Social Innovation Fund: Healthy Futures / IMPACT Expansion Subgrantee Evaluation; June 13 - June 2017

IMPACT (depression treatment model)
Implementing Organization: 
John A. Hartford Foundation


Community challenge:
Low-income adults in medically underserved rural communities lack access to depression treatment services other than medication, and to frequent and proactive follow-up with providers.

Promising solution:
Collaborative care uses a team-based approach including a behavioral care manager and a psychiatric consultant to support the primary care provider so patients can be treated in the primary care clinic using the full range of evidence-based treatments and established principles of chronic illness care.

Purpose of evaluation:
To replicate a proven program model in high-need rural areas where patients may face challenges accessing effective depression care. The implementation evaluation looked at how well clinics implemented collaborative care, variation across sites, and factors accounting for observed variations in implementation.


  • Rural primary care clinics serving low-income patients can achieve improvement in depression symptoms comparable to those published in research trials and large-scale implementations.
  • Patients with more severe depression at the start of treatment were less likely to experience complete absence of all symptoms by the end of treatment.
  • Clinic-level processes of care and patient-level clinical outcomes vary widely from clinic to clinic, which is consistent with other Collaborative Care implementations.
  • Primary care providers were positive about their experiences with Collaborative Care; provider burnout is associated with poorer health outcomes for patients and lower retention of providers.
CNCS Program(s): 
Social Innovation Fund
CNCS Focus Area(s): 
Healthy Futures
Study Type(s): 
Level of Evidence: 
University of Washington AIMS Center
Year Published: 
Date Posted Online: 
December 10, 2018
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