IMPACT (Improving, Mood-Promoting Access to Collaborative Treatment) (Title III-D Program)

IMPACT (Improving Mood-Promoting Access to Collaborative Treatment) is an intervention for patients 60 years or older who have major depression or dysthymic disorder. The intervention is a 1-year, stepped collaborative care approach in which a nurse, social worker, or psychologist works with the patients regular primary care provider to develop a course of treatment. Intervention participants receive a 20-minute educational videotape and a booklet about late-life depression and are encouraged to have an initial visit with a depression care manager (DCM).

During the first visit, the DCM completes an initial assessment, provides education about treatments, and discusses the patient’s preference for depression treatment (i.e., antidepressant medications and psychotherapy). All patients are encouraged to engage in behavioral activation such as physical activity or pleasant events scheduling. The DCM works with the patient and his or her primary care provider to establish a treatment plan according to the recommended treatment algorithm. New cases and cases needing treatment plan adjustment are discussed with a consulting team psychiatrist during weekly team meetings. The DCM follows up with patients in person or by telephone approximately every 2 weeks during acute phase and approximately monthly during the continuation phase.

IMPACT has been adapted for many different populations and settings. Research studies and evaluations of these programs show that IMPACT is effective with a wide range of depressed patients, including adults of all ages, diabetics, cancer patients, arthritis patients, and adults with acute coronary artery syndrome. Research data have also documented the effectiveness of IMPACT with Latino and African American patients, Latino cancer patients, and Spanish-speaking Latino diabetics of all ages.

  • Program Goals:
  • -Trained depression care manager works with the patient, the patient’s primary care provider, and a psychiatrist to develop and administer a course of treatment

 

  • Target Audience:
  • -Adult patients who have a diagnosis of major depression or dysthymia, often in conjunction with another major health problem. IMPACT was implemented with the following populations:
    • a) Patients who were 60+ and had a diagnosis of major depression or dysthymia alone or in conjunction with comorbid panic disorder, posttraumatic stress disorder, mild cognitive impairment, and/or chronic medical illnesses.
    • b) Patients who are 18+ and had a diagnosis of major depression or dysthymia as well as comorbid cancer and/or diabetes

 

  • Program Description:
  • -Beginning of the intervention, patient meets with the DCM and receives a 20-minute educational video and a booklet about late-life depression. During meeting, DCM completes an initial assessment of the patient’s depressive symptoms, encourages patient to engage in behavioral activation (e.g., physical activity, pleasant events), and discusses options for treatment over the next 10-12 weeks (first treatment step): antidepressant medication or a course of 6-8 psychotherapy sessions (e.g., Problem Solving Treatment in Primary Care) delivered by the DCM in a primary care setting. For patients already taking antidepressant medication, treatment can include increasing the dose, augmenting the medication with psychotherapy, or switching to a different medication or psychotherapy. DCM then works with patient and patient’s primary care provider to establish the treatment plan. If patient has not significantly improved, treatment plan is changed with the agreement of the patient and their primary care provider

 

Contact information

Reference Material

  • Unutzer et al. (2002). Collaborative care management of late -life depression in the primary care setting: a randomized controlled trial. The Journal of the American Medical Association, 288(22), 2836-2845.

 

  • Unützer, J., Hantke, M., Powers, D., Higa, L., Lin, E., Vannoy, S. D., et al. (2008). Care management for depression and osteoarthritis pain in older primary care patients: a pilot study. International Journal of Geriatric Psychiatry. 23(11), 1166-1171.