The John A Hartford Foundation
Social Innovation Fund 2012
TITLE: The John A. Hartford Foundation SOLE INTERMEDIARY: The John A. Hartford Foundation (JAHF) ISSUE-BASED SIF (HEALTHY FUTURES) to disseminate the IMPACT model of depression treatment through community health clinics as subgrantees to serve low-income, rural communities in Wyoming, Washington, Alaska, Montana, and Idaho (WWAMI) KEY MEASURABLE OUTCOMES: 1) increased access to effective depression treatment for low-income patients in rural areas, 2) decreased depression and improved social and occupational functioning among these patients, 3) improved economic well-being of individuals and families served by subgrantees TECHNICAL ASSISTANCE AND EVALUATION PARTNER: University of Washington AIMS Center AMOUNT REQUESTED: $1,000,000 (100% for subgrants) for the period 09/01/2012 -- 08/31/2013 SOURCES OF INTERMEDIARY MATCH: Foundation assets SOURCES OF SUBGRANTEE MATCH: Clinical revenues, philanthropic organizations, and/or public health funders 2012 PRIORITY: This project will improve the economic well-being of individuals and families served by subgrantees through 1) reduction of costs related to health care expenditures, 2) improvements in employment and related income, and 3) reduction in costs related to caregiving needs for patients with depression that are often borne by family members. PROJECT OVERVIEW: Depression is one of the leading causes of disability worldwide, the number two cause of disability in the US (after heart disease) and is associated with poor health and economic outcomes, including higher healthcare costs, reduced productivity, and lower incomes. The WWAMI region is a philanthropically underserved rural area with little access to effective depression care. This project will support 5-8 nonprofit community primary care clinics in the WWAMI region over 3 years to implement evidence-based IMPACT depression care. In this program, primary care providers are supported by trained mental health specialists to care for the large number of patients they see with undiagnosed, untreated or ineffectively treated depression. Effective treatment using IMPACT improves depression symptoms, social and work-related functioning, and economic outcomes. Subgrantees will each identify and treat at least 600-1,000 adults over 3 years. We will conduct independent assessments of patients' depression, functional, and economic outcomes. The effects of improved treatment will benefit individual patients, their family and caregivers, the community-based health care providers developing new skills to more effectively serve a high-need population, and community organizations who will partner with participating primary care clinics to provide meaningful ways of engaging individuals in paid and nonpaid activities as they recover from depression. JAHF and UW will issue a joint solicitation for subgrantees that will be advertised to clinics in the WWAMI region. Subgrantees must be located in counties designated as medically underserved and/or health professional shortage areas, serve at least 1,500 unique patients each year, and have a patient population that is at least 50% uninsured or covered by Medicaid. Clinics must agree to participate in training, technical assistance, evaluation, financial reporting, and overall progress monitoring. Subgrantees will be selected based on criteria that include patient demographics, strength of plan for recruiting mental health providers, experience with other quality improvement initiatives, strength of plan for matching funds, and strength of plan for spread during program implementation and sustainability after grant funding ends. Subgrantees that successfully implement the program in Year 1 will be eligible to expand in Year 2 to additional patients and/or delivery sites. TRACK RECORD: JAHF is a grantmaker with over 80 years of philanthropic experience, including funding the original research trial that established the effectiveness IMPACT and the subsequent grant to disseminate the program to over 500 clinics. The AIMS Center Director was the lead researcher on the IMPACT research trial and has directed dissemination of the program for the past 8 years. In addition, he is an internationally recognized health services researcher who will lead evaluation of the proposed project. ORGANIZATIONAL & FINANCIAL CAPACITY: JAHF has a staff of 16 professional and support personnel. It has assets over $480 million and an annual grants budget between $18 million and $20 million.