYN clinics, community-based health centers and schools. Large-scale practice implementations have shown Collaborative Care can serve patients with a wide range of behavioral health problems—from mood and anxiety disorders to substance abuse and chronic pain.
Since its inception, the AIMS Center has trained more than 6,000 clinicians in Collaborative Care and has provided resources, training, coaching, and psychiatric consultation to more than 1,000 clinics around the world.
Since its inception, the AIMS Center has trained more than 6,000 clinicians in Collaborative Care and has provided resources, training, coaching, and psychiatric consultation to more than 1,000 clinics around the world. We’re interested in local, national, and international partnerships that bring innovative ideas to scale, so when Langston, now a Program Director at Hartford, approached Unützer, now Chair of the UW Department of Psychiatry and Behavioral Sciences, about a Social Innovation Fund initiative (SIF), he jumped at the chance to get involved.
Through the SIF initiative, the federal government serves as a catalyst to bring together public and private resources to evaluate and grow innovative, evidence-based solutions that transform lives, particularly in low-income communities.The initiative is helping eight primary care community clinics deliver better mental health care to approximately 8,000 adults by funding implementation of the IMPACT/Collaborative Care model in rural areas of the western United States. The Hartford Foundation received the $3 million SIF grant from the Corporation for National and Community Service (CNCS) and contributed an additional $3 million to help fund the eight clinics and to support coaching, training and evaluation from the AIMS Center. Each subgrantee organization is required to match its award.
We are grateful for the diverse array of funding partners the initiative has attracted, among them: the Kinskey Family Foundation in Wyoming; the public health department and the Board of County Commissioners in Lewis County, Washington; the Rasmuson Foundation; the Margaret A. Cargill Foundation; and the Helmsley Charitable Trust.
The AIMS Center is working with each of the clinics during all phases of the implementation, from building a vision of how the model fits into their organizational mission to developing a plan for long-term sustainability after the grant ends. Sustainability planning is extremely important for long-term success, especially in rural areas that often have a lack of resources, high rates of poverty, a prevalence of uninsured patients, and a lack of mental health professionals. Although each clinic with whom we work has different challenges, we’ve found that building capacity early on to deal with common hurdles can help clinics sustain an effective program.
In addition to providing training and coaching assistance for the SIF initiative, the AIMS Center is testing the effectiveness of the Collaborative Care model in terms of cost and clinical outcomes, something previously unresearched in rural settings. It’s yet another example of how the ongoing relationship between the AIMS Center and the John A. Hartford Foundation keeps pushing mental health care forward into new territory. Without the support of Hartford, the Collaborative Care model would not be where it is today: a proven, evidence-based model of integrated care that has helped thousands of people get their life back due to better mental health care.
We look forward to what the next 17 years will bring.
For more information, please visit our Social Innovation Fund page.
This is the first in an occasional series of Health AGEnda posts on the Hartford Foundation's Social Innovation Fund projects.