Early last week, the John A. Hartford Foundation submitted our first ever grant application. We’ve always been the recipient of grant applications, so the process for us was new and exciting, and a terrific learning experience. It reflects a changing philanthropic landscape in which we operate, a new opportunity to advance our mission, and, prospectively, a new set of responsibilities for us.
We have applied to the Social Innovation Fund (SIF), a unique federal program that brings philanthropic dollars to the social sector by selecting grant making institutions as intermediaries. My goal here will be to keep you informed about what is going on and to give you some sense of what it means.
The SIF was established in 2009 by the Edward M. Kennedy Serve America Act and is administered by the Corporation for National and Community Service (CNCS), an independent federal agency that also manages Senior Corps and AmeriCorps. It falls into a broader federal effort seeking to use incentive mechanisms, such as awards and prizes, to spur the development of innovations requiring the technical expertise and involvement of the private sector. By its design, the SIF acknowledges that the big complex problems facing our society can only be addressed by diverse networks of parties too broad and disparate for any one agency or office to coordinate. The SIF approach is also driven by the need to put scarce financial resources to better and more coordinated use.
How do we fit in? To be sure, we have long thought of ourselves as “social innovators,” and we have a history to prove it. The SIF would allow us to leverage our grant making on an even larger scale. The SIF requires grant makers to match their awards and assume responsibility for distributing the combined pool of federal and private dollars to subgrantees, who in turn also match their subawards. The SIF supports community-based initiatives to expand and replicate promising, evidence-based social innovations that can be applied across the nation and that improve economic security, youth education and civic participation, or population health – for example, by increasing access to health services for the underserved.
Should our application be selected for inclusion into the portfolio of SIF initiatives, we would partner with Jürgen Unützer and the University of Washington’s Advancing Integrated Mental Health Solutions (AIMS) Center. Together we would launch an initiative to disseminate the AIMS Center’s model of integrated, collaborative care for the treatment of depression across the WWAMI region (Washington, Wyoming, Alaska, Montana and Idaho). The dissemination of the IMPACT (Improving Mood – Promoting Access to Collaborative Treatment) model is an excellent opportunity to reach an underserved older adult population.
Personally, I’m glad that we’re attempting such an ambitious program. Depression is one of the most common health conditions, and can be terribly disabling and debilitating. It often co-occurs with chronic medical diseases and can substantially worsen associated health outcomes. It occurs in one out of 10 older adults seen by a primary care physician, but is often undiagnosed and untreated. In Medicaid populations, rates of depression have been estimated to be as high as 20%. If poorly treated, it can result in a downward spiral with tragic consequences.
IMPACT uses an innovative team-based approach in which the patient and primary care provider receive support from trained mental health specialists. A patient’s treatment plan is intensified step by step until symptoms improve. A state-of-the-art tracking and reminder system supports close follow-up of depressive symptoms, reduces ineffective treatments, and prevents patients from falling through the cracks. Moreover, IMPACT offers a cost effective strategy that has been shown to yield net savings in every category of health care costs examined and also generates a return on investment of $6.50 per dollar spent. This is why the Hartford Foundation has invested in its wide-spread dissemination.
To further spread IMPACT, our proposed SIF project will select as subgrantees high-performing community-based primary care clinics operating in rural, low income communities in the WWAMI region, where 43% of residents live in non-metropolitan areas and poverty rates in rural counties range from 19% in Wyoming to 31% in Alaska and Montana.
Most of these communities are considered medically underserved or labeled as a health professional shortage areas. The IMPACT model suits these rural areas especially well because it allows remote access to the expertise of psychiatric specialists who can help direct care, even if none are available locally.
Technical assistance from the AIMS Center will enable clinics in the WWAMI region to implement the model successfully, grow their infrastructure to deliver collaborative care treatment, and expand their service footprint to benefit a larger pool of patients. We hope not only to increase community access to effective depression treatment, but to demonstrate how the treatment enables patients to reclaim their lives, resume their professional careers, and improve their economic well-being.
This is a source of great excitement to us all. Please let us know what you think.